Is your hospital pharmacy prepared to use new blockbuster drugs to help patients without overtapping your budget? Terry Smith says it can be done with the right planning and strategy. He’s a registered pharmacist and vice president of McKesson RxOTM .
In this edition of Pharmacist to Pharmacist, we asked Smith how your hospital pharmacy can work with other stakeholders to manage existing and new high cost drugs
We also asked him what tactics you can use to support drug safety while reducing your costs and generating new revenue for your hospital.
What are you responsible for in your role?
Smith: Our RxO team and I help our hospital pharmacy customers improve their processes, grow revenue and find cost savings. I try to have as much direct contact with clients as possible. That’s done through onsite visits, virtual meetings, and conference calls. As a pharmacist, it’s important for me to listen, understand, offer suggestions, and implement recommendations with other pharmacy leaders.
What is the biggest challenge for hospital pharmacies?
Smith: It’s balancing the demands of the primary patient care role with maintaining the financial viability and bottom line of the organization. New pharmaceutical products and their associated costs are growing at a fast pace, which requires the right management for optimal patient care. Proper labor resources can often be a challenge, depending on type and location of the hospital pharmacy
What makes that balancing act so challenging for hospital pharmacies?
Smith: Manufacturers continually market new drugs. The pace is incredible. You have the complexity of existing and new drugs such as oncology, biologics, specialty, orphan and immunotherapy drugs. They’re effective, but can be costly. It’s critical to manage their appropriate use and access to them in a fiscally responsible way.
What operational challenges do hospital pharmacies face doing this balancing act?
Smith: Challenges include balancing traditional distribution functions, clinical decisions and management of the pharmacy as a business within a larger organization. Operationally it not only takes strong pharmacy leadership, but the support of hospital administration and medical staff to be successful. The labor pool and proper mix of pharmacy staff is also sometimes challenging, based on the type and location of the hospital.
How can hospital pharmacies overcome these challenges?
Smith: It’s critical to have a contemporary and well thought out strategic plan by leaders and their colleagues in the pharmacy and the healthcare system. It’s also important for all teams from top to bottom to understand and participate in the plan. Clinical decisions should be considered with the supply chain process to overcome any operational issues with the plan.
What tactics should hospital pharmacies consider as part of that strategic plan?
Smith: Hospital pharmacies should prioritize financial improvement opportunities with strong clinical, cost savings, and revenue generating opportunities (e.g. formulary management, six sigma processes and purchasing controls). They should also transition their focus toward the outpatient and ambulatory practice of pharmacy. Leadership should continue to incorporate a cross disciplinary team within the health system to help drive results and positive patient outcomes.
What new hospital pharmacy revenue opportunities do you see?
Smith: The biggest outpatient opportunity is in revenue cycle. Systems and resources that accurately bill payers for reimbursable drugs and the services provided is critical. It’s also just as important to collect revenue due to the organization. This is where technology can really help. You can connect applications to revenue cycle, pharmacy and accounting functions that validate all of the billed services and products. The applications can verify claims before they are sent to payers and can check whether health plans have paid you the right amounts.
What about clinical opportunities for hospital pharmacies?
Smith: Clinical pharmacists play a key role within the Pharmacy and Therapeutics Medical committee. The committee has responsibility for medication use based on a variety of criteria including safety. Along with other health system professionals, hospital pharmacists are developing policy and procedures that drive formulary standardization across each health system (e.g. acute and ambulatory), which is very important. They are responsible for the review of high cost, high utilization areas like oncology, cardiology, and rheumatology which impact patient care. They can also implement drug spend and management tools (e.g. utilization) to identify, track and manage appropriate use and contribute to sustained positive outcomes.
Are there other hospital pharmacy trends to watch out for?
Smith: A big trend that hospital pharmacies should stay on top of is the growth in outpatient care. More care is shifting to outpatient settings. Continued transition into the outpatient and ambulatory markets is based on the shift of spend, utilization and controlling patient readmissions. Ongoing access to the pharmacist as the drug utilization expert by health system executives, physicians, nurses and ancillary departments will continue to grow as they are a common bridge between many caregivers. The specialty pharmacy system will also continue to grow for patients with unique disease states.
Would that further expand the role of the hospital pharmacist as a provider?
Smith: Yes. A hospital pharmacist is the key person who connects with other professionals in the continuum of care. As provider roles evolve, it will result in a positive expansion of their duties. This will include monitoring and preventing adverse events, hospital readmissions and improving outcomes. As a provider, the pharmacist and staff can be a central repository for collecting medication histories and understanding the health conditions of a patient better. Ongoing communication with the patient, physician and other healthcare providers will be very important.
How will the role of a hospital pharmacist be different five years from now?
Smith: Hospital pharmacists will continue to depend more on information systems and technology to analyze data and provide appropriate recommendations. A greater role in ambulatory care services within outpatient services, clinics and specialty pharmacies will also be a prime area of responsibility for many pharmacists. They will have expanded responsibilities that impact insurance payers and will require the authorization of medication use. But what won’t change is the pharmacist’s role, which is looked upon as a trusted professional for the patient’s drug management and well-being.
What do you like best about being a hospital pharmacist working at McKesson?
Smith: It’s very rewarding to share experiences with other hospital pharmacists. I can share my learnings as a former pharmacy director and healthcare consultant. Best practices that I gain from customers in other parts of the country are also very gratifying. The team of pharmacists, executives, and other colleagues I work with at RxO are very passionate and experienced. And working directly with our customers to help them reach successful clinical and financial outcomes is very fulfilling. For me, that’s the satisfying part of my job.
Editor’s note: If you have a question for one of our pharmacists, please leave a comment and let us know. We’ll be sure to cover it in a future edition of Pharmacist to Pharmacist.
Related: Learn more about McKesson’s consulting and technology solutions for hospital pharmacies
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