Latest / Becker’s Healthcare Podcast / Nishaminy Kasbekar, BS, PharmD, Chief Pharmacy Officer at Penn Medicine

Transcript

Nishaminy Kasbekar, BS, PharmD, Chief Pharmacy Officer at Penn Medicine · Becker’s Healthcare Podcast

0:00
Welcome to the Becker's Pharmacy Leadership Podcast. I'm
0:03
Ella Jeffries, pharmacy reporter with Becker's Healthcare. Today,
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I'm joined by doctor Nish Kasbicker,
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chief pharmacy officer at Penn Medicine.
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In this episode, we'll be discussing how pharmacy
0:13
leaders are rethinking care delivery through technology, workflow
0:17
design, and deeper integration with clinical teams. Nish,
0:20
thank you so much for joining me today.
0:22
To start, how are you thinking about what
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the pharmacy model of the future should look
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like and how Penn Medicine is working toward
0:29
that?
0:30
Sure. Thank you so much for having me
0:32
today.
0:33
I think when I think about the pharmacy
0:35
model of the future,
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I I would say there's a couple themes
0:38
that stand out for me. So,
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first is is kind of meeting patients where
0:43
they are. So shifting the pharmacy model from
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kind of being location based to being centered
0:49
more on patient convenience,
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providing home based care, and then, you know,
0:54
some digital touch points.
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The second, I would say, is really making
0:59
sure it's integrated and not siloed. So, you
1:02
know, in the past, I think pharmacists sat
1:04
more on the periphery of care and now,
1:07
looking at pharmacists being kinda embedded across the
1:09
entire continuum, whether it be inpatient,
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ambulatory clinics, infusion centers,
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specialty care.
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And then the third, I would say is
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is automation
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and AI will definitely become kind of the
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backbone
1:24
of all of the care that we give,
1:26
and allow pharmacists to kinda practice at the
1:29
top of their license.
1:32
Definitely. Thank you for sharing.
1:34
And do you have any specific examples of
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how you and your team are working towards
1:38
that model? Yeah. I mean, I I I
1:40
think at Penn Medicine,
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this hasn't really been a vision. It it's
1:44
something that we're actively building. And so we
1:46
we've definitely put in an automation and kind
1:49
of robotic infrastructure
1:51
where,
1:52
we have automation
1:53
that is dispensing, you know,
1:55
reducing errors, kind of creating capacity for pharmacists
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to focus more on clinical activity and patient
2:00
care.
2:01
We're definitely embedding our pharmacists across the care
2:04
continuums,
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and supporting complex medication management.
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And then,
2:10
one of the things that we've probably focused
2:12
the most on in the past couple of
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years is really creating a patient centered retail
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pharmacy network,
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that is looking to prioritize,
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you know, convenience, continuity,
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personalized
2:22
care for our patients,
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in terms of medication management.
2:28
Great.
2:29
And going back on that automation part that
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you spoke about earlier, there's, you know, a
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lot of focus on that right now. Where
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have you seen those technologies actually make a
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difference either in efficiency or patient care for
2:40
you guys at Penn Medicine?
2:42
Yeah. We've, we've kinda focused a little bit
2:45
on repetitive work. And so an example I
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can give you is we recently implemented an
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AI powered
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clinical reasoning platform that basically takes EHR data
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and then uses it for prior authorizations.
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And so what used to take our technicians
2:59
a significant amount of time has now been
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really streamlined.
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So it's really transformed our prior authorization workflow
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and allowed our staff to kinda redirect their
3:09
energy more towards direct patient care and patient
3:12
support,
3:13
as well as clinical problem solving. So, you
3:16
know, it's been a great example on my
3:18
mind of of how we've been able to
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not just improve efficiency, but also remove friction
3:23
for individuals that are, you know, participating or
3:25
working in this space.
3:29
Definitely. Thank you for sharing that example.
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And more on that, you know, the role
3:34
of the pharmacist themselves and pharmacy technicians evolving
3:37
within the care team. You know, where are
3:39
you seeing seeing them have the most impact
3:41
today and how intentional has that shift been
3:43
from an operational standpoint?
3:46
So I I think that we,
3:49
we're seeing a little bit of redefinition.
3:52
So in the past where, you know, pharmacists
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and technician
3:55
roles were primarily on
3:57
dispensing and distributing drugs. I I think that
4:00
model is really shifting
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to providing more clinical care. And so what
4:04
we've seen is pharmacists now move into partner
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roles. So we have pharmacists that, you know,
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are rounding with providers. They're interpreting labs. They're
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adjusting therapy.
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They're they're seeing impacts in places like antimicrobial
4:18
stewardship, anticoag management, heart failure.
4:21
At the same time, you know, as the
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pharmacist role has expanded, we we've seen the
4:26
pharmacy technicians
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really step up to be that operational backbone.
4:30
So, you know, working in the pharmacies,
4:33
running automation,
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expanding kind of their capabilities and prior authorization
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support and transitions and things like that. So
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we're not just seeing pharmacists advance. We're kind
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of seeing the entire pharmacy
4:46
department kinda move forward and be clinic more
4:49
clinically integrated, I would say, than ever before.
4:54
Gotcha. That's great to hear.
4:56
And on the flip side, from a patient
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perspective, where do you think pharmacy can move
5:01
the needle the most, and how are you
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measuring the whether those changes are actually improving
5:05
outcomes?
5:06
Yeah. I mean, I think when you still
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talk to patients,
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a lot of the same questions arise. Right?
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Like, where do I get my medication? Can
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I afford it? When do I start it?
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What are the adverse events? And so, you
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know, I think medication access is probably still
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a major lever
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where I see,
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pharmacists and technicians moving that needle to help
5:27
remove barriers,
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that delay therapy. So so things like you
5:31
know, we talked a little bit about prior
5:33
authorization, but that leads to,
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quick delivery of the medication
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to the patient,
5:39
and then providing
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kinda transparency
5:42
at the point of prescribing of the financials
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behind it and then,
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pharmacy coordination with drug information and medication education,
5:51
and things like that.
5:53
I think that,
5:55
we're still seeing transitions of care as a
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touch point. So as patients transition from, you
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know, inpatient to outpatient settings,
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we see a role of pharmacists being pretty
6:06
big here in terms of bedside counseling or
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post discharge outreach,
6:11
reconciling medications. And so all of this will
6:14
affect the impact.
6:15
So it'll definitely
6:17
reduce patient errors. It'll reduce,
6:20
any kind of confusion a patient may have
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as well as potentially keep patients out of
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the hospital.
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And so that kind of ties into,
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you know, having a pharmacist on care teams
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will directly improve safety,
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and outcomes and hopefully allow them to be
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more adherent
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to their medications.
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Pretty much everything I've mentioned is really
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measurable.
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So we can track things like time to
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therapy or prior authorization turnaround,
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adherence rates, readmission rates,
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adverse events.
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So so all of this measurement
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should, at the end of the day, you
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know, help us continue to improve outcomes
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and allow our system to be more integrated,
7:04
in patient care.
7:07
Definitely. Thank you so much for sharing that.
7:10
And I'd say within that, you know, as
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pharmacy and pharmacy teams are trying to improve
7:15
the patient care experience, they are still under
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a lot of pressure to manage costs, you
7:19
know, but still innovate for their patients. How
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are you balancing those priorities, and how do
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you think about return on investment?
7:28
I you know, I think that, right now,
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everyone's balancing kind of cost pressures with the
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need to innovate. And so I I think
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what we're starting to see is really focus
7:37
on on
7:38
innovations that maybe remove waste.
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So everybody's taking kind of a keen look
7:43
at their workflows and seeing what they can
7:46
do to reduce manual work, you know, free
7:48
up kind of staff capacity.
7:51
I I think we're also seeing
7:53
direct investment in in what impacts revenue and
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how do we focus our teams either in
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specialty pharmacy or med access,
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and provide kind of a measurable
8:05
return
8:06
in terms of impacting revenue or preventing loss.
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I think one thing we have to kinda
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mention is workforce sustainability. So, you know, labor,
8:16
is, you know, a big cost, but at
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the end of the day,
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it's also a risk. Right? So if we
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don't have the appropriate labor,
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they're not skilled enough, or they're not learning
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kind of the new,
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workflows
8:30
or or skills that are needed to kind
8:32
of design some of these new roles that
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we're creating, it could be a problem.
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So we kinda have to look at all
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of that together,
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and and the ROI of all of that
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so that we can kinda mesh the innovations
8:44
with also the workforce and then the impact
8:47
that we're making,
8:49
in patient experience as well as, you know,
8:51
financial revenue and workforce stability.
8:55
For sure. And do you have any specific
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examples of those skills or roles that you
8:59
were talking about that are becoming increasingly important
9:02
within your team? Yeah. I mean, I I
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think, so pharmacists, we all know, are lifelong
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learners. Right? I mean, medications
9:09
come out every day. They're new medications. There's
9:11
changing guidelines.
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And I think our pharmacists
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do a really good job of of staying
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in front of,
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any of these kind of new guidelines, new
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new meds, they have, the ability to do
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that. But I think the pharmacists of the
9:26
future are really going to have to develop
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more of an adaptive skill set. So they're
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going to have to learn new things like
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pharmacogenomics,
9:34
precision medicine,
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you know, how to interpret
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different types of reports,
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they're going to have to develop a fluency
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in artificial intelligence and digital health.
9:46
And none of this is really taught in
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pharmacy school.
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And so I think this isn't just focused
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on pharmacy
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pharmacists. It's also focused on our students,
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and making sure that, you know, our students
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are also learning these skills as well as,
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you know, taking on more kind of direct
10:05
patient care roles. And so communication,
10:09
motivational interviewing, you know, interprofessional collaboration is also
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on the list.
10:14
Lastly, I think, you know, it's a change
10:17
in time. And so having the landscape shifting
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this way, we really need to have people
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thinking entrepreneurially,
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and making sure that, you know, our pharmacists
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are thinking kind of outside of the box.
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And then in the same respect, you know,
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the same applies to our technicians that we
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are investing
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in our technician's skill sets so that they
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can actually be operators of our increasingly complex
10:43
systems like our automation.
10:46
And that if they're taking on more of
10:48
care coordination or benefits, that they also are
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being trained in that patient facing
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administrative work.
10:59
Yeah. Those are great examples and insights. Thank
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you for sharing.
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And as you've worked to, you know, evolve
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your model, what have been some of the
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biggest challenges or maybe things that didn't go
11:09
as planned that's or just anything that surprised
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you?
11:13
I I mean, I guess, you know, the
11:15
pharmacy model is not really a evolving a
11:18
model is not really a straight line, and
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so there's always,
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I think workflow redesign is sometimes harder than,
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you know, the technology that you're trying to
11:27
implement.
11:28
So, you do definitely need to have kind
11:31
of some,
11:32
change management, not just an operational change, but
11:35
also cultural change,
11:37
because, you know, even though it seems like
11:40
the innovation is great and it works well,
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you need your workforce to be ready to
11:45
kinda pivot and adapt,
11:48
to what, you know, may come of it.
11:49
And then I I guess the biggest thing
11:51
is kinda sustaining that momentum.
11:54
So making sure that,
11:56
we're not, you know, just focused on the
11:58
innovation, but you're also focused after the innovation
12:00
is implemented and making sure that, you know,
12:03
it is working as designed and, you know,
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there isn't any more,
12:07
areas that you would
12:09
necessarily need to adopt either people wise or
12:11
workflow wise as you integrate,
12:13
these therapies.
12:17
For sure. Thank you for sharing.
12:19
And looking ahead to the future, you know,
12:21
what do you think will define leading pharmacy
12:23
programs over the next few years, and what
12:25
should leaders be paying attention to right now?
12:29
I you know, I'm so excited about the
12:31
future. I think the pharmacy future is really
12:33
bright, and I think that there are significant
12:35
opportunities
12:36
ahead where pharmacists can really impact patient care.
12:41
I I think, you know, we've talked a
12:42
little bit about AI and, you know, how
12:45
that supports kind of the future of clinical
12:47
decision making and and personalized medicine.
12:50
But some other areas, I think that there
12:52
are going to be expanded pharmacist roles.
12:55
And I think a lot of that is
12:56
going to be focused on removing repetitive
13:00
kinda operational tasks, but more importantly, integrating
13:03
digital therapeutics,
13:04
advanced delivery systems.
13:07
And I think a lot of that is
13:08
gonna be surrounded by consumer driven expectations.
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So,
13:14
I I see the vision of pharmacy as,
13:16
you know, being a clinically integrated structure
13:20
and shifting to more of a dynamic, agile,
13:23
technology enabled,
13:25
area that can clinically
13:27
impact
13:28
the profession,
13:30
in health care significantly. And, you know, in
13:32
my mind, it's really an exciting time to
13:35
be a pharmacist.
13:38
Definitely. And I think a lot of leaders
13:40
couldn't agree more.
13:42
You mentioned those consumer driven expectations.
13:44
Is there any that you are that come
13:47
to mind that you think could be possible?
13:50
Yeah. I mean, I I think,
13:52
that,
13:53
consumers
13:54
are expecting health care to be convenient,
13:57
health care to come to them, not, you
14:00
know, them reaching out and going into a
14:02
pharmacy
14:03
versus, you know, the pharmacist coming to them.
14:07
And so, you know, I think pharmacies will
14:09
become care hubs in their communities, but I
14:12
also think there'll be more, home based care
14:15
and more diagnostic based care,
14:17
you know, in the pharmacy future.
14:22
Gotcha. Thank you for explaining that. And then
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lastly, if you have to make one big
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bet on the, you know, biggest shift or
14:28
biggest thing to invest in pharmacy, what would
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that be?
14:32
You know, I think today, it is really
14:34
change management. It is getting our students, our
14:37
pharmacists that are in the workforce, our technicians,
14:40
to understand that change isn't coming, that it's
14:43
actually here.
14:44
And so we need to adapt
14:47
how we are doing things and we need
14:49
to, you know, start learning those skills now
14:52
for our future,
14:54
and making sure that, you know, we're advocating
14:56
for the role of the pharmacist and kind
14:58
of the impact that a pharmacist can make
15:00
in patient care in a positive way.
15:05
Great. Well, thank you so much for this
15:07
conversation. It's been really great for sharing all
15:10
these insights. That's all for today's episode of
15:12
the Becker's Pharmacy Leadership Podcast. A big thank
15:15
you again to Nish for joining us. Thanks
15:17
for listening, and we'll see you next time.