By: Phil Brummond, Dave Hager and Steve Rough

In a modern health system, previous publications on the minimum skills and competency areas required of a top pharmacy leader are incomplete. The most recent substantial work in this space was the High-Value Pharmacy Enterprise (HVPE) Project, published in AJHP in 2021. This paper outlined the following core competencies: emotional intelligence, continuous professional development, strategic planning, driving innovation, business acumen, professional organizational involvement, and mentorship. These are undoubtedly valuable in health system pharmacy leadership and in many other leadership roles across different industries. They are unlikely to change over time and were likely true 10 years ago.

Meanwhile, the health system environment is changing rapidly. While these historic skills are essential, they may not be sufficient to fulfill the high demands placed on current pharmacy executives. For example, one area of growing importance in terms of core competencies is ensuring continuous accountability for compliance. As we work with clients, we see that this maintenance work, particularly as health systems grow, is pushed down the priority list at the risk of patients and the career of the health system pharmacy leader. Some of these  core competencies, like professional organizational involvement, are valuable within the profession, but can be detrimental  to the top pharmacy executive’s standing within their health system. As Visante works with top health system pharmacy programs across the country, we’ve identified eight essential skills that are needed to meet the ever-changing needs of the health system pharmacy enterprise.

Mastery of healthcare finance complexities. While the HVPE describes general business acumen as an area of core competency, it references budgeting, reporting, business plan development, revenue cycle, project management, and strategic planning. Top health system pharmacy executives need to have a depth of knowledge far surpassing the level  obtained in an MBA program. Instead, they need to understand where the money flows throughout the system – which entity is profiting at each step in the medication use process and what levers are available to favorably shift value back to the health system.

Another facet is the rapidly changing nature of health care finance – even a month in lapse of focus can have dire consequences to a health system. For example, in a given month you may encounter federal legislative changes on drug pricing (e.g. Inflation Reduction Act of 2022), new entries into the retail pharmacy space (e.g. CostPlus Drug Company, Amazon Pharmacy), actions by pharma in relation to 340B (e.g. ESP Data requirements), or changes within payer’s strategies to contain infusion spend (e.g. Cigna and Aetna oncology site of care restrictions). Constant vigilance and systems for staying up-to-date are essential. The ability to understand the value proposition in each of these to the main players in-market, and to take action strategically and proactively, are vital skills.

Tangible ideas for new pharmacy revenue streams, such as: optimizing the medical benefit pharmacy revenue cycle, specialty pharmacy, and home infusion. Given half of health systems have negative margins following the pandemic, health system senior leaders are relying on pharmacy departments to create new programs, services or strategies that bring in new hard dollars. Historically, negative margins have led to a focus on labor expense savings, but health system leaders are nervous, for now, to put pressure back on their workforces. How long this reluctance will last as the federal government’s pandemic financial support  runs out will be highly variable.But make no mistake – either top pharmacy executives will have an arsenal of new revenue ideas or they will be asked to find labor expenses to play their part in shoring up health system finances.

Values that place the organization, not pharmacy, first. This is one of the most significant changes since the rise of the Chief Pharmacy Officer (CPO). The strategy behind the CPO’s elevation  was that pharmacy would finally have the seat required to best advocate for pharmacy – and have a voice similar to other team members such as nurses and physicians. What has largely transpired instead is that the CPO is looked upon like other administrative or financial leaders similar to laboratory or supply chain. The expectation is not to be just an advocate for advancing the profession, but instead this is a three to five-year role to move the priorities of the organization forward, largely around new business ventures. If successful, the CPO gains additional areas of oversight and can even find themselves taking on additional responsibilities having a broader influence on organizational strategy. Building a 20-year leadership career by stabilizing and slowly progressing the pharmacy department is no longer desired by senior leaders at the top organizations.

Advanced negotiation skills and the ability to leverage them with external business entities (group purchasing organizations, wholesalers, pharma, automation vendors, technology companies, start-ups, etc.). The medication use process is ripe for disruption, and health care in general is seeing a growing number of new entries into the market. Given the exorbitant amount of money the US spends on health care, everyone is trying to solve health care’s problems. So new technologies and services are often targeted at health care, and top pharmacy executives will have as many partners outside of health system pharmacy as they have inside it.

Real innovation will likely come from these outside groups, as it has in every other industry. Leaders who have networks that will allow them early access to new services will provide a competitive advantage to their organizations. Again, senior health system leaders are not just looking for innovation that will advance pharmacy’s goals, but for solutions that will deliver results to patients more holistically. This will require a broad array of partnerships that may fundamentally change where top pharmacy executives spend their time.  For example, the potential impacts of  artificial intelligence (AI) on  pharmacy is an area that has received a lot of talk but little action. A top pharmacy executive will  need to have the right partnerships to make AI in pharmacy a reality. This will set a new  standard for the profession, and potentially for healthcare more broadly.

Entrepreneurial skills beyond traditional silos of inpatient, ambulatory, and retail. This is a type of innovation that  will produce tangible new revenue streams for the organization, and it  requires expertise in  setting up separate business entities. This could include creating their own technology platforms, spinning out parts of their existing work into LLCs, or even marketing their services in areas of excellence to other health systems. These leaders will seek accountability for areas of medication use not typically thought of within the pharmacy purview to create new financial opportunities and partnerships. We commonly see this in employee health plan design, population health and overall infusion strategy including site of care. Leaders whose journey followed one of the transitional silos of inpatient, ambulatory or retail may be at a competitive disadvantage unless they can  gain expertise in these emerging areas.

Creativity in how to maximize pharmacy supply chain value for the organization. The potential benefits to patients and the organization are significant when the pharmacy supply chain is optimized,  improving access to care and financial performance. Currently, we work with a number of clients where an outside view has found traditional opportunities they are missing. Our consultants also identify that  few organizations  look beyond traditional opportunities to maximize savings. Moving beyond this  short-sighted approach should involve planning  for the worst-case scenario in terms of possible pharma and regulatory erosion of 340B savings. Great executives will have plans in place for how they will pivot today’s services and resources  in the event that 340B savings are reduced in the future.

Transformational leadership to move from an organization to a system. This comes down to three major steps. First, the leader needs to have insight into optimal system structures that meet the unique needs of their organization. Next, they need to  tie business and clinical performance to that new structure to get support to implement it. Finally, they need to have the change management skills to establish the system structure. Pharmacy can lead the way in this area as a clinical department where system approaches create real value back to the organization. This can be a model for others to follow.

The ability to attract a diversity of top talent in a world of workforce challenges. Every pandemic has had workforce implications that rippled through society for years, and it is naïve to think this will not be our future  as well. Given the breadth of expertise needed and the patient populations we serve, highly skilled and diverse candidates will be critical. The old model was to establish a health system pharmacy administration and leadership residency program to keep the talent you developed. While this is still necessary, the demands are much higher now for diversity of experience. The network of leaders  pharmacy executives will recruit from  needs to be broader. Nationwide, we see , organizations hiring thought leaders from other sectors outside of pharmacy, including analysts, project managers, and even former executives from adjacent health care fields (PBMs, wholesalers, retail chains, etc.). This will not be about smooth sales pitches, but  having a regional and nationwide network that pulls talent in and retains them.

As a top pharmacy executive (or future executive), this is a daunting list. As Peter Drucker famously said, “Universal genius has always been in scarce supply.” There are not enough leaders  who have all eight of these skills, plus the core competencies to occupy all the health systems who need them. And those with these competencies don’t always have the bandwidth to accelerate the changes they aspire to lead. Having a trusted partner to shore up soft spots in any of these areas will be essential to most, if not all, health systems. This could be accomplished through insourcing leaders with expertise in these areas and fostering  regular dialog with them to ensure competence, or by engaging an outside consulting firm with deep expertise in these areas for guidance. Top health system executives realized years ago that health care was changing too quickly for one person to master all the complexity. So they turned to consultants for help, keeping one to two on retainer at all times. Visante is seeing pharmacy executives who lean into this benefit similarly to their senior leader counterparts. As is often said, a leader needs to act like the position they want to grow into.

 

Healthcare is technology today.

From the health-monitoring aspects of Apple Watches and smartphones to the electronic health records within health systems themselves, healthcare has firmly become synonymous with technology.

Yet despite this fact, only about 50% of IT projects are successful, when the success of these initiatives is crucial to fostering high-performing organizations.

This is where pharmacy informatics and technology (or PharmIT) can serve a vital role in developing innovative solutions to health system medication-use challenges. Here is a look at what PharmIT is and how it can improve outcomes for hospitals and health systems throughout the country.

What is Pharmacy Informatics and Technology?

PharmIT is a subset of health informatics, and is an umbrella term encompassing everything to do with medication use management, informatics, and health information technology. PharmIT contributes to the transformation of healthcare by analyzing, designing, implementing, maintaining, and evaluating information systems that improve medication-related outcomes.

Why Do Hospitals and Health Systems Need Pharmacy Informatics and Technology?

High-performing pharmacy organizations need a high-performing PharmIT program.

One important aspect of PharmIT is analytics. Health systems not only need more data and information – they also need to be able to aggregate and visualize it to determine the best way forward.

When organizations are looking to implement a new service like home infusion or specialty pharmacy, technology needs to serve as the backbone of those initiatives in order for them to work to the best of their ability. Unfortunately, the internal IT services for many health systems are stretched thin, with 80-90% of their time being dedicated to maintenance. This leaves minimal time for new projects.

PharmIT – specifically when leveraged through an expert partner like Visante – can help make up for this lack of time and resources by focusing on three key areas: applications, automation, and analytics.

Applications

Applications within PharmIT can be described as any software program used to help achieve the clinical, operational, financial, or safety goals of the health system. Electronic health records are a great example, serving as the main application or operating system (OS) of a given hospital.

Automation

PharmIT can also help hospitals and health systems automate repetitive tasks and free up time by making previously menial tasks much more efficient. This allows clinicians to practice at the top of their license rather than focusing on time-consuming and repetitive work.

Analytics

We live in a world of data overload, with too much information and not enough time to review it and use it to inform decision-making. Analytics helps bridge this gap to make better decisions in a fraction of the time. PharmIT is an invaluable tool for helping aggregate info, visualize it, and then utilize it to make decisions.

Technology

Beyond the three key areas of PharmIT is the technology itself, which can be described as anything used to deliver patient care within an organization. One example is smart IV pumps, which are a piece of technology with an application. In this case, the technology itself is used to make it safer and more efficient for nurses to provide care.

People, Processes, and Outcomes

It is important to note that applications, automation, and analytics are only one side of the equation when it comes to PharmIT. To maximize impact, we also have to focus on the people, processes, and outcomes of a given technology.

Here are some of the key questions to ask in regard to how technology will impact your health system.

People

• Do we have the right people in place to use, maintain, and optimize this technology?
• What is their skillset?
• Will we save time by implementing this technology?

Processes

• How will we utilize this technology?
• What are the preferred workflows?
• What are the policies and procedures we need to put in place to utilize this technology to its highest benefit?

Outcomes

• Why are we utilizing this technology?
• What are we hoping this technology will help us achieve?
• Does this technology align with the tactical and strategic objectives of the organization?

Experience the Full Potential of PharmIT with Visante

Visante has acquired The Robertson Group (TRG) to add pharmacy informatics and technology to its service line. Together, we help clients optimize clinical systems to provide safe, effective, and efficient patient care. Our goal is to transform healthcare through pharmacy practice.

To do this, we must transform the technology solutions that will help us get there. We optimize solutions to make sure our clients are getting best and most effective use of them. We make sure these solutions are safe, effective, efficient, economical, and that they will help health systems achieve their tactical and strategic objectives.

Contact us today to learn more.

Originally published via Becker’s Hospital Review

Leading health systems have invested significantly in pharmacy infrastructure to improve patient care and financial results. An important lesson: optimizing pharmacy’s value through a system approach results in better quality, service, financial performance and efficiency.

During a session sponsored by Visante as part of Becker’s CEO + CFO Virtual Event in March, Alan Yordy, former CEO of Vancouver, Wash.-based PeaceHealth, current president of the Infinity Group, and senior partner emeritus of the CEO Advisory Network, and Steve Rough, senior vice president at Visante, facilitated a discussion with three healthcare leaders about best practices for driving value through pharmacy at a system level. Panelists were.

• David Benner, chief ancillary officer at CHRISTUS Health in Irving, Texas
• Phil Brummond, senior vice president at Visante
• Tim Lynch, senior vice president of clinical services at MultiCare Health System in Tacoma, Wash.

Four insights: 

1. Health system pharmacies face significant pressures that affect the bottom line. These pressures include shifts in the site of care and workforce challenges like burnout and turnover. “Business disruption is coming from many directions, such as the 340B drug program, supply chain issues, the financial challenges driven by the COVID-19 pandemic and more,” Dr. Brummond said. 

2. CHRISTUS Health’s comprehensive pharmacy services transformation is delivering systemwide clinical and financial benefits. CHRISTUS Health is an international, Catholic, nonprofit health system. When Mr. Benner joined in November 2018, there were no standardized clinical pharmacy activities or consistently applied medication safety processes. In addition, no strategic roadmap existed for 340B, retail or ambulatory services. “Pharmacy wasn’t contributing value in a meaningful way,” Mr. Benner said. “It was viewed as a cost center and an expensive one at that.” 

The pharmacy team built a foundation for success focused on three pillars: clinical, operational and financial excellence. An example of an innovative program that CHRISTUS Health adopted is ambulatory pharmacy specialty disease management for its associates. The pharmacy services transformation efforts have paid off. In fiscal year 2022, CHRISTUS Health expects $26.2 million in drug supply chain savings, a 340B net impact of $110 million, specialty pharmacy net operating income of $1.5 million and savings of $14.6 million for the ambulatory pharmacy specialty disease management program for associates. 

3. MultiCare Health System’s pharmacy function is now a strategic asset, rather than a cost center. MultiCare is the largest nonprofit, community-based, locally owned health system in the state of Washington. When Mr. Lynch joined in 2019, MultiCare lacked a pharmacy system structure and had significant gaps in operational performance. The 340B program was underperforming and opportunities existed to grow specialty pharmacy revenue. 

“We created a new pharmacy organizational structure with a chief pharmacist role and then identified key leaders within functional areas,” Mr. Lynch said. “This system structure is highly reliable and produces results.” 

Ambulatory pharmacy has been a bright spot for the organization. “In 2019, MultiCare had 10 retail pharmacies with negative operating performance, due partly to a lack of standardization,” Mr. Lynch said. “Now we have 11 retail pharmacies and two specialty pharmacies that are seeking dual accreditation. In 2021, the retail pharmacies had more than $18 million in net operating margin, while the specialty pharmacies had $47 million.” 

4. Leadership commitment for pharmacy services is the key to long-term success. Both Mr. Benner and Mr. Lynch noted that top-level leadership support is essential for transforming pharmacy. “It’s crucial to provide the people, tools, resources, flexibility and space for pharmacy leaders to be entrepreneurial,” Mr. Lynch said.

Dr. Brummond agreed. “The right level of executive support in combination with the right strategy and entrepreneurial leadership can blaze the way for a bright future when it comes to addressing the challenges and opportunities facing pharmacy services.”

Several industries have been hit hard by workforce shortages over the past couple years, and healthcare is certainly no exception, with current market conditions making it increasingly difficult for hospitals to both attract and retain top talent.

But what exactly has been driving these shortages within the healthcare space? Here is a closer look at the primary factors behind the issue and how prior authorization support from Visante can help alleviate these challenges while driving profitable business to your internal pharmacy.

3 factors of workforce shortages

While there are several varying contributors at play, 2022 pharmacy workforce issues are being largely driven by these three key factors.

Factor 1: Employee burnout

The pandemic paired with everyday work-related challenges has significantly increased work-related stress and has accelerated burnout rates for healthcare workers and pharmacists. This burnout has led to a pharmacy technician workforce crisis, causing increases in turnover rates that hurt both patient care and pharmacy business growth.

Factor 2: Workforce mobility

The concept of a decades-long tenure with a single employer has become less common in today’s climate, with employees now being much more open to changing jobs if a better opportunity becomes readily available. Many workers today strive for a better work-life balance than in decades past, and the pandemic has created numerous opportunities for remote work that previously did not exist. As hospitals work to attract and retain top talent, employee mobility and flexibility must be considered as a top-level feature.

Factor 3: Growing skills and compensation gaps for technicians

A strong technician workforce is the backbone of any successful pharmacy operation – yet these individuals are still the lowest-paid healthcare tech workforce in the country. Despite the job of a pharmacy technician being highly complex and specialized, compensation has failed to keep up with the unique demands of the position. Because of this, many organizations are experiencing 20-30% turnover and associated technician vacancies.

So what are hospitals and health systems to do? Visante is here to help alleviate these challenges by providing remote prior authorization support for our clients.

Remote prior authorization support

Visante works with hospitals and health systems to provide all services related to medication access and affordability. This includes:

• Benefits investigations
• Prior authorization submissions
• Coordination of denials and appeals with the clinical care teams
• Free drug program and enrollment for patients

The scope of our personalized support extends across both specialty and non-specialty medications within your clinics, including clinic-administered and infused medications.

For newer specialty pharmacy programs, providing efficient prior authorization services is critical to achieving excellent patient care and to improving pharmacy financial performance. Our support can integrate with your existing prior authorization workflows (if centralized services are already established), or we can help develop centralized workflows and provide staffing support.

Who needs prior authorization support?

There are many reasons your organization may need assistance with prior authorization, including:

• You’re new to specialty pharmacy services and need a plug-and-play solution to quickly get off the ground while you hire internal resources
• You have challenges managing seasonal changes in prior authorization volume
• You have challenges with workforce recruitment and retention and are looking for supplemental support in addition to your established prior authorization team
• You’re looking for long-term staffing for your specialty pharmacy program due to a variety of potential reasons

Visante assists with each of these situations and can work collaboratively with you and your team to determine how best to support your organization and patients.

Contact us today to get started.

Establishing and maintaining a robust and efficient pharmacy supply chain and effectively managing drug utilization can be stressful and demanding tasks for pharmacy leaders and staff, but doing so successfully can drive value for the organization through reduced drug cost, standardization of processes, improved medication safety and mitigation of the impact of drug shortages.

Here is a closer look at the primary supply chain challenges facing pharmacies for 2022 and how key decision-makers can go about optimizing for future success.

Challenge 1: Managing pharmacy supply chain across multiple software and vendor platforms

Within today’s industry landscape, many pharmacy leaders are required to manage supply chain data across several different software systems, from enterprise resource planning (ERP) and electronic medical record (EMR) systems to automation vendor platforms and beyond. Efficiently and accurately maintaining data across multiple platforms requires an abundance of focus and the right resources in terms of both people and systems. For 2022, a lack of resources can pose a significant roadblock for organizations looking to optimize their pharmacy supply chain.

Challenge 2: Managing day-to-day tasks

Apart from the longer-term challenges posed by utilizing various software platforms, day-to-day tasks also represent a key challenge for pharmacy operations. Such tasks can include:

• Ensuring efficient processes for ordering and managing medication supplies are working as designed
• Managing inventory across multiple locations
• Ensuring order-to-pay processes are optimized and that payment to vendors is being issued in a timely fashion to maximize discounts
• Ensuring you are paying the right price for medications across all vendor accounts and sites of care

These shorter-term tasks may seem minor at first glance, but they can have a tremendous impact on the overall performance of your pharmacy supply chain.

Challenge 3: Focusing time on strategic programs that enhance the value of pharmacy supply chain

While a focus on day-to-day operations is important, developing strategic programs is also a great way to drive value for your pharmacy. By implementing a strategic sourcing program to focus on areas of opportunity and building relationships with pharmaceutical manufacturers, you can significantly enhance the value of your supply chain in the short and long term.

Challenge 4: Navigating drug shortages

Drug shortages are an issue that has always been present but that has grown increasingly urgent in recent years and will again be a major concern in 2022. Primary causes of drug shortages include:

• The FDA inspecting and shutting down manufacturing plants
• Manufacturers deciding to discontinue production of a line of drugs
• Manufacturers being unable to acquire critical materials such as active pharmaceutical ingredients (APIs) or other supplies due to global supply chain shortages

When it comes to overcoming drug shortages, making a continued effort to stay informed on global news and trends and gathering as much information as possible is a great place to start. From there, having a proactive plan in place to effectively manage drug shortage challenges is an essential next step. It’s important to remember that while you can’t control drug shortages, you can successfully mitigate their effects if you’re properly prepared.

Defined resources for drug shortage management should be a specific line item in your pharmacy’s budget. It’s important to also ensure appropriate staffing to help manage new and ongoing drug shortages, which various types of software can also help monitor.

Optimize pharmacy supply chain with the use of external resources

All health systems have the opportunity to derive value through their pharmacy supply chains, and the use of external resources like Visante can help augment internal resources and skillsets that may be in short supply. We work with health system pharmacy departments to optimize:

• Data usage
• Order-to-pay processes
• Strategic sourcing programs that focus on finding value
• And more

Our consulting services start with an assessment and proceed with hands-on implementation support for our customized recommendations.

We also specialize in helping justify, design, and build Consolidated Pharmacy Services Centers (CPSCs), which help expanding hospital systems deliver higher levels of patient care while driving improved efficiency, cost savings and revenue growth.

CPSCs also provide the ability to centralize many elements of the pharmacy enterprise that are performed redundantly across multi-hospital systems, including pharmacy supply chain, sterile and non-sterile compounding, repackaging, specialty pharmacy and home infusion services, and more.

Visante’s pharmacy supply chain experts help hospitals and health systems achieve reliable, safe, and efficient drug supply chain performance while also realizing significant financial returns. Our drug supply and utilization management strategies lead to:

• Lower drug expense
• Improved labor efficiency
• Reduced on-hand inventory
• Less waste
• And more

Contact us anytime for a discussion on optimizing your pharmacy supply chain for improved performance.

Prefilled Saline Flush syringes are not just a nursing convenience, they are an important part of vascular access device maintenance and play an important role in reducing the risk of bloodstream infections.

On August 19^, 2021, Cardinal issued a voluntary nationwide recall of Monoject™ Flush Prefilled Saline Syringes because of a defect that could reintroduce air back into the syringe after the air had been expelled. The affected lot numbers were from 2019 – 2021 and essentially removed 267 million prefilled saline syringes from the hands of healthcare providers.

This market disruption has caused a cascade of additional shortages of 0.9% sodium chloride 10 mL, 20 mL, and 50 mL preservative free vials. Fresenius Kabi has 0.9% sodium chloride 10 mL and 20 mL vials on back order and the company estimates a release date of early-January 2022 for the 10 mL vials and mid-November 2021 for the 20 mL vials. Pfizer has 0.9% sodium chloride 10 mL LifeShield syringes on back order and the company estimates a release date of January 2022. The 10 mL vials, 20 mL, and 50 mL vials are available in limited supply.

Survey results recently published in the American Nurse Journal revealed that the registered nurses use the 10 mL prefilled saline flush syringes for all types of vascular access devices, regardless of the amount of saline needed to flush the line. More than one-half of the respondents said they use only one 10 mL syringe to flush before and after an IV push medication thru a short peripheral catheter (SPC)– they are reusing the same syringe – which is an unsafe practice due to touch contamination of the syringe tip. The nurses said they reuse the same 10 mL syringe because they only need a small amount to flush a SPC and they hate to make more waste.

The current shortage in 10 mL prefilled flush syringes coupled with the shortage of saline vials may force nurses to reuse saline flush syringes as a way of conserving a precious resource. What are some ways to safely manage practices during this shortage?

1. Ask Supply Chain to order the smaller volume syringes. Some manufacturers supply 10 mL diameter syringes with 3- or 5- mL fill volume. The 10 mL diameter is safe for accessing device patency and carries enough saline to flush most vascular access devices including a PICC line.
2. Collaborate with pharmacy on IV medication preparation. In some hospitals, nurses reconstitute IV push medications at the bedside in lieu of pharmacy prepared products. To conserve saline flush vials and/or syringes, pharmacy should consider alternative methods for reconstitution and/or dilution such as vial transfer devices, pharmacy-prepared infusions, or pharmacy prepared IV push syringes.
3. Nursing must not be put into the position of saline flush syringe reuse nor should they revert to unsafe practices such as preparing flush syringes from large volume bags of saline.
4. Collaborate with Pharmacy to prepare saline flush syringes under sterile conditions. Reassign a nursing resource to assist pharmacy as needed.

Learn more about Prefilled Saline Flush syringe use at National Coalition for IV Push Safety.

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/cardinal-health-issues-nationwide-recall-select-monojecttm-flush-prefilled-saline-syringes

https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=764

Burger M & Cross C. 2021. One and Done: Preflled Saline Flush Syringes. American Nurse Journal July 2021 on-line only at https://www.myamericannurse.com/one-and-done-for-prefilled-flush-syringes/

For many hospital systems, pharmacy is an undervalued resource, and one that typically does not receive the right level of investment to achieve optimal success. While recognizing this undervaluation and underutilization is an important first step, determining which steps to take to unlock the potential behind your hospital pharmacy program can be a much more challenging endeavor.

In these instances, a hospital pharmacy assessment can serve as an invaluable initiative toward transforming this essential component of your operation in the short and long term. Here is a closer look at what a hospital pharmacy assessment is and the key advantages it can provide within optimizing your organization.

What is a hospital pharmacy assessment?

A hospital pharmacy assessment – also often referred to as pharmacy performance optimization – is a comprehensive evaluation of all moving parts within your pharmacy department. Once complete, the evaluation is used to lead an implementation strategy that can improve patient care and your bottom line.

A hospital pharmacy assessment includes:

• A complete evaluation of your current business and programs
• Opportunity identification for safety, clinical, operational, regulatory, and financial improvements, including:
  • Pharmacy Revenue Cycle performance
  • Specialty and retail pharmacy growth
  • 340B program optimization
  • Drug supply chain utilization
  • Infusion therapy and site of care growth strategies
  • Employee pharmacy benefit program redesign
  • Sterile compounding compliance
  • Pharmacy leadership alignment and performance
• Strategic planning support based on identified opportunities
• Program enhancement design and implementation

In Visante’s execution of this process, we frame our work around eight primary questions and considerations.

1. Are all entrepreneurial opportunities being explored and leveraged?

For most organizations, areas like retail pharmacy, specialty pharmacy, infusion pharmacy, and pharmacy benefit management can represent many millions of dollars in additional revenue and margin when properly optimized.

2. Is the organization optimizing investment in pharmaceuticals by buying drugs at the best possible advantage?

Pharmaceuticals currently represent the fastest-growing element of U.S. healthcare spend (currently over 18% of U.S. healthcare dollar), with healthcare spending on prescription drugs as a whole exceeding half a trillion dollars annually. This makes it critical for organizations to ensure they have an effective strategy in place for buying pharmaceuticals at the best possible advantage.

3. Are business practices and principles sound and well organized?

We like to look at pharmacy service lines as individual businesses within the context of each larger organization. It is rare to find hospitals and health systems that have invested in the infrastructure and analytics needed to support a business of that size. We take a critical look to ensure that investment is optimized and that visibility into pharmacy operations is well established.

4. Are pharmacy revenue cycle processes sound, optimized, and properly managed?

We often find a significant disconnect between pharmacy and revenue cycle operations leading to millions in avoidable write-offs, and aim to create a more robust interface between the two parties to help ensure all available charges due are optimized and collected.

5. Are all supplies, drugs, and personnel appropriately optimized?

There are tremendous opportunities with business practices in this area with regard to inventory management, waste reduction, and personnel. Assessing personnel starts with volume, efficiency, and outcomes. Are you producing what you hope to produce given the volume and efficiency present?

6. Is medication therapy optimized?

Medications represent the primary treatment modality for over 85% of patients in any healthcare organization, yet it is estimated that in the U.S. we waste over $290 billion on ineffective medication therapy. Working to ensure your investments in clinical pharmacy services are optimized is critically important to improving outcomes for our patients and for your organizations’ bottom lines.

7. Are we taking steps to reduce medical error and to improve patient safety?

Medications are the primary contributor to medical error in the U.S. Having the right processes and personnel in place to minimize this risk is extremely important for patients and organizations.

8. Are regulatory compliance and risk reduction being properly prioritized?

Hospitals’ control of narcotics and other controlled substances has come under increased scrutiny in recent years, with multimillion dollar fines potentially coming into play. FDA and United States Pharmacopeia standards for sterile compounding continue to increase and HRSA oversight of 340B compliance continues to escalate creating additional program risk. Having a strategy to proactively optimize and reduce risk in these areas is essential.

9. Is 340B performance optimized by addressing clinic strategies to elevate savings?

340B program compliance is essential to high-performing pharmacy and to making sure patients receive their medications in an affordable manner. Our work serves to identify and optimize opportunities to streamline the 340B program, elevate operations among clinics, and ensure smooth transitions to elevate financial performance.

Benefits of a hospital pharmacy assessment

From early opportunity identification through strategic planning and implementation, there are numerous benefits pharmacy performance optimization can help uncover throughout the process.

Key benefits of a hospital pharmacy assessment include:

• Revenue and margin growth
• Reduced costs
• Improved patient care and safety
• Regulatory compliance
• Streamlined operational efficiency
• Improved nurse and physician efficiency and retention

Optimize your pharmacy business opportunity with help from Visante

At Visante, we put our industry-best experience and knowledge to work to help build high-performing pharmacy programs best-suited to each of our clients’ individual needs – and we are ready to do the same for you. We listen and work closely with you throughout the assessment process to ensure support of your objectives and delivery of a personalized plan that can manifest optimal growth. Our team also stands at the ready to facilitate smooth implementation of our recommendations, so you can experience more successful and effective business practices today and tomorrow.

Contact us today to begin optimizing your pharmacy program through hands-on, personalized support.

You are invited to participate in a pilot project to design and test a methodology for a large-scale study to determine the value of periodic physical inventory of ADCs. Please contact Colleen Connelly cconnelly@visanteinc.com or Maureen Burger mburger@visanteinc.com for questions or additional information.

Objective
To design and test a method to measure the output (number of discrepancies) detected during routine periodic physical inventory of ADCs during a six-month period. Recruiting partners with any ADC system, e.g., BD, Omnicell and Cerner.

Introduction
The counting of controlled substances has been an essential nursing practice since the introduction of the Controlled Substances Act of 1970, and many nursing hours have been devoted to counting controlled substance in an effort to control and mitigate diversion.

Automated Dispensing Cabinets (ADCs) are now widely used by hospitals as part of the effort to maintain accurate narcotic counts. ADCs create and store electronic records of every narcotic transaction. Periodic physical inventory of each ADC is still considered a best practice to support early detection and investigation of diversion.[1]The frequency and format for periodic physical inventory varies widely, from weekly to monthly or never.

Since ADC technology provides real-time information about narcotic transactions, including product, user, patient, time and date, it is unclear whether the physical inventory of narcotics is also a worthwhile use of precious nursing resources. This is particularly important to consider as nurses are inundated with an increasingly long list of tasks to complete each day.

Background
There is scarce data available to show whether or not periodic physical ADC inventory impacts diversion detection.  A systematic literature review of ADCs, bar-coded medication administration and electronic medication management systems found only 11 studies that examined the impact of ADCs.[2] However, one study noted, “discrepancies could go unnoticed and left unaddressed for extended periods of time because the hospital pharmacy was short-staffed and unable to deal with ADC discrepancy reports.”[3]Are unnoticed discrepancies due to short-staffing a problem today, or are discrepancies appropriately and timely resolved?

Nolan and colleagues conducted a Failure Modes and Effects Analysis to identify potential sources of controlled substance diversion and develop solutions.[4] Two failure modes were identified with physical counts, including tampering or replacing controlled substances and fabricating discrepancies. The results suggests that an opportunity for discrepancy is created every time a drawer is opened and counted. In other words, periodic physical inventory could actually increase the risk for diversion.

[1] [1] Brummond P, Chen D, Churchill W, Clark J, Dillon K, et al. ASHP Guidelines on Preventing Diversion of Controlled Substances. 2017. AJHP; 74:5. https://doi.org/10.2146/ajhp160919

[2] Zheng W, Lichtner V, Van Dort BA, Baysari MT. The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. 2021. Research in Social and Administrative Pharmacy; 17; 832–841. https://doi.org/10.1016/j.sapharm.2020.08.001

[3] Balka E, Kahnamoui N, Nutland K. Who is in charge of patient safety? Work practice, work processes and utopian views of automatic drug dispensing systems. 2007. Int J Med Inform 7; 6 S, S48–S57.   https://doi.org/10.1016/j.ijmedinf.2006.05.038  

[4] Nolan K, Zullo AR, Bosco E, Marchese C, Berard-Collins C. Controlled substance diversion in health systems: A failure modes and effects analysis for prevention. 2019. AJHP; 76:1158-1164. https://doi.org/10.1093/ajhp/zxz116

Visante Inc. announces that Adrianne (Maxie) Friemel (PharmD, MS, BCPS, CRCR) has joined the firm as Senior Director, Pharmacy Revenue Cycle Services.

Visante says these Friemel’s deep, contemporary expertise will expand capabilities in its quickly growing consulting areas of pharmacy revenue cycle, drug reimbursement, and pharmacy financial integrity. These areas of expertise help hospitals, health systems and integrated delivery networks to greatly improve financial and operational performance for the entire organization.

“Maxie brings a very unique expertise in the marketplace in an area where many health systems have immense opportunity for better integrity and performance. Her addition to the Visante team highlights our focus on the business of pharmacy, and continues to promote our efforts to help our partners achieve success in the pharmacy revenue cycle space,” said Joe Cesarz, Visante VP.Jim Jorgenson, CEO of Visante, commented, “The experience and expertise that Maxie brings to our group is really fantastic for our clients. Her approach to pharmacy revenue cycle is innovative and forward-thinking. She has incredible knowledge and her experience is going to be a huge asset to help clients achieve a high-performing pharmacy enterprise. “

Maxie Friemel will support Visante partners in all aspects of pharmacy revenue cycle. Prior to joining Visante, she was the Manager of Revenue Integrity for Pharmacy and Oncology at SCL Health where she oversaw both services lines of pharmacy and oncology revenue cycles for over five years. Friemel designed and developed the concept of Revenue Practice Teams which treated revenue cycle as a service line and engaged multiple interdisciplinary teams to better optimize front to back-end processes. She was previously the Manager of Supply Chain and Transitional Care at UW Health and Chartwell Home Infusion. Friemel is a well-respected author, speaker and blogger in pharmacy revenue cycle.

Join Joe Cesarz, as he discusses the support Visante offers for prior authorizations.