Les Krenk

Maui pharmacist Les Krenk has a simple formula for succeeding in a business dominated by a few major chain stores that discount prices on high-demand medications and health-care products through bulk buying.

Understand what the patient wants. Know what the patient needs. Provide the service.

It’s simple but can be hard to do. It takes time, effort and composure to treat someone with a medical problem as a patient, not a customer. With a customer, you make the sale and move on to the next. With a patient, you provide service.

“We want to look at how we can improve our procedures for patients to help them optimize their outcomes by correctly taking their pills and understanding the consequences of non adherence. If we can do that, we can help to reduce health care costs,” Krenk said.

The pharmacy business has been moving in the opposite direction but Krenk is sticking to his formula because being a pharmacist isn’t just a business. It’s a way of life.

The career started 40 years ago, he said, when he worked for pharmacies on Oahu, moved on to Castle & Cooke Merchandising operating the Holiday Mart stores, eventually starting his own business on the North Shore. Then 21 years ago, he moved to Maui and took over ownership of Maui Clinic Pharmacy.

“It was a place to take a vacation that wasn’t on Oahu,” he smiles. “Been on vacation ever since, seven days a week, although my wife has me down to six days a week (that’s six days of work).

“It’s both a business and a profession and I love them both.”

While other independent pharmacists on Maui have shut down, Krenk has expanded his Pharmacy Group to three shops, at the Maui Clinic in Kahului, in Makawao and in the old Nagata Store in Paia. They’re all clean and friendly in the tradition of the family drug store. They’re also busy.

“My distributor tells me at the Maui Clinic I’m the second busiest independently owned outlet he has. I’ve got the only independent pharmacy where there’s every one of the major chains within a mile of the store and we’re the second busiest pharmacy in Hawaii. What does that tell you?

“We’ve got the most complete and the busiest independent pharmacy on the island.”

Krenk alludes to the effects of the chain pharmacies on the marketplace. For him as a medical provider, the bigger impact is reimbursement rates set by Medicare and Medicaid plans.

It can be a test of accounting skills to keep up with what the government supported plans will and won’t cover and how much they will pay, he says.

“We need to be able to know what is covered and how much is covered, but when we ask, we’re told go look it up. When you go on the website, it’s 300 pages long. It’s not easy to find what you need to know and sometimes you just want to give up.”

With the chain pharmacies, he said, there can be benefits for a patient in lower costs if the patient is using high volume products.

“There is a lot of good with the big guys coming in. They can cut the costs for a patient. The negative to it is they take the provider out of the picture.”

The service that draws patients to Krenk’s pharmacies includes his relationship with providers and patients.

“They know if they walk in and we find a problem with the prescription, we’ll take care of it. We’ll call the doctor and talk to them and get it fixed,” he said. “We are able to provide the service.”

There is another element that forces an independent who wants to take care of patients’ needs to wrestle with costs and potential losses.

“Pharmacies used to carry medical products from A to Z, but when the big chains came in, they moved their product mix from E to X. They stopped carrying medical products that had small markets and low reimbursements. Like ostomy bags. The patients need them, but Medicaid reimbursements don’t cover the cost of them so they just don’t carry them.”

Then the costs fall on the small independent who doesn’t have the benefits of high-volume purchasing power, having to weigh what patients need and what they can realistically afford to pay.

“That’s part of it. We have to look closely at what we are doing and ask why are we doing it? Is this the best way?”

Then he repeats, again, that he provides for patients, not customers.

It’s why he’s looking forward to a pilot program set up by the University of Hawaii College of Pharmacy assigning a resident pharmacist to his operations for a year. Another resident is assigned to Maui Memorial Medical Center.

The pharmacist will follow up with patients, making phone calls or setting up appointments for the patient to discuss the effects of a medication, whether there were side effects, and how it worked on the ailment being treated.

They will also be able to do what Krenk advocates for any pharmacist: Take time to talk to a patient about the medication being prescribed and counsel them on whether there is potential for interactions with other drugs or with the patient’s diet, and the proper way to take the medication.

The goal of the program is to determine what benefits there may be to active intervention with patients on medications. The ultimate goal is to reduce time in hospitals.

“If we can keep them out of the hospital, reduce the frequency of hospital days, we’ve done something positive,” he said.

“It’s about service. You’ve got to take the time to talk to the patient. It’s not just about the medication. It’s about their health and what they can do. If the patient has rheumatoid arthritis, you can talk about other factors that affect their rheumatoid arthritis.

“If they need help with their diabetes medication, you can talk to them about the right procedures and tell them what they need to do with their diet and their activities. I can do that because I’m a diabetes educator as well.

“If you let the patient know you’re available to them and back that up by letting them talk to you, you can help them with their health.

“If you can help them with their health, help them to feel better or get the most out of a medication, that’s the greatest thing in the world.”