Latest / Becker’s Healthcare Podcast / Tracey Spangenberg, Associate Chief Pharmacy Officer at UC San Diego Health

Transcript

Tracey Spangenberg, Associate Chief Pharmacy Officer at UC San Diego Health · Becker’s Healthcare Podcast

0:00
This is Laura Dierdo with the Becker's Healthcare
0:02
podcast. I'm thrilled today to be joined by
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Tracy Spangenberg,
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associate chief pharmacy officer at UC San Diego
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Health. Tracy, it's a pleasure to have you
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on the podcast today.
0:13
Laura, thanks so much. I'm excited to be
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here. I appreciate the invite.
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Absolutely. Now I'm looking forward to our conversation
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and digging a little bit deeper into some
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of your recent initiatives
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as well as how you're thinking about the
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future. But before we dive in, can you
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tell us a little bit more about yourself
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as well as UC San Diego Health?
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Well, thank you so much. Yes. I'm a
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pharmacy graduate. Actually, I'm a a foreign pharmacy
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graduate. I graduated from the University of KwaZulu
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Natal in South Africa,
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and had the distinct,
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honor of being able to,
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work
0:49
over in The US.
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Came over in in the nineties,
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and started my career in retail operations,
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was
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a regional
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retail
1:01
director,
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for,
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one of the
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third largest
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chain drugstores, which gave me a a tremendous
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perspective
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about just how hard it is in that
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retail
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setting both to run a business model with
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very slim margins, but also to make sure
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we we don't burn pharmacists out.
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After that, I I moved over into
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mail order operations with the third largest,
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mail order, facility and was VP of operations
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there,
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for mail service,
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and then was just super excited to,
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come over into health system pharmacy,
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bringing those
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different perspectives and backgrounds into,
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running the
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outpatient
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retail pharmacy operations for UC San Diego Health.
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So,
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that's that's it in a nutshell.
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Vad, what great experience in learning lessons you've
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had throughout your career and then to be
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able to bring that to your current role,
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I can imagine is really beneficial.
2:08
I I'm curious. Can you tell us a
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little bit more about a project or initiative
2:11
you led in the last year? What did
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you do and what were the results?
2:15
You know, obviously, many.
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Health systems are so complex, and that's what
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makes them so exciting and interesting.
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But I think the most,
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important one,
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which has long term impact for the health
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system
2:30
is establishing a central,
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bioauthorization
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team for pharmacy benefit.
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As you know,
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prior auths are just the bane of existence
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for providers and for patients.
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And our
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pharmacy technicians with their knowledge and experience,
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do it better, you know, just,
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for having years of experience in in navigating
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that prior auth space.
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So,
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we were able to get executive support to
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start the first phases of our prior authorization
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team.
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And I think,
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really, the
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the complexity
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of our
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integrated
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EMR workflows,
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was probably one of the biggest
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learnings,
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as you try to centralize something
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that is
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connecting
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multiple clinics,
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multiple business models,
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into one collective unit.
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It requires a huge amount of change management,
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a lot of stakeholder,
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investment
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and time.
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And we we really focus the first six
3:44
months
3:45
of 2025
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on foundational
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things,
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like developing standard work,
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really truly understanding the workflows and the workload
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variability.
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A lot of
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focus on technology,
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trying to move everybody onto one
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prior authorization
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platform,
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lots of training,
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lots of
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communication
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for that trench management component.
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And so it took us about
4:17
seven months before we
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did our initial launch,
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and have worked very hard and closely
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on understanding what's working, what's not working, process
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improvement,
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and excited to say, you know, we've,
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really launched and and supported now,
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four of the biggest, largest clinic
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areas at UC San Diego,
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with full prior authorization
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support,
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and excited to see that it is
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both providing
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tremendous
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improvements in patient access.
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It's
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relieved a huge burden of, you know, providers
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in having to handle a lot of that
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administrative
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functions with prior authorization.
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But in addition, it's providing us an opportunity
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to have our health system pharmacies
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fill the prescriptions for these patients
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and so has been,
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very beneficial
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in revenue growth and prescription growth for for
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the system. So,
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early days, we've got a lot to do
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and learn,
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but so far,
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the initial numbers are are looking
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fabulous and the initial feedback
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is very positive. So,
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excited for the next phases and for us
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to continue growth,
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on this initiative.
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That's fantastic to hear. You know, really impressive
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to think about the scope of a project
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like that and and being able to actually
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put something together that makes a measurable difference,
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in a short period of time is, incredible.
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And so, you know, when you think about
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that process, and I know you mentioned being
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able to learn and iterate along the way,
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what was the most important thing you learned
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and and adjusted,
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as you were in the development phase?
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You know, it's a good question. And I
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think,
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our our biggest adjustment
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was
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bringing in multiple
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teams
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together in one unit
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that had never
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operated as a team before.
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And so disparate,
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platforms
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that they were working on, disparate,
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you know, standard work,
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disparate
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perspectives about, you know, what the mission was
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and,
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you know, really
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the criticality
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of being very
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prescriptive and deliberate in change management.
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And I think the key
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for our success in that area, and I
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think it's still work in progress,
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was really having
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those that are directly doing the work
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be a big part
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of the planning
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and of the input,
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to make sure we were really listening and
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understanding
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before
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implementing change,
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which we knew it was gonna be big,
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but I I don't think we understood
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really how
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really huge that change was in so many
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areas.
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So I I think that would be the
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biggest
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biggest piece.
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That's helpful for understand to understand. Thank you
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for digging a little bit deeper there. Now
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looking ahead to 2026,
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what are some of the big priorities and
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headwinds that you're most focused on right now?
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I think there is probably
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three, you know, areas to answer that question.
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It's the continued growth and implementation of our
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central prior auth team.
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It is, such an impactful initiative that,
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you know, we need to keep on
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pressing forward and learning,
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and and implementing
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more,
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MSOT, which is multi step
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order transmittal,
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and
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learning how to nuance that in the workflows.
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The second is
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really massive impacts going on in the payer
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space
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with the,
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maximum fair price.
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The first 10 drugs,
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rolled out,
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in January, and we've got another slew of
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drugs for 2027
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to look forward to.
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That has huge,
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margin impacts,
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and then also biosimilars.
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It's a swirling space with, you know, certain
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payers,
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picking and choosing winners and losers in that
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biosimilar space, and it's how to navigate that
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from a procurement perspective
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and, making sure that we're not disrupting patient
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care,
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you know, as we try to figure out
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which payer is gonna pay for what,
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how we procure it,
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and understanding the the business implications.
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And then I think the third thing, which
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is always that elephant in the room is,
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three forty b changes.
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It seems like a weekly,
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there's some sort of curve ball, you know,
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in that three forty b space. And so
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keeping abreast of that and,
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you know, blocking and tackling, you know, as
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as that is such a a meaningful
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program
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for the entire health system,
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and for
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patients care.
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It's it's really important that we understand and
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keep abreast of those changes.
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Absolutely. And that's such a great point. I
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think all of the elements that you mentioned
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there are top of mind for so many
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hospitals and health systems right now, but especially
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thinking about
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that three forty b, and with all the
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changes. And, you know, I think,
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a lot of uncertainty attached to it, but
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at the same time, it sounds like, you
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know, being able to stay on top of
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the news and and, have the nimbleness to
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adjust is so important.
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Do you how do you see the team
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being able
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to sustainably,
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think about,
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continued development,
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with that program in such flux? How are
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you kind of guarding against whatever,
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impacts you need to absorb?
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You know what? I I think it's, it's
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really a a full team approach.
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We are very disciplined,
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around initiatives
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that we are,
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implementing, making sure that we are measuring results,
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and adjusting
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course
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should results not be
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meeting expectations
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or
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if there has been a change in
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the three forty b space,
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understanding what that change and implication might be
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and then looking
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for other initiatives that can
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counterbalance it.
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And and it really does take a a
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full team
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to be able to tackle the complexities of
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that. And so,
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we have the fortunate
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blessing of just incredible leaders that are all
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bought into a common vision about
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the the importance of what we do in
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our
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outpatient setting and,
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the importance of what we do to the
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entire organization.
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So,
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really engaged leaders,
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which really help us drive
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multiple initiatives and own those initiatives,
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and bring home the results,
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is is really, I think, our secret,
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and how we'll tackle, you know, twenty twenty
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six and 2027
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on the on the go forward.
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I think
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really also being open minded about adopting
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new tools, AI tools, automation tools, you know,
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things that,
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can help us
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not not only do the the analysis and
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the diagnosis, but also help us with efficiency,
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you know, and help us
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mitigate some of these,
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erosions.
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That's helpful to understand. And, you know, I
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appreciate the technology piece too, is evolving as
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quickly as, everything else, and so that that's
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great to hear.
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What do you think the hardest thing you'll
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have to do in the next year will
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be?
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I think it's, it's really balancing these eroding
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margins and these
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onslaughts, you know, into our business model
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with investments
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that we need in order to grow,
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and where we invest in order to grow.
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So
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I think that's gonna be
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a continuous
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tight rope we need to walk,
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and making sure that we're we're maintaining that
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operational
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discipline.
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I also think,
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one of the hardest things for the coming
13:00
year is to continue
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to press and elevate
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the dialogue
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around
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the value that our outpatient retail pharmacists have
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in the continuum of care.
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In a health system,
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our retail pharmacies are truly the connective tissue
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across
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multiple clinical disciplines.
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We have the ability to access the entire
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EMR,
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and are able to really drive outcomes and
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results.
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But I I do believe it's a
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a perception
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that is still
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not fully understood
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and not fully appreciated. So,
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really socialization
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and advocacy
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for what the what the impact is of
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health system retail pharmacies in so many places.
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So
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That's helpful to understand. And I think especially
14:00
looking at how I know many of those
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hospital retail pharmacies and and other,
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you know, new and and interesting,
14:08
ways to provide access to care are certainly,
14:11
making a a difference. And so it'll be
14:13
interesting to see what kind of rises to
14:15
the top as being, you know, those spaces
14:18
that can make the biggest positive impact on
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the community.
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And to that point, I'm curious for your
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perspective,
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what
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do you how are you thinking about growth?
14:27
What do you see as being some of
14:29
the biggest opportunities for the next year or
14:31
so?
14:32
You know, growth for us, as we are
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a closed
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network pharmacy, really, our our mission is to
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serve as many UCSD
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health
14:42
patients with pharmacy services as possible.
14:45
Our best growth opportunities
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are continued
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partnership
14:50
with the health system and health system leadership,
14:54
and continuing
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to talk about the value that we provide
14:59
not only for the patients,
15:02
but also,
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you know, with with patients using our retail
15:07
pharmacies, we have extremely high NPS scores,
15:12
which helps the overall health system.
15:15
And we have a a distinct impact on
15:18
readmission rates.
15:20
So, you know, again, beyond our own profit
15:24
and loss statement that has a significant impact,
15:27
on the metrics that matter for the health
15:30
system.
15:31
And then pharmacies
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are one of the most
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sticky businesses,
15:36
or business models
15:38
because we serve the patients so well, because
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we have such high scores, because we are
15:42
able to do so much more than the
15:45
average corner drugstore.
15:47
Patients remain
15:49
wanting to use UCSD health pharmacies,
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and that will then,
15:55
you
15:55
know, initiate them wanting to stay with the
15:58
health system as their health system of choice.
16:01
So I think we add a lot of
16:02
value,
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to the overall growth of the system and
16:06
the metrics,
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and I think it's a synergy and partnership
16:10
with the health system leadership,
16:12
that can help us in our in our
16:14
own growth.
16:17
I love that. Tracy, thank you so much
16:19
for joining us on the podcast today. This
16:21
has been such an informative and and fun
16:23
conversation, and I look forward to seeing you
16:25
as well at our chief pharmacy officers summit
16:27
in April. I know you'll be speaking on
16:29
a panel and really digging deeper into some
16:32
of the themes we talked about here as
16:33
well as, expanding the conversation and connecting with
16:36
colleagues and and more. So I look forward
16:39
to seeing you there.
16:41
Well, Laura, thank you so much. It was
16:42
a great conversation, and I hope you have
16:44
a wonderful day.