Pursuing an Integrated Approach to Pharmacy

Given the continued shift toward value-based care, hospital and health system leaders are constantly looking for ways to curb spending while enhancing care and streamlining patient access.

“The pharmacy department presents a prime opportunity for improvement,” says Michael Wascovich, Senior Director of Pharmacy Services at Premier®. “Prescribing and administering drugs are significant components of patient treatment, and because of this, the pharmacy function can become a significant cost center. With unsustainable growth in drug spend, this is often cited as a top concern for healthcare executives. By implementing best practices around buying, using and monitoring medications—and integrating those efforts across the care continuum—healthcare organizations can get a handle on pharmacy costs while still enabling high-quality patient care.”

Different avenues of change

“It doesn’t make sense to treat the patient in the acute setting with one medication and then transition the individual to a different drug for the next level of care merely because of a different insurance benefit,” says Wascovich. “If the original medication is working well, insurance should not dictate that the patient changes the course of treatment. Being moved to another medication not only is frustrating for the patient, but also can be detrimental to the individual’s health, which could result in being readmitted to the hospital. Unfortunately, this scenario happens all too often.”

Or perhaps there is an expensive specialty or biological medication that a patient needs, but the treatment can be administered in an outpatient infusion center or in a physician’s office rather than in the hospital, which may be more expensive. Maybe the patient prefers to receive the drug at home with a visiting nurse present to make sure the administration is safe and effective. Rethinking how these specialty medications are delivered can improve patient satisfaction, reduce costs and boost quality.

Premier is partnering with healthcare organizations to address challenges in pharmacy operations, taking a variety of approaches based on best practice and clear data. As one of the largest group purchasing organizations (GPOs), Premier helps healthcare organizations rework existing purchasing arrangements and design new contracts. Aligned closely with health systems across the country, Premier can also provide a unique perspective on pharmacy operations.

“We are working inside our partner organizations’ facilities every day, so we know their culture, operations, people and products,” says Wascovich. “We can look across the approximately 3,900 hospitals we work with to generate collaboration, share best practices and spot improvement opportunities. Our members range from large academic teaching hospitals and integrated delivery networks to community hospitals and rural-based organizations. Because of these multiple perspectives, we can engage organizations wherever they are on the journey to better care delivery, offering flexible and customizable plans that optimize pharmacies affiliated with healthcare providers to yield results.”

Premier also uses its comprehensive data analytics tools to turn large volumes of data into translatable, meaningful information for taking action.

“We deliver organization-specific information that can reveal challenges and opportunities, and we also offer benchmarking information, so organizations can see where they are versus their peers,” says Wascovich.

Taking a collaborative approach

“During these meetings, we talk about the organization’s pharmacy investment and how to make it more strategic, yielding a positive return,” says Wascovich. “We consider the organization’s population and the region of the country in which it is located and then ask questions about its goals and the role pharmacy will play in achieving them. In some cases, organizations already have strong processes in place; however, many times there are clear opportunities for improvement. Based on initial conversations, we deploy a pharmacy consulting team that creates a strategic plan for closing the gap between existing processes and the health system’s goals. In these relationships, we aim to be transformative, moving away from hospital-centric operations and embracing more patient-centered strategies.”

Premier recently worked with a large Midwestern health system that had acquired several community hospitals and was considering how to optimize the pharmacy function and turn it into a strategic asset.

“The health system engaged our advisory team for about 12 months, and we provided a multifaceted offering to transform the pharmacy program,” says Wascovich. “We advised the organization to hire a CPO to serve as a member of the health system’s executive team, taking enterprisewide responsibility over all pharmacy services. We also created an organizational structure and strategic plan for each patient care area where medications were being used, so that we addressed quality gaps and allowed the hospital to capitalize on each new revenue opportunity. We worked to smooth out care transitions between treatment settings and developed pathways, so medications were able to transfer. We also gave the organization guidance on their call center, mail order operation and formulary governance.”

Although the organization’s team achieved many benefits early in the process, one area of significant improvement that was unplanned was the enhanced collaboration between pharmacy, nursing and other clinical staff. Nurses and pharmacists now work together to proactively address any medication issues before the patient leaves the hospital. For instance, if there is a problem with drug coverage—where the medication is not approved by insurance or the patient cannot afford the copayment, for example—the team works together to resolve it before the patient leaves the nursing unit, minimizing treatment delays or lapses. The health system’s call center also has been integrated into the care program, allowing patients to quickly get answers to any medication-related questions they may have. When patients call, nurses or patient-service representatives triage certain high-risk individuals, sending them to the pharmacist when warranted. If there is a concern, the pharmacist can team up with his or her colleagues and respond to the issue because all care providers have access to a shared electronic medical record.

Overall, the health system has seen tremendous growth since starting the initiative, transforming its basic pharmacy offerings into a much more valuable strategic asset for the organization. This has created valuable brand equity with the region’s population.

“Now, patients and payers associate quality and a positive experience with the pharmacy program and the health system, helping the organization attract and retain more patients,” says Wascovich. “The organization also has seen the benefits of a smoother discharge process and fewer opportunities for patients to slip through the cracks, which translates into less costly care and reduced readmissions.”

Start with the current picture

“You need to establish a vision for the pharmacy, how that compares to where you are now, and what you need to change to reach your goals,” says Wascovich. “These questions are not always easy to think through, and joining with a partner who has experience in navigating them may be a valuable consideration. Regardless of how an organization begins, there are substantial advantages in getting this large spend under control, so that it delivers ROI while moving you in the direction of more integrated and value-based care.”

About Premier

Large-scale healthcare transformation is not easy. However, with the right partner, organizations can realize meaningful change. Premier is collaborating with health systems across the United States to reimagine pharmacy operations, offering data and advisory services to enable stronger integration, reduce costs, improve care and drive performance.