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Balancing Patient Care with Financial Strategy: Navigating Pharmacy Reimbursement | Cardinal Health™ Counter Talk™ Podcast · Pharmacy Podcast Network

0:05
Speaker 1: You are listening to the global network of podcasters dedicated
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Speaker 1: to the pharmacy profession. Welcome to the Pharmacy podcast Network.
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Speaker 2: The testimonials appearing in this podcast reflect individual experiences, and
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Speaker 2: Podcast Network is for independent pharmacists to learn about the
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Speaker 2: state of the industry, innovative services and solutions, and the
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Speaker 2: future of pharmacy. Join me your host Jason colorI for
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Speaker 3: And wherever you listen to your favorite podcasts.
1:10
Speaker 4: Hello everyone, and welcome back to the Cardinal Health counter
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Speaker 4: Talk podcast. I'm your host Jason colorI, and today is
1:16
Speaker 4: an episode that I'm sure is on everyone's mind these
1:18
Speaker 4: days and on improving your retail independent pharmacies, financial health
1:23
Speaker 4: so Today we'll be talking with seventeen year pharmacist Jean
1:26
Speaker 4: Paul Dubau from Morristown Medical Center in Morristown, New Jersey
1:30
Speaker 4: and part of the Atlantic Health System. He has implemented
1:33
Speaker 4: and supported both programs and contracts, resulting in new realized
1:37
Speaker 4: multimillion dollar fiscal revenue increases and internal savings across the pharmacies,
1:43
Speaker 4: reaching more patients every year, as well as helping thousands
1:47
Speaker 4: of AHS patients access medicine at lower costs to multiple
1:51
Speaker 4: programs and patient access initiatives.
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Speaker 3: Welcome to the show, Jean.
1:56
Speaker 1: Thank you, Jason, thanks everyone for having me here. It's
1:59
Speaker 1: a great experience and hoping to share my experiences with
2:02
Speaker 1: the team and other pharmacies as well.
2:05
Speaker 4: Yeah, so not to follow too much of a script here,
2:07
Speaker 4: but I do want to ask you, like I do
2:10
Speaker 4: every guest that comes on, what was your journey into
2:13
Speaker 4: the pharmacy profession?
2:14
Speaker 1: Great, Like you mentioned, I'm a pharmacist of seventeen years,
2:17
Speaker 1: a farm d I remember way back in the days
2:19
Speaker 1: of those early pre college pre med courses working as
2:22
Speaker 1: a pharmacy technician just kind of to get by and
2:25
Speaker 1: things like that on the day to day and someone
2:26
Speaker 1: when I respect that I worked with just a really
2:28
Speaker 1: hard working and individual who really went out of his
2:31
Speaker 1: way and what kind of included me kind of leaned
2:33
Speaker 1: over to me and said, hey, if I can do this,
2:34
Speaker 1: you can do this, kid, you should sign up with school.
2:37
Speaker 1: You know, I think you've got some potential. And not
2:40
Speaker 1: immediately something that happened over many years, but the long
2:43
Speaker 1: kind of transition through six years of pharmacy school, financing
2:46
Speaker 1: largely myself with some federal funds, and kind of really
2:50
Speaker 1: learning to achieve and get into become a pharmacist acting
2:53
Speaker 1: and license was quite a process that really it changed
2:57
Speaker 1: me for the better and really really helped me see
3:00
Speaker 1: different parts of the world that my earlier farmedy post
3:02
Speaker 1: years across to retail and specialty community settings throughout New Jersey,
3:07
Speaker 1: and I've managed it independent for years while providing population
3:10
Speaker 1: specific services like immunizations pre COVID. During COVID helped provide
3:16
Speaker 1: and introduce meds to beds at Overlook Medical Center in Summit,
3:19
Speaker 1: New Jersey, and other quality initiatives across Atlantic since coming
3:23
Speaker 1: on board in twenty twenty one. With our teams here today,
3:26
Speaker 1: I managed the business, financial and patient access features of
3:30
Speaker 1: our three outpatient pharmacies at Atlantic, I serve as our
3:33
Speaker 1: official and CPDP contact and since twenty twenty one, I
3:37
Speaker 1: think in your intro mentioned it pretty good. Each year
3:40
Speaker 1: we've implemented and supported new programs and contracts on board
3:44
Speaker 1: every single year, resulting in new revenue, new increases in
3:48
Speaker 1: internal savings, and also the best part is reaching more
3:52
Speaker 1: patients every year twenty four and change percent actually for
3:55
Speaker 1: this past year, which is a huge increase for us
3:58
Speaker 1: as a system. Commenturately as well, So happy to share
4:02
Speaker 1: our secrets are, what our difficulties are and are the
4:06
Speaker 1: challenges of independent pharmacy.
4:08
Speaker 3: Yeah, so you're a little bit of a jack of
4:10
Speaker 3: all trades.
4:10
Speaker 4: You've kind of touched on a lot of different aspects
4:13
Speaker 4: of pharmacy in your career, which is always good as
4:15
Speaker 4: you go forward and implementing these new services. As you've discussed,
4:19
Speaker 4: why did Atlantic Health System choose to open a retail
4:22
Speaker 4: pharmacy with Morristown Medical Center and also Newton Medical Center,
4:26
Speaker 4: And also if you could explain a little bit, maybe
4:29
Speaker 4: dive a little deeper into what the Atlantic Health System,
4:33
Speaker 4: what their job is, what they are, their entity, and
4:38
Speaker 4: why they are decided to open some pharmacies and what
4:40
Speaker 4: that network looks like beautiful.
4:43
Speaker 1: Yeah. Absolutely, Atlantic Health is a regional, regional player and
4:48
Speaker 1: it's so great to be part of this team. I
4:51
Speaker 1: was actually selected out of a different pharmacy rule to
4:53
Speaker 1: come and board with our business, financial contracts and quality
4:56
Speaker 1: and it's really developed over the years since twenty twenty one.
5:00
Speaker 1: But to do the background, so as far as outpatient
5:03
Speaker 1: pharmacies at our system, across our system, first outpatient pharmacy
5:06
Speaker 1: was at launch in two thousand and nine. It's a
5:08
Speaker 1: closed door pharmacy. It's based out a living Stone. It's
5:10
Speaker 1: up and running and growing, providing core pharmacy services to
5:13
Speaker 1: our team members at a net value for our system.
5:16
Speaker 1: Since that time and over the years, we've scaled that
5:19
Speaker 1: net value savings by multiple things including you know, avoiding
5:22
Speaker 1: dispensing fees combined with preferred product invoice purchases with cardinal
5:26
Speaker 1: tracking rebate opportunities direct and indirect. That quickly brought the
5:31
Speaker 1: value to the system. It became very clear that we
5:33
Speaker 1: had a positive impact as part of the system. Our
5:37
Speaker 1: two retail units followed in twenty thirteen, you know, basically
5:41
Speaker 1: across our system. At that time, if we're going back
5:43
Speaker 1: a little bit here, there's a lot of buzz of
5:45
Speaker 1: meds to beds. There's a lot of buzz of quality
5:47
Speaker 1: the independent outpatient. We're seeing huge losses and challenges which
5:52
Speaker 1: we still do see, but kind of everyone's that. We're
5:54
Speaker 1: asking you where to go? Where's that value? Is it?
5:57
Speaker 1: Through Part D tracking patients adherence and the buzz in
6:01
Speaker 1: our system like a lot of others, was you know,
6:03
Speaker 1: can we open a retail that supports direct adherence goals,
6:07
Speaker 1: allows for meds to beds, provides transitions teams with insights
6:11
Speaker 1: into the challenges even for our patients who don't fill
6:13
Speaker 1: with our pharmacies. But based on our inside knowledge and
6:17
Speaker 1: following that buzz, the first our first opening was MMC retail,
6:21
Speaker 1: which is our current largest format one at Morristown Medical
6:24
Speaker 1: Center in Morristown, New Jersey, twenty thirteen. There's our whole
6:28
Speaker 1: health system community staff Newton subsequently a little bit west,
6:32
Speaker 1: and our system represents that region and also helps patients
6:36
Speaker 1: from all walks of life. The next year they got
6:38
Speaker 1: their NPI up and running. We kind of there was
6:40
Speaker 1: this buzz and there was financial support behind that one,
6:43
Speaker 1: but two extensions, so we went with that and since launch,
6:48
Speaker 1: and they've been opened and have developed their internal and
6:51
Speaker 1: external kind of patient sets through the years. We've both
6:54
Speaker 1: sites have meds to beds. At Morristown, we're servicing more
6:57
Speaker 1: than ten grant based and need based program and I
7:01
Speaker 1: affectuate some of the financials on that as well as
7:03
Speaker 1: work to make sure we have continuous flows matching the
7:06
Speaker 1: right populations. And we also meet with different outside of pharmacy.
7:09
Speaker 1: Those stakeholders in patient care could be members of grants,
7:13
Speaker 1: it could be the medical groups, could be practices who
7:16
Speaker 1: aren't able to access medication. So it's kind of developed
7:19
Speaker 1: into a really excellent footprint at both facilities with an
7:22
Speaker 1: appetite for more in the future, as long as we're
7:24
Speaker 1: able to keep our net positive margins on the volatile
7:29
Speaker 1: retail side as we know in independent pharmacy.
7:31
Speaker 4: Yeah, yeah, well, I mean, let's talk about that a
7:33
Speaker 4: little bit. I actually want to know, I want you
7:35
Speaker 4: to dive a little bit deeper into not only the
7:37
Speaker 4: services that you have that your retail pharmacies provide, but
7:40
Speaker 4: also the population you serve.
7:42
Speaker 3: Tell us a little bit about that.
7:44
Speaker 1: So the patient populations, I would say very significantly, and
7:48
Speaker 1: our goal is to treat all the patients. So I
7:50
Speaker 1: would say our core population base that we treat that
7:54
Speaker 1: is on the financial kind of structural side, is actually
7:57
Speaker 1: our team members. So at both of our outpatient farmacies
8:00
Speaker 1: at Morristown and Newton, maybe not fifty percent, the ratio varies,
8:04
Speaker 1: but this last year we had a record number of
8:06
Speaker 1: fills across all of our pharmacies by our team members.
8:09
Speaker 1: Greater than one in four of those who didn't have
8:13
Speaker 1: to use our services who work for us, you know,
8:15
Speaker 1: they get a better cope opted to use our pharmacies,
8:19
Speaker 1: So greater than twenty five percent of our entire system,
8:21
Speaker 1: Greater than twenty thousand team members on a board with utilizers,
8:25
Speaker 1: I think it's around fifteen thousand utilizers on average for
8:29
Speaker 1: maintance medications, So really exciting. So that patient population being
8:33
Speaker 1: serviced as part of our core features our savings just
8:36
Speaker 1: by you know, servicing our team. Those savings allow us
8:39
Speaker 1: to keep the licenses, look at profit models other parts
8:43
Speaker 1: of retail meds to beds, things that we can offer
8:46
Speaker 1: at a loss but for adherence value, so that that
8:50
Speaker 1: opens it up to our other kind of patient populations.
8:52
Speaker 1: So that would be kind of the public that said
8:55
Speaker 1: at Morristown specifically, but definitely Newton as well. Providers lean
8:59
Speaker 1: on us from oncology, from cardiology, from some need based
9:03
Speaker 1: programs to really help local community members as well as
9:06
Speaker 1: those traveling for let's say more sound for oncology care.
9:10
Speaker 1: We have a large oncology section there and we have
9:12
Speaker 1: pharmacy services built in and kind of accelerated contracts as
9:18
Speaker 1: well as we meet with stakeholders to see if the
9:20
Speaker 1: services we can offer can match the current need. We
9:24
Speaker 1: have patients who might be on hospice, who may not
9:26
Speaker 1: be able to fill a medication. It's all around the board,
9:29
Speaker 1: and we treat so many across our locations of retail,
9:33
Speaker 1: you know, within our multi contracts through Leadernet via Cardinal
9:37
Speaker 1: as well as direct contracts with Medicaid, really anywhere we
9:41
Speaker 1: can help out. It's been a very successful. The amount
9:45
Speaker 1: of patients and the categories are dynamic, and this past
9:49
Speaker 1: year we have the service the most amount of grant patients,
9:52
Speaker 1: need based patients and cash patients. Ever, we also served
9:57
Speaker 1: the largest volume including all including our team members. Kind
10:00
Speaker 1: of a multifaceted year of growth for US across both
10:04
Speaker 1: stores and our system. With kind of I wouldn't say
10:06
Speaker 1: everyone relying on us, but our ability to provide features
10:09
Speaker 1: specific to practices, paired with being a patient facing public
10:13
Speaker 1: pharmacy and kind of held together at the base allowing
10:17
Speaker 1: us to do all these things is service servicing our
10:19
Speaker 1: team members at a financial benefit. So really it's a
10:23
Speaker 1: multifaceted group of patients. We try to help as many
10:26
Speaker 1: as we can.
10:27
Speaker 4: Well, with so many different types of services that you're offering,
10:30
Speaker 4: and all these amazing patients that you serve and all
10:33
Speaker 4: these different things that you have kind of either dipped
10:36
Speaker 4: your toe in or just you know, went full went
10:38
Speaker 4: fall into the to the pool of all.
10:40
Speaker 3: These different services.
10:41
Speaker 4: What reimbursement challenges has your retail pharmacy faced?
10:44
Speaker 1: So I would say everything you've read of the newspapers
10:47
Speaker 1: and more, just kidding. Reimbursement is you know, across pharmacy
10:51
Speaker 1: for years, maybe the nineties maybe, yet after the tipping
10:54
Speaker 1: point of the nineties, reimbursement challenges are across the industry
11:00
Speaker 1: clearly not getting better. For independence there, it's clearly more challenging.
11:06
Speaker 1: Even with the even playing field with the dir fees
11:09
Speaker 1: of twenty twenty four going away, we saw at those
11:12
Speaker 1: times a lot of the part dees and competitive contracts
11:14
Speaker 1: for patients that we want to reach, patients that are
11:17
Speaker 1: common those using our services at our Hull system and
11:20
Speaker 1: maybe being a discharge and maybe non preferred or might
11:24
Speaker 1: be we're at the five cent reimbursement, you know, kind
11:27
Speaker 1: of joke of that year across the board. Maybe it's
11:30
Speaker 1: some of the other not changed, but other PBMs with
11:34
Speaker 1: as we all know, over time, the contracts are aren't degrading,
11:37
Speaker 1: they're they're calculating to be vertically integrated with you know,
11:40
Speaker 1: those payers and to have their rebates for the most
11:44
Speaker 1: expensive medications and their benefit is not to fill it
11:46
Speaker 1: through community as well as we're community even though we're
11:50
Speaker 1: you know, we work within Atlantic Health, our goal is
11:53
Speaker 1: the community and we're that's also how we're subscribed with
11:56
Speaker 1: with cardinals. So reinforcement challenges are every single day. We
12:00
Speaker 1: have so many features with you guys. I have direct
12:03
Speaker 1: calls from our teams asking for assistance with claims, asking
12:07
Speaker 1: for help with purchasing is. It's a constant thing that
12:11
Speaker 1: really needs management. I actively work on this and this
12:15
Speaker 1: is something that kind of was transformed in between twenty
12:18
Speaker 1: twenty one and twenty twenty two with us. Part of
12:20
Speaker 1: it was working with your team and the RCS team
12:22
Speaker 1: regarding monitoring some of these functions on the purchasing side,
12:26
Speaker 1: on the claim side, looking at some of these MAC issues,
12:29
Speaker 1: things that are invisible, things that hit your pharmacy's bottom line.
12:32
Speaker 4: Well, how did you how did you identify Cardinal Hell's
12:35
Speaker 4: reimburse the RCS our reimbursement Consulting Services solution as a
12:39
Speaker 4: potential solution in.
12:42
Speaker 1: This case, we were super lucky. So when I came
12:44
Speaker 1: on board, aware of RCS services and similar things from
12:47
Speaker 1: other companies and providers and working across pharmacy for many years,
12:52
Speaker 1: but specifically RCS. When I came on board in twenty
12:54
Speaker 1: twenty one at Atlantic, we were current subscribers the services.
12:58
Speaker 1: I would say, we're a little bit less or I
13:00
Speaker 1: would say less. They weren't fully being optimized or utilized,
13:03
Speaker 1: and they were also kind of fractured by site meeting.
13:06
Speaker 1: Different people would take the calls, and then the representative
13:09
Speaker 1: kind of had a different approach, and we kind of
13:12
Speaker 1: I took the rates in twenty twenty one, and we
13:14
Speaker 1: standardized our CS meetings and a number of other things,
13:17
Speaker 1: including our charging. Foremost, we revaluated everything in that that
13:21
Speaker 1: calendar year and into twenty twenty two the fall. We
13:25
Speaker 1: made a number of changes and one of those is
13:28
Speaker 1: we kind of took the RCS calls and meetings with
13:31
Speaker 1: our representative much more seriously. We actually asked for kind
13:36
Speaker 1: of changes in our reporting. Can we get customized reporting? Hey,
13:38
Speaker 1: we're having issues with specific generics, can we get those
13:41
Speaker 1: filtered by loss? You know, we're having issues with a
13:44
Speaker 1: particular PBM, I want named specific ones. You can probalyki
13:48
Speaker 1: of all the big three or four issues with all
13:50
Speaker 1: of them? You know, how do we remain competitive? And
13:54
Speaker 1: it was a combination of really using purchasing interventions of
14:00
Speaker 1: education at our sites, real time reprocessing, which is an
14:04
Speaker 1: RCS tool of kind of identifying claims within a short,
14:07
Speaker 1: weird window that you can reprocess it to really jump
14:10
Speaker 1: in there and make it a make a change before
14:13
Speaker 1: it's permanent, as well as train proactively. So kind of
14:16
Speaker 1: a great combination of those things. So we were lucky
14:19
Speaker 1: to have it, I guess. As the overall question that
14:22
Speaker 1: said we really started using it at that time.
14:24
Speaker 4: Yeah, being being proactive I think is something that pharmacists
14:27
Speaker 4: are learning to get better and better at you know,
14:29
Speaker 4: it's it's always you know, a lot of pharmacists that
14:31
Speaker 4: we've talked to obviously in the past, have been a
14:34
Speaker 4: little bit reluctant for change and implementing solutions like this.
14:37
Speaker 4: But I feel like when you do it in the
14:38
Speaker 4: right way and you kind of guide yourself into it
14:41
Speaker 4: and you could see how much it could help, it
14:42
Speaker 4: really does benefit the pharmacy and the bottom line overall, John,
14:46
Speaker 4: how has enrolling in this solution addressed the specific financial
14:49
Speaker 4: pressures you were experiencing overall?
14:51
Speaker 1: Jason, I would say overall, it really gives us peace
14:54
Speaker 1: of mind kind of mentone cheesy I would say power,
14:58
Speaker 1: power of the team. So internally we have our teams
15:01
Speaker 1: at Atlantic and Cardinal has multiple services. But when we
15:04
Speaker 1: get together with our representative, who's amazing, we're able to
15:08
Speaker 1: see direct through lines from the actions that we take
15:11
Speaker 1: on purchasing driven by our meetings with our CS agent,
15:14
Speaker 1: review of the claims, and our ability to how that
15:17
Speaker 1: trickles down to our overall goal of maintaining margin positive
15:21
Speaker 1: business overall. Obviously, claim to claim things are all over
15:24
Speaker 1: the place, and it's different challenges, but really that looking
15:27
Speaker 1: at the big picture knowing that our rep has our back,
15:31
Speaker 1: as well as going to present me at every single
15:33
Speaker 1: meeting with something that I'm not expecting, which is great
15:35
Speaker 1: because it's things we wouldn't have seen normally by not accepting,
15:39
Speaker 1: by not trying the features. Basically could be a claim,
15:42
Speaker 1: could be a loss, it could be a purchasing opportunity.
15:46
Speaker 4: I actually wanted you to just mention a little bit
15:49
Speaker 4: more about the OURCS team, the Reimbursement Consulting Services team,
15:53
Speaker 4: because you know it's kind of in the name. It's
15:55
Speaker 4: not just helping people obviously helping pharmacies get better reimbursement,
16:00
Speaker 4: but it's really there's someone on the phone each and
16:03
Speaker 4: every day to help guide you if you have those questions.
16:06
Speaker 4: Talk a little bit more about that and that experience.
16:08
Speaker 1: Absolutely so, the calls we have are direct and dynamic.
16:12
Speaker 1: They're bi weekly and what it entails is someone our
16:16
Speaker 1: expert who's reviewed our weekly claims for both of our pharmacies,
16:21
Speaker 1: will give us real time input kind of on risks.
16:25
Speaker 1: Concerns could be from something simple like day supply, could
16:28
Speaker 1: also be audit risk, FDA package insert information could be
16:31
Speaker 1: recommendations for package size. It could also be some internal
16:36
Speaker 1: intel of what to watch out for that other pharmacies
16:38
Speaker 1: are reporting from either audit behaviors or things that we
16:42
Speaker 1: need to be better prepared for as a team across
16:45
Speaker 1: independent band together, as well as that we need to
16:48
Speaker 1: educate our sites. I work directly with our site teams
16:51
Speaker 1: at MMC and NMC as well as our team member pharmacy,
16:54
Speaker 1: and a lot of what I learned from our RCS,
16:57
Speaker 1: either the direct intel and or specifcific information on claims
17:01
Speaker 1: and processes are issues that are across all of our stores.
17:05
Speaker 1: I'll often be resharing and kind of making my own
17:07
Speaker 1: education back to our teams. They lean on me as
17:10
Speaker 1: a resource for kind of everything that's processing in addition
17:12
Speaker 1: to some of the business and quality programs. But I
17:16
Speaker 1: really would be without something to back it up with
17:20
Speaker 1: if I had, I would not have a service that
17:22
Speaker 1: provides me with what I need to share back to
17:24
Speaker 1: our teams regarding processing weekly.
17:26
Speaker 3: Without that.
17:27
Speaker 4: Yeah, I appreciate you saying all that, because I really
17:30
Speaker 4: do want people to understand that is a big part
17:32
Speaker 4: of what the RCS solution does, you know, walking you
17:36
Speaker 4: through these those certain situations how to maybe implement them
17:40
Speaker 4: throughout your other pharmacies. And really it's not just going
17:43
Speaker 4: in blind and trying to figure it out on your own.
17:46
Speaker 4: Once your solution is up and running, it's it's really
17:49
Speaker 4: a partnership that you build over.
17:51
Speaker 3: The course of time, especially as soon.
17:53
Speaker 4: As you you know onboard and you know to that
17:56
Speaker 4: to that end, what was the onboarding process like, you know,
18:00
Speaker 4: talked about some pharmacists getting a little bit, you know,
18:02
Speaker 4: maybe have some trepidation about getting into a new solution,
18:06
Speaker 4: you know, affecting their pharmacy business. But what was the
18:08
Speaker 4: onboarding process like and what was required for your retail
18:11
Speaker 4: pharmacy to begin using RCS.
18:13
Speaker 1: So, since we were up and running prior to my
18:16
Speaker 1: onboard with Atlantic with the RCS services, I believe it's
18:19
Speaker 1: a contractual add on I've been previously. It's a very
18:22
Speaker 1: simple way. So basically, once you're signed up within the package,
18:25
Speaker 1: it kind of is attached to you use your name.
18:27
Speaker 1: But my experience was a friendly representative reached out to
18:31
Speaker 1: me basically once the service was active, to set some
18:34
Speaker 1: time to kind of see what we could glean from
18:37
Speaker 1: the service. And at first it was a little uncomfortable
18:39
Speaker 1: for myself. And you know, you hear of services, you're
18:42
Speaker 1: like what's the value of this After dedicating some time
18:46
Speaker 1: to kind of going through the reports that existed and
18:49
Speaker 1: then honing in on the ones that help us uniquely at Atlantic,
18:53
Speaker 1: so some of our claims that are cost rebate and
18:55
Speaker 1: those programs for losses, things like that where we need
18:59
Speaker 1: to look for opportunity as well. It was really simple,
19:02
Speaker 1: and for us it was a civil process because it
19:05
Speaker 1: was already up. But I would imagine the experience would
19:08
Speaker 1: be translable to other pharmacies to not be afraid of.
19:11
Speaker 1: It's super helpful. It's person based based on your rep
19:13
Speaker 1: and they'll provide and use the kind of hard details
19:16
Speaker 1: and numbers to help your sites uniquely and ours vary.
19:20
Speaker 1: We are actually use the same tools, but different reports
19:23
Speaker 1: based on the patient's and kinds of programs at each
19:26
Speaker 1: site to best use our time.
19:27
Speaker 4: Well, speaking of numbers, because I'm sure that's what mostly
19:30
Speaker 4: pharmacists care about. What financial improvements or opportunities has your
19:35
Speaker 4: retail pharmacy uncovered since implementing RCS.
19:38
Speaker 3: I know you went through a little bit.
19:39
Speaker 4: Before, but specifically what has RCS done uncover and help
19:44
Speaker 4: you implement some different solutions in your pharmacy?
19:47
Speaker 1: Sure? So the tools with the active store level decisions,
19:50
Speaker 1: So it's kind of a day to day. What big
19:52
Speaker 1: picture financially has OURCS done for Atlantic Health? I would
19:56
Speaker 1: say it arms us. It identifies short term losses and
19:59
Speaker 1: provide additional protections for verification and high risk audit items.
20:03
Speaker 1: It prepares us for audits, prevents audits, and those are
20:07
Speaker 1: all quantifiable items. We've seen the most audits ever in
20:10
Speaker 1: this past twenty twenty five at Atlantic. We did very
20:13
Speaker 1: well on all of them. Subsequent years as well, with
20:16
Speaker 1: some of the tools in preparation as well as mitigation
20:20
Speaker 1: and how to prepare and reply to those within fday
20:23
Speaker 1: indications always to our benefit. That's a value that would
20:27
Speaker 1: be individually audit based, but I can tell you there
20:30
Speaker 1: was greater than six and twenty twenty five, definitely in
20:33
Speaker 1: the six figures and beyond depending on protected dollar value
20:36
Speaker 1: of those. And that's just one quantification. The RCS to
20:39
Speaker 1: our bottom line is essential for us to stave off
20:42
Speaker 1: issues with purchasing. In twenty twenty five, we basically we
20:46
Speaker 1: have twenty five percent more patients. We had greater than
20:49
Speaker 1: fifty percent increases in revenue. Our margin is net positive.
20:53
Speaker 1: A lot of Pharmaci's margin is not net positive. So
20:55
Speaker 1: not to get into the exact numbers, but our ability
20:58
Speaker 1: with this very aggressive TBM kind of environment that has
21:02
Speaker 1: been going in for a while, but it is more
21:05
Speaker 1: difficult than ever. The core takeaways for us are remaining
21:09
Speaker 1: net margin. In one year, we more than doubled our
21:13
Speaker 1: internal MMC and our team of repomacy, and that bolsters
21:16
Speaker 1: our bottom line and the dollars that we're able to
21:18
Speaker 1: redistribute for quality programs. So our CS has been essential
21:24
Speaker 1: to some of those values and our ability to continue.
21:28
Speaker 4: And with that value, have you found that within our
21:30
Speaker 4: CS and what it's doing your.
21:32
Speaker 3: Bottom line is there?
21:34
Speaker 4: Have there been discoveries within that that has made you
21:37
Speaker 4: change your business model? You know you have a little
21:41
Speaker 4: bit more let's say financial flexibility. How's this maybe affected
21:45
Speaker 4: your business model at all?
21:47
Speaker 1: That's a great question, Jason, So I would say it
21:50
Speaker 1: is bolstered kind of our ongoing quality model. So Atlantic
21:52
Speaker 1: health quality is our goal. We offer many health services.
21:55
Speaker 1: We have Atlantic Medical Group. We serve the community across
21:58
Speaker 1: northern New Jersey and actually part of Central New Jersey
22:01
Speaker 1: now and our goal is that adherence that hcap rating
22:04
Speaker 1: that patient experience which is not known in the reconciliation
22:08
Speaker 1: of pharmacy our patient pharmacy, we see dollars, we see cents.
22:13
Speaker 1: What it has allowed us to do is by mitigating audits,
22:17
Speaker 1: by mitigating financial loss, by ensuring net margin positive at
22:21
Speaker 1: our retail units year over year, that allows us to
22:25
Speaker 1: grow those core features. We've introduced technology meds to bedside
22:29
Speaker 1: readers for point of sale systems at both stores at
22:33
Speaker 1: MC and NMC, and part of that is the support
22:37
Speaker 1: of this model being able to keep those a net
22:39
Speaker 1: margin positive for our retail sides while still having our
22:42
Speaker 1: core feature prescriptions for our team members that are kind
22:45
Speaker 1: of the bedrock of keeping our functionality and our fingerprint
22:49
Speaker 1: or footprint rather at our sites.
22:51
Speaker 4: So I got to say, what advice would you give
22:53
Speaker 4: an independent pharmacists experiencing similar reimbursement challenges.
22:58
Speaker 3: I know, you know, maybe part of me want you
23:00
Speaker 3: to be like.
23:00
Speaker 4: Oh, just sign off RCS, but I know that's not
23:02
Speaker 4: you know, the avenue everybody can take. But in your experience,
23:07
Speaker 4: what is the advice you've given independent pharmacists experiencing these
23:09
Speaker 4: reibursement challenges? What to look for and you know, finding
23:13
Speaker 4: the right partner like a RCS to help to help
23:17
Speaker 4: improve your financial business.
23:19
Speaker 1: Great. I would say to them, you absolutely in today's
23:22
Speaker 1: environment need cardinals RCS services with meetings with representative or
23:28
Speaker 1: something identical from another company to get the most out
23:31
Speaker 1: of your pre and post processing market assistance, intel actions
23:36
Speaker 1: in real time that you need to take could be
23:38
Speaker 1: purchasing and could be discharged. I'm thinking right away this year,
23:40
Speaker 1: there's FDAXAMCEN from our inpatients, there's FDA recommendations, there's PBMs
23:45
Speaker 1: going against all that. Without consultation with other pharmacies, which
23:49
Speaker 1: independents are great at doing. Our RCS agent kind of
23:52
Speaker 1: connecting a lot of these behaviors in the market and
23:55
Speaker 1: ways to go with that, we wouldn't have a leg up.
23:57
Speaker 1: And there's other features I would like to let everyone know.
24:01
Speaker 1: I think they need something like this that provides the
24:03
Speaker 1: ability and insight to act on both pre and post
24:07
Speaker 1: audit risks, to to allow training and basically identify performance
24:11
Speaker 1: at sites, to see purchasing decisions and mistakes coming through
24:15
Speaker 1: on the claim side, to go back and make changes
24:18
Speaker 1: to protect your bottom line. I think it's essential. So
24:22
Speaker 1: I just wanted to share as a service type essential
24:25
Speaker 1: and a great thing for RCS as well as other
24:29
Speaker 1: programs like it, is that they're compatible with other tools
24:32
Speaker 1: like that communication with other pharmacies like subscriptions to groups
24:37
Speaker 1: like Also, i'd say relay health as a product that's
24:39
Speaker 1: very popular almost in all systems, it's not as savvy.
24:43
Speaker 1: It also does catch a lot of errors, and it
24:46
Speaker 1: is totally compatible with RCS. So I think the more
24:48
Speaker 1: of the merrier. Look at your costs, but service like
24:52
Speaker 1: RCS for us as essential, and I can only imagine
24:55
Speaker 1: our ability to continue providing services and expand and reinvest
25:00
Speaker 1: our patients. The volatile arm of retail is essential and
25:04
Speaker 1: we're we've been keeping it that positive. This is one
25:07
Speaker 1: feature that really adds to that allows us to well.
25:11
Speaker 4: John, last question for you and I just I always
25:13
Speaker 4: like to ask pharmacists. I know you know you guys
25:16
Speaker 4: deal with so many different patients, and you've connected with
25:19
Speaker 4: a lot of different patients. There's probably a lot of
25:20
Speaker 4: patient stories out there. Can you think of a of
25:23
Speaker 4: a recent patient story or a group of patients that
25:28
Speaker 4: not only OURCS helped you help you treat, but also
25:31
Speaker 4: gave you the flexibility to maybe expand a different service
25:35
Speaker 4: so you could help that patient.
25:37
Speaker 1: Sure, I can think of a kind of an immediate thing.
25:39
Speaker 1: It's probably not a gold horse driveaway story, but it's
25:41
Speaker 1: a real time one that's been going on and we've
25:43
Speaker 1: been watching it this year. It's not exciting outside of pharmacy,
25:46
Speaker 1: but it really does connect to our patients. Yeah, both
25:49
Speaker 1: are Newton and morris Stone stores difficient for discharge patients
25:53
Speaker 1: with cediff, you know, transitions to the community. That's not
25:56
Speaker 1: always the right medication for it. However, when it is,
26:00
Speaker 1: we don't diverge from that. So in the market we've
26:02
Speaker 1: seen with the launch of the generic it's a source
26:04
Speaker 1: product currently, which is great that cardinals participating in that,
26:08
Speaker 1: but what we seem, like all drugs when they go generic,
26:11
Speaker 1: is kind of a fracturing of payers and risks, and
26:16
Speaker 1: we've had to have really intense communications to make sure
26:19
Speaker 1: we're continuing service while monitoring that reimbursement situation. And it's
26:23
Speaker 1: one of those things where they'll tell you it is
26:25
Speaker 1: sure to get better, but at launch, multiple net losses
26:28
Speaker 1: on said product, you know, following interchange laws. Trying to
26:31
Speaker 1: help patients, like at our facilities, we'll see patients who
26:35
Speaker 1: will maybe you have four days of inpatient intensive therapy.
26:38
Speaker 1: The treatment plan is to bridge them there on a
26:40
Speaker 1: ten day but axomis in deficid regimen, let's say, and
26:44
Speaker 1: they'll get their discharge medications. The PBMs last year started
26:48
Speaker 1: going after breaking up packages for that for medication and
26:52
Speaker 1: that only got confounded with all of a sudden the
26:55
Speaker 1: generics out. Pharmacies are giving the generic patients are thinking
26:58
Speaker 1: they're saving and then pharmacy are losing thousands, often for claim.
27:03
Speaker 1: So we've been really working with our RCS agent. She's
27:05
Speaker 1: been amazing. Market conditions. Cardinal can't change those things, but
27:08
Speaker 1: we're seeing on the week to week where it's getting better.
27:11
Speaker 1: We're also we're able to negotiate a store level special
27:15
Speaker 1: pricing and lock it in for our stores because of
27:18
Speaker 1: our population value and as well as that protects us
27:21
Speaker 1: on the back end, we're prepared for audits on any
27:23
Speaker 1: and all of those the medical benefit of the patient
27:26
Speaker 1: now where we're following the FDA indication to continue those
27:29
Speaker 1: therapies for that ten days unless there's some reason to
27:32
Speaker 1: stop it. We have follow up teams from the Medical
27:35
Speaker 1: Cyber Track Adherence. It's really cool to be part of
27:39
Speaker 1: that and it's one of those things where we're not
27:41
Speaker 1: making money on that particular product, but it's essential for
27:44
Speaker 1: us to help our community. So we're actively doing everything
27:48
Speaker 1: we can. Our RCS tools an agent really helps us
27:51
Speaker 1: with those, helps us better and monitor those, and we'll
27:55
Speaker 1: roll with the punches. Our net effect is we don't
27:57
Speaker 1: want that patient to get rehospitalized. And there's not one
27:59
Speaker 1: that seems story is I think it was just eight yesterday,
28:02
Speaker 1: eight in the past quarters. It's eight unique patients that
28:06
Speaker 1: we would we want them to be taken care of.
28:09
Speaker 3: No, yeah, I love that. Yeah, I love that.
28:12
Speaker 4: That's incredible and thank you so much for what you
28:14
Speaker 4: and your team do. I want to say thanks to
28:17
Speaker 4: Jean Paul again for giving our listeners some great insights
28:19
Speaker 4: on improving your pharmacy's financial health utilizing cardinal health reimbursement
28:24
Speaker 4: consulting services.
28:25
Speaker 3: Thanks for listening.
28:26
Speaker 4: Today's episode of the Cardinal Health counter Talk podcast, and
28:28
Speaker 4: as a reminder, if this is your first time listening,
28:31
Speaker 4: make sure you subscribe and download the Cardinal Health counter
28:34
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28:37
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28:38
Speaker 3: Everyone works