2014 Dynamic Dozen No. 1: Integrity Pharmacy LLCIntegrity Pharmacy LLC started on a hunch by Integrity Home Care executives in 2008. They identified a niche to serve senior citizens prescriptions with a custom in-home management system.

The next phase of growth for the spun-off pharmacy is following another hunch by executives: a subniche for seniors in extended care facilities.

“Long-term care has been an explosive area of growth,” co-owner Paul Reinert says of the division launched in 2011 that now claims more patients served monthly than its home care counterpart.

In total volume, the home care service still represents the majority of Integrity Pharmacy’s nearly $20 million annual business, but long-term care comprises 40 percent and climbing.

“I still expect long-term care to overtake home care and be a bigger part of our total sales. It’s inching up,” says Reinert, the chief financial officer, of the division’s role in the company notching three-year revenue growth of 121 percent last year.

Integrity Pharmacy delivers prescriptions to area assisted living facilities and skilled nursing care centers representing some 1,800 resident beds. About 1,650 patients per month receive medication management through the in-home service. These patients often take more than a dozen meds a day, and botching a dosage could mean a wellness setback or a return trip to the hospital.

For Integrity Pharmacy President and CEO Rocky Levell, it’s personal.

Last summer, his father was admitted to the hospital for cardiac troubles, and he was sent home with 23 meds.

“He was a disaster waiting to happen,” Levell says. “He went home with a laundry basket full of his drugs. I’m a pharmacist, and it took me two hours to straighten his meds out. I’m on a personal mission.”

In the big picture, Integrity Pharmacy leaders observe an industry cracking down on hospital readmission rates.

“It’s a big problem, and it’s a costly problem,” Reinert says. “Hospitals are paid on a per stay basis for most inpatients by Medicare, so they have an incentive to get people out as fast as they can. The concern was they get them out too fast, they come right back in and the hospital gets to start new admissions to get paid again.”

Born from the Affordable Care Act, the federal Medicare program began enforcing readmission penalties on hospitals in October 2012, and last year about two-thirds of hospitals had to forfeit some $227 million in Medicare funds. The government’s goal is to reduce the readmission rate within a month of discharge, which has hovered at 19 percent for several years, according to the Kaiser Family Foundation.

“The nursing home is really trying to do everything they can to reduce the likelihood of somebody being readmitted within 30 or 60 days. Sometimes, they discharge them and as soon as they get home, they get their meds screwed up and land back in the hospital,” Reinert adds. “The nursing homes can’t do anything about it, but the hospital is keeping score on the nursing homes.”

Pharmacy officials are working to get into the medicine stream earlier than before by getting prepackaged prescriptions in the hands of clients, mostly the elderly, before they return home.

“Who’s going to win on the other side of this is who can increase compliance and decrease hospital stays,” Levell says. “I think we’re right in the sweet spot.”

Last year, the company delivered nearly 20,000 prescriptions each month.

Among the extended care delivery stops in Springfield are Jordan Creek Nursing & Rehab, Maranatha Village, Joy Assisted Living and The Gardens.

On Jan. 1, Integrity Pharmacy added a distribution center in Grandview concentrated on serving longterm care clients in the Kansas City area and across the state line. Other extended care clients operate around Lake of the Ozarks and Joplin.

Coverage on the home care, or retail, side now extends to Kansas City and Columbia.