Latest / Becker’s Healthcare - Clinical Leadership Podcast / Neil Gilchrist, Vice President of Pharmacy Business Operations at Beth Israel Lahey Health

Transcript

Neil Gilchrist, Vice President of Pharmacy Business Operations at Beth Israel Lahey Health · Becker’s Healthcare - Clinical Leadership Podcast

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  - This is Laura Dedo with the Becker's Healthcare Podcast.
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  I'm thrilled today to be joined by Neil Gilchrist,
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  vice President of Pharmacy Business Operations at Beth
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  Israel Lahey Health.
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  Neil, it's a pleasure to have you on the podcast today.
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  - Great. It's exciting to be here.
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  - Absolutely. You know, I'm looking forward
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  to our discussion because I know there's
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  so much happening in the pharmacy space right now,
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  and it, it is really such a important aspect of healthcare
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  and evolving quickly, and so I'm looking forward
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  to learning more about what you're doing at
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  Beth Israel Lay Health.
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  But before we dive into my questions,
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  can you tell us a little bit more about yourself,
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  your background, and the health system?
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  - Absolutely. Um, as you mentioned, my name is Neil Goku.
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  I'm currently in the role of Vice President
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  of Pharmacy Business Operations
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  for Beth Israel Leahy Health Pharmacy.
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  Um, I've been in health system pharmacy really
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  for the past 20 years.
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  A number of different roles from direct patient care roles
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  and varying leadership roles.
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  Most, uh, recently as Chief Pharmacy officer
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  for a multi-hospital health system, um, I believe my, my,
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  you know, my background in direct patient care role
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  as a critical care clinical pharmacist really gave me the
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  opportunity, um, to develop some of my leadership skills.
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  Uh, it's, I think, think really important
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  as a healthcare leader to understand
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  and see the other roles, uh, in a health system
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  and working side by side with physicians, nurses,
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  radiologists, respiratory therapists,
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  many other healthcare providers,
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  really influenced me early on in my career to see how
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  that teamwork is so important to the delivery of healthcare.
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  - Absolutely. I love that. And definitely, you know,
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  is such a, a fascinating way to, um, get that experience
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  and, and certainly carry it into the leadership roles.
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  Now, I was wondering if you could tell me a little bit about
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  the pharmacy program at Beth Israel Lehe
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  Health, what makes it so unique?
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  - Absolutely. So Beth Israel, Lehe Health, um, just
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  to give you, uh, an overview
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  of our system is a 14 hospital health system that's
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  geographically located in the Boston Metro Boston area,
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  Massachusetts, and in Southern New Hampshire, uh,
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  our system employs approximately 39,000 caregivers,
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  including 4,700 physicians.
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  Um, the system overall has about 2,500 inpatient beds,
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  and we see over 4.1 million outpatient visits
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  and 407,000 ed visits a year.
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  So a fairly large health system, um,
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  that also is complimented by our pharmacy program.
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  Uh, our pharmacy team is, uh,
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  over 1500 team members across the system.
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  And what makes us unique really is
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  how our pharmacy department is structured.
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  Uh, each of these hospitals,
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  the 14 hospitals have a dedicated inpatient pharmacy along
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  with some sites operate outpatient
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  infusion pharmacy services.
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  Um, those local pharmacy teams are focused on the acute care
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  patients that are in the hospital,
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  in the emergency department, inpatient beds
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  or critical care or areas.
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  Um, but beyond that, the acute care programs, uh,
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  really roll up under the system pharmacy corporate team.
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  We have approximately 350 team members focused on
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  the ambulatory care programs.
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  These programs really span across ambulatory clinical
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  pharmacy services, so seeing patients in the clinic,
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  specialty pharmacy program, our retail pharmacy services,
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  and then our additional services included medication access,
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  that could be prior authorization, financial assistance,
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  renewal services.
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  Uh, if I could talk a little bit more about our,
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  our corporate office as well, which is based out
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  of a 120,000 square foot office
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  and central service center dedicated
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  to these pharmacy programs.
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  Um, we have a fairly large fulfillment area,
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  20,000 square foot fulfillment pharmacy with automation
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  that can fill up over 10,000 prescriptions per day.
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  And then we, uh, complimented as well
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  by a large distribution center with a warehouse
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  that really allows us to navigate drug shortages
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  and make strategic purchases.
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  So those are kind of the, the i, the, um, ideas
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  that are the areas that really are unique to our program.
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  - Yeah, absolutely. That's amazing to hear.
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  And certainly as you mentioned, so many of those different,
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  um, aspects of the program can be essential
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  and I know health systems are looking at ways to continue
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  to optimize and really combat, as you mentioned, trying
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  to figure out processes
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  around prior authorizations especially, as well as, um,
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  drug shortages and leveraging technology to automate more
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  and, and really become more efficient.
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  From your perspective, which projects
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  and initiatives are you most
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  excited about for the next year?
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  What do you see as being really, um, essential in order
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  to continue your success?
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  - Yeah, we have a lot of projects
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  and initiatives underway, um,
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  and I think of them in really three categories.
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  Um, the first is really what have we already developed
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  or built and how do we grow those programs.
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  Um, the second is more focused on our, um, clinical programs
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  and go more into the space of health equity.
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  And then third would be around business development.
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  So if I could take a few minutes to kind of walk through
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  what some of those projects are, um,
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  I think would be helpful, uh, for listeners, the,
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  the first is around, um, our current business lines,
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  and so that would be our specialty pro program
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  and our retail pharmacy programs as well.
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  We have seven retail pharmacies across the system.
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  Um, and, uh, these programs really, uh,
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  are in their growth phase right now where we're able
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  to extend our services to more of our patients
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  that we serve, uh, as well as our, our caregivers, our,
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  our team members across the system.
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  Um, we're excited to launch, uh, as well
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  to complement these programs, uh, pharmacy based app
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  with a partner, uh, this year
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  and that will really help
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  to drive an optimal di digital experience
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  for our patients and and colleagues.
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  Um, under the category of clinical programs,
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  we have over 40 ambulatory clinical pharmacists
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  that are supporting our primary care and specialty clinics.
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  Um, and the past year really has been a focus
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  around a cardiometabolic space
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  and how do we ensure that patients have access to some,
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  uh, pretty innovative drugs in the space of SGLT twos
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  and GLP ones,
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  and how do we reduce some
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  of the disparities in health equity to make sure that some
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  of these underserved communities
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  or populations of patients can have access
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  to these therapies.
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  And so there's been a lot of focus on that.
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  We're really excited to move into the space of
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  a pharmacist led system-wide anticoagulation program
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  over the next year, as well
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  as a remote patient monitoring program that's managed, um,
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  by pharmacists and working closely
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  with our physician colleagues.
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  Um, so those are two clinical programs
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  that are really just coming together, um,
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  over the next, uh, six months.
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  Um, and then last, uh, is really exciting is
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  around business development.
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  Uh, we will be launching, uh,
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  later this year our own pharmacy benefits management
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  or PBM uh, product.
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  Our team really has built out that infrastructure
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  and data analytics to support our health system
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  initially with this solution.
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  And then looking further at
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  how we can support other health systems
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  and plan sponsors to maximize financial management.
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  So there's that aspect
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  of business development is is a PBM solution.
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  And then lastly is the area around rare diseases,
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  which really is a, a growing space.
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  If you look at 2023,
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  there were about 40 new rare disease
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  therapies that came to market.
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  Um, and these range from a few thousand dollars up to two
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  to $3 million for a single dose.
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  And these therapies can be life changing, life saving,
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  however the population size that, uh, are eligible
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  for these drugs can be anywhere from under a thousand
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  patients to under a hundred patients.
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  And how do you connect that lifesaving therapy,
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  a life changing therapy to this really small population?
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  It's, it's a different model here
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  where you can't just have pharma send out a large sales team
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  to educate everybody about them,
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  but as health systems, we have this data about patients
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  that, uh, may have been diagnosed with the disease state,
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  that single patient at your health system,
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  or, uh, they may have tests
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  or biomarkers that could be indicative of the disease.
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  And we're in a position as health system to connect those so
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  that we're looking at a solution to be able to help navigate
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  that rare disease space.
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  - Well, that's fascinating to hear
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  and certainly, you know, some great things
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  as you mentioned that are happening.
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  I wanted to question just one bit further.
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  Looking at the business development side,
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  especially in developing
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  and then now be need to offer the PBM, um, what was it like
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  to build that infrastructure out, um,
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  within the health system?
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  What did it take, how long I,
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  I guess were you working on building that
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  and then too, you know, on the data analytics side,
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  how do you see that really, um, coming to fruition
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  and what does it take to build this, I guess, product that,
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  um, is now beneficial for the health system
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  and you're ready to, um, work with others on as well?
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  - I, I think I would answer both of those questions kind
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  of together, is that it's all really built off
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  of the foundation of a strong
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  pharmacy dedicated infrastructure.
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  And this is really important is that you need
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  to have those internal data analytics team.
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  We have our own data warehouse
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  where our electronic health record feeds into, um, so
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  that we can really, um, pull that data much more nimble
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  and quickly and be able to make decisions based on that.
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  It also is complimented, uh, in our program,
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  which I think is unique, is having a strategy
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  and business development team within pharmacy
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  with project management team members.
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  We have a marketing communications team in finance,
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  and how do you pull all that together under pharmacy
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  to be able to, um, use data to quickly make decisions,
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  develop a strategy around that data,
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  and then activate the team to be able
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  to implement those objectives.
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  And so thinking about the, the PBM aspect
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  or the rare diseases, um, is you really need to, um,
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  have those, the, those resources available to move quickly
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  and that it's a two year journey or so,
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  but um, if you have the right pieces to pull together,
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  you're able to move much quicker.
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  - Absolutely. I, I love that. And it's just so helpful
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  to understand and see kind of that process
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  and like you said, that strong, uh, pharmacy department
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  and strategy background.
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  Now, before we wrap up our conversation here,
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  I was wondering, um, if you could speak to, you know, some
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  of the different headwinds that you're keeping your eye on,
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  um, right now, what's really top of mind for you?
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  - Sure. Um, I, I think for all many,
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  if not all health systems across the country, uh,
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  I think top of mind is financial challenges
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  of health systems with reduction in reimbursement,
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  the inflation costs for supplies, medications, and,
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  and labor as well.
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  Uh, I think everybody is faced
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  with these financial challenges,
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  and so that really influences a lot of the decisions, uh,
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  that are going into health systems today.
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  Uh, that may also, uh, is influencing, um,
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  capital investment decisions.
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  And so how do you build out programs when there's such a
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  tight capital environment right now?
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  Um, so financial challenges is definitely top of mind.
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  Um, it's hard to ignore kind of the, the, uh,
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  what's occurring right now over the past week
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  or so with the significant change, healthcare, cyber attack
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  and thinking about cybersecurity.
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  Uh, I do think that that that is a headwind
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  that we will continue to be challenged with.
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  And how do our health systems, uh, navigate
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  that moving forward with this current landscape?
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  Um, drug shortages continue to be a challenge.
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  They have been for the past 15 plus years,
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  and they've only gotten worse
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  where drug shortages may not be, uh, as many new ones,
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  but the shortages that are occurring are continue to occur
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  still primarily in the generic sterile injectable product
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  space where it's impact
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  and it inpatient care really challenging
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  for acute care pharmacy services.
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  Um, on the ambulatory side, we still see shortages.
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  Um, right now we continue to see amphetamine products
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  for A DHD and then the surgeon in demand
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  for medical weight loss with GLP one medications
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  that's impacted care for diabetes patients as well
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  as those trying to access this drug class
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  for weight loss, um, therapies.
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  The last couple headwinds really, um, PBMs
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  and DIR fees is definitely an area that
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  continuing to look at.
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  There is a lot of bills and discussion around PBMs
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  and discriminatory pricing, uh,
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  and any willing provide laws.
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  And so continue to watch PBMs on the DIR fees.
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  We are in kind of this first quarter phase of 2024
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  where we are seeing DIR fees assessed from the end
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  of last year as well as at the point of sale now
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  with the change of how that program works.
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  And the final headwind, which is a significant one,
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  is really the evolving landscape of the three 40 B program
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  and how pharma PBMs state Medicaid programs
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  and health systems, uh,
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  are gonna navigate the three 40 B program changes,
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  um, for the years coming.
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  - Absolutely. I, I think, you know, you such hit,
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  hit the nail on the head so well, in terms of some
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  of the ongoing challenges,
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  whether they're the financial challenges
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  or the shortages that have plagued the healthcare system
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  for a while and being able to deal with those plus,
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  you know, some of the new cybersecurity issues
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  and the evolving three 40 B program.
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  How do you really make sure your team, um, stays focused
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  and energized and motivated amid such change
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  and transformation and uncertainty too within the landscape?
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  - Yeah, it's very challenging in the landscape.
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  Um, I, you know, I, I think we need to make sure
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  that we're connecting back with our, uh, team members
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  that are doing the work every day.
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  We often refer to frontline team members
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  or direct patient care team members.
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  We need to ensure that we're connecting
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  with our team members at all levels
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  and that information is flowing up to leadership
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  and that we're also effectively communicating to all
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  of our team members to make sure that there's alignment.
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  Um, we can't change the direction
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  of the ship if we're not communicating to our team.
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  Um, and so that's critical to, uh,
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  being successful in this environment.
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  - Absolutely. Well, Neil, thank you so much
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  for joining us on the podcast today.
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  This has been such a fascinating and insightful conversation
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  and I look forward to connecting with you again soon.
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  - Thank you for having me on. Appreciate it.