Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Nick Capote, Director of Infusion, Oncology, and Investigational Drug Pharmacy Services at the University of California, San Francisco

Transcript

Dr. Nick Capote, Director of Infusion, Oncology, and Investigational Drug Pharmacy Services at the University of California, San Francisco · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - Welcome everyone to the Becker's
• 0:02
  Healthcare podcast series.
• 0:03
  I'm Maria Moham, writer
• 0:04
  and moderator with Becker's Healthcare.
• 0:07
  I'm absolutely thrilled to have with me today Dr.
• 0:09
  Nick Capi, director of Infusion Oncology
• 0:12
  and investigational drug pharmacy services at the University
• 0:15
  of California San Francisco.
• 0:17
  Doctor, it's very nice to have you on the podcast today.
• 0:20
  To get us started, would you mind please introducing
• 0:22
  yourself and telling us a bit about your background?
• 0:26
  - Absolutely, and thank you for having me.
• 0:28
  As you mentioned, my name is Nick Capote,
• 0:31
  and, uh, I live in San Francisco
• 0:33
  and I'm fortunate to work at UCSF Health.
• 0:36
  Uh, I am one
• 0:37
  of the pharmacy directors within the pharmacy department.
• 0:40
  We have a, a rather large pharmacy department supporting the
• 0:43
  overall institution, uh, for clinical services
• 0:46
  as well as research.
• 0:48
  And fortunate to be able to call myself a team member
• 0:51
  and oversee oncology infusion and investigational drugs.
• 0:55
  You know, fortunate is a word I used when associating myself
• 0:59
  with UCSF Health in terms of my background.
• 1:01
  I'm also fortunate to have experienced a diversity
• 1:04
  of practice environments, uh, and leadership styles.
• 1:07
  Uh, being in leadership, the ability to gain a variety
• 1:11
  of perspectives is really important to me.
• 1:14
  Way back when I was doing my pharmacy school training,
• 1:16
  the didactic portion of pharmacy, uh, I was in Memphis,
• 1:19
  Tennessee at University of Tennessee Health Science Center,
• 1:22
  and it was there that I gained a really just immense
• 1:24
  appreciation for the clinical application of pharmacy.
• 1:27
  It really opened my eyes to what pharmacists could do, uh,
• 1:30
  on the healthcare team, uh, elbow to elbow with other,
• 1:34
  uh, practitioners.
• 1:36
  Uh, after that, I completed two years
• 1:37
  of pharmacy residency training in Madison,
• 1:39
  Wisconsin at University of Wisconsin Health, uh,
• 1:42
  the big academic medical center there in Madison,
• 1:45
  and that was a residency program focused on practice
• 1:48
  and effective implementation
• 1:49
  of change management and leadership.
• 1:52
  After that, I took my first role managing acute care
• 1:55
  pharmacy operations at Tufts Medical Center.
• 1:57
  Uh, essentially what that means is getting the, uh,
• 2:01
  medications and managing the processes for those medications
• 2:05
  to our patients that are in our embedded inpatient units,
• 2:08
  as well as to some of our outpatient areas, whether they're
• 2:11
  procedural, uh, or, uh, infusion
• 2:14
  or other outpatient clinic areas.
• 2:16
  Um, during my time at Tufts Medical Center, I was able
• 2:19
  to take on more responsibility over those three years within
• 2:22
  the pharmacy department
• 2:23
  and began the formation
• 2:24
  of the first home infusion service for the system.
• 2:27
  And then most recently, in 2022, I made the transition
• 2:31
  to director of pharmacy role at UCSF Health.
• 2:34
  So just over 3000 miles from Boston
• 2:36
  where I've been for the past six years.
• 2:37
  Uh, now I call San Francisco home,
• 2:39
  and I'm fortunate to serve
• 2:40
  as several pharmacy teams that I represent.
• 2:43
  - Wonderful, wonderful.
• 2:45
  Thank you so much for giving us that background on yourself
• 2:47
  and what you're currently doing right now.
• 2:50
  Um, two really jump into the questions today.
• 2:52
  The first thing I really wanted to ask you is
• 2:55
  what are the biggest issues you're following in
• 2:57
  healthcare in 2024?
• 3:01
  - Sure. Well, there's a lot of them, uh,
• 3:02
  but I'll focus on a couple, uh, for the, uh, purpose
• 3:05
  of time, uh, one of which is workforce trends,
• 3:09
  and secondly, uh, what's going on in the payer space.
• 3:12
  Uh, payers and insurance, uh,
• 3:15
  and health plans are always keeping us on our toes.
• 3:17
  Uh, so I'll start with workforce trends.
• 3:19
  Um, specifically focusing on the pharmacy workforce is
• 3:22
  that really is where I focus
• 3:24
  and spend my day to day, um, within the pharmacy department.
• 3:28
  Um, some trends to take note of is that applicants
• 3:30
  to schools and colleges of pharmacy are down as well
• 3:33
  as applicants to residency training programs.
• 3:35
  So that, that's our pipeline.
• 3:36
  And it's so important that we're not only making sure that
• 3:39
  we have larger number
• 3:41
  of applicants per fair within our schools
• 3:44
  and colleges of pharmacy, making sure that we are, uh,
• 3:47
  training the, the best and the brightest,
• 3:49
  but also making sure that we have, um,
• 3:51
  our training programs constantly fed
• 3:53
  with those high quality, uh, applicants going
• 3:56
  through our schools and colleges of pharmacy.
• 3:59
  So, interestingly enough, uh,
• 4:00
  there has been an obvious shift in other sectors
• 4:04
  of pharmacy, uh, as well that are, it's just kind
• 4:07
  of going in parallel with the trend
• 4:08
  that I just mentioned in terms of applications being down
• 4:11
  to schools as well as training programs.
• 4:14
  Traditional areas of pharmacy have been, uh, hospitals
• 4:17
  and health systems as well as community
• 4:20
  and independent pharmacies, um, independence
• 4:23
  and chains, I should say.
• 4:25
  Um, but less traditional, uh, yet emerging.
• 4:28
  More and more are pharmacists going to work
• 4:30
  for drug manufacturers?
• 4:32
  This isn't anything new,
• 4:33
  but it looks like the, the trend is increasing,
• 4:36
  and this is great.
• 4:37
  We want to have pharmacists represented in the
• 4:40
  pharmaceutical industry.
• 4:41
  Uh, however we are seeing
• 4:43
  that shift from the more traditional practice areas, one
• 4:46
  of which i, I work in myself,
• 4:47
  and so we're just trying to make sure that we have
• 4:49
  a good sense of how that is affecting, uh, the pool
• 4:53
  of applicants that we are ultimately looking for, uh,
• 4:56
  for our needs, uh, in the health system to take care
• 4:58
  of our patients within our practice model.
• 5:01
  Um, I'll also note that management
• 5:03
  and application of pharmacy services are more complicated
• 5:06
  than ever, thus needing to, to bolster, um,
• 5:09
  with high quality applicants and, and pharmacists.
• 5:13
  And then another interesting
• 5:14
  and related trend in the workforce is the regular closure
• 5:17
  of train of chain
• 5:19
  and independent pharmacies, uh, though
• 5:21
  for different reasons when you compare chain versus
• 5:23
  independent, so independence, uh, it seems like a lot of
• 5:27
  that is related to the closures of, related
• 5:30
  to if those locations are, continue
• 5:32
  to be financially viable.
• 5:34
  Um, there's a lot that goes into it.
• 5:37
  Reimbursement models as well as competition in addition
• 5:40
  to the availability of pharmacists and pharmacy technicians.
• 5:44
  And then second to that, focusing more on the change.
• 5:46
  You're seeing a lot of consolidation of locations, brick
• 5:50
  and mortar locations.
• 5:51
  You're seeing, uh, various pain pharmacies,
• 5:54
  specifically I'll, I'll call out Walgreens,
• 5:56
  leveraging robotics automation and central fill.
• 5:59
  Uh, in fact, in 2022 in October,
• 6:02
  there was a Wall Street Journal article pointing out about
• 6:04
  Walgreen's strategy to centralize and leverage automation
• 6:07
  and robotics to, uh,
• 6:09
  support their pharmacy operations, uh, nationwide.
• 6:13
  And what that's translated into it looks like is, uh,
• 6:15
  some consolidation of some physical pharmacy locations, uh,
• 6:19
  potentially threatening access pharmacy services.
• 6:23
  And then the second trend that I'm monitoring has to do
• 6:26
  with payer activity, specifically as it relates
• 6:29
  to shifting patients to sites of care that payers, uh,
• 6:31
  deem to be lower cost.
• 6:34
  And my position is that there should be incentives in place
• 6:37
  for a shared provider and patient decision when a patient
• 6:39
  is, say for example, getting an infusion,
• 6:42
  the health system should be doing everything it can
• 6:43
  to promote access while ensuring safety
• 6:46
  and effectiveness of therapy.
• 6:48
  Um, however, when a payer has a policy that places a lot
• 6:51
  of risk on the health system, by shifting those patients
• 6:55
  and their infusions to a, uh, say, site of care
• 6:58
  that's lower cost for the payer, um,
• 7:01
  while the health system is still acquiring
• 7:03
  and handling an incredibly expensive, uh,
• 7:05
  and complicated drug, uh, the safety profile of that episode
• 7:08
  of care has to be considered.
• 7:10
  We are seeing more and more monoclonal antibodies, uh, types
• 7:14
  of medications that produce a higher immunogenic response
• 7:16
  than most other class of medications being forced decisive
• 7:20
  care that are typically less equipped to manage or
• 7:22
  or less familiar with these therapies.
• 7:24
  So these shifts can be prob problematic as the bottom line,
• 7:27
  uh, when mandated, uh, without that shared provider
• 7:29
  and patient decision making.
• 7:32
  My hope is that we can establish our own infrastructure fast
• 7:35
  enough to minimize any negative impacts to our patients.
• 7:38
  The silver lining in all
• 7:39
  of this is health systems are incentivized more than ever
• 7:42
  to invest in their own infrastructure
• 7:43
  to meet the patient where they are.
• 7:45
  I just wish the patient provider could decide which resource
• 7:48
  that the health system they should
• 7:49
  utilize rather than the payer.
• 7:51
  But we are moving in the direction
• 7:52
  of making a more well-rounded side
• 7:54
  of care strategy in the example that I gave.
• 7:57
  So those are a couple trends that I'm watching,
• 7:59
  but many more that
• 8:00
  we probably don't have time for today.
• 8:02
  - Yeah, yeah, absolutely. Thank you so much for sharing.
• 8:04
  That is very insightful, um, especially
• 8:07
  to me in our audience.
• 8:09
  The next thing that I wanted to ask you about,
• 8:10
  and maybe you kind of answered it already in the,
• 8:13
  in the last question,
• 8:14
  but what are you most excited about right now
• 8:16
  and what does making you nervous,
• 8:17
  whether it's something you're dealing with, um,
• 8:20
  in your job description or something that you're watching?
• 8:25
  - So I'm a bit of a technology nerd,
• 8:27
  and I really like the technical side of any process.
• 8:32
  Um, in fact, before I was a pre-pharmacy major,
• 8:35
  I was a mechanical engineering major,
• 8:37
  and I still have that technical interest today, uh,
• 8:40
  that drove me to potentially consider an engineering major.
• 8:44
  So I guess I'm most excited about technology
• 8:46
  and what promises it might hold for healthcare.
• 8:49
  Hospitals and health systems have traditionally been slower
• 8:52
  to adopt these technologies for a myriad
• 8:54
  of reasons we don't have to get into.
• 8:55
  But the bottom line is artificial intelligence,
• 8:58
  what everyone is talking about it,
• 8:59
  it will impact healthcare in one way or another
• 9:02
  and hopefully for the better.
• 9:03
  Um, the reason I'm
• 9:04
  so confident in this projection is I understand the iter
• 9:08
  iterative cycle of this technology
• 9:10
  to be much faster than any technology we've seen before.
• 9:14
  While other technologies have iterated on themselves
• 9:18
  o over the course of years,
• 9:20
  this one is iterating on itself over the course of months
• 9:23
  and will probably continue to get faster,
• 9:25
  um, to maybe weeks.
• 9:27
  Uh, it seems like so many people are working on solutions.
• 9:30
  Uh, a friend of mine who lives in the Bay Area, um, close
• 9:33
  to me who I was with just this weekend,
• 9:36
  is working on an AI enabled technology
• 9:38
  that would allow practitioners in the primary care
• 9:41
  environment specifically
• 9:42
  to research the most evidence-based options
• 9:44
  for patients faster than ever, sift through the guidelines,
• 9:47
  sift through the evidence, and integrate those decisions,
• 9:50
  uh, into their practice, into the health record, uh,
• 9:54
  technologies that we are adopting, uh,
• 9:56
  as soon as they hit the market.
• 9:57
  So not so much the artificial intelligence probably being
• 10:01
  slow to adopt in healthcare,
• 10:02
  but technologies that we are adopting that make me excited,
• 10:05
  uh, are promising and very complex drugs, uh,
• 10:09
  specifically in the oncology world, bispecific antibodies
• 10:12
  and chimeric antigen receptor t-cell therapies
• 10:16
  while CAR T has been around since 2017 with the introduction
• 10:19
  of Kymriah, we literally have hundreds
• 10:21
  of these in the drug pipeline now for, while we only had
• 10:24
  to worry about a couple, we have many coming at us in the
• 10:27
  coming years that are looking at FDA approval potentially.
• 10:30
  Uh, and for many disease states more than just cancer.
• 10:33
  Uh, at UCSF, we are working on improving the care journey
• 10:36
  for the patient by allowing an outpatient episode
• 10:39
  of care for these therapies.
• 10:40
  So that's specifically, uh, what we're working on,
• 10:43
  not only adopting these as fast as we can
• 10:45
  where they make sense within our care portfolio, um,
• 10:48
  but also allowing an outpatient episode
• 10:51
  of care rather than keeping
• 10:52
  that patient confined to a hospital bed.
• 10:54
  So those are just some examples of things I'm excited for,
• 10:57
  things that we're working on, um,
• 10:59
  and what's to come hopefully in the future.
• 11:01
  - Yeah, yeah, absolutely. Thank you so much for sharing.
• 11:04
  And doctor, before I let you go, the last thing I wanted
• 11:06
  to ask you is, what would the most effective healthcare
• 11:09
  leaders need in order to be successful in the next two
• 11:13
  to three years, would you say?
• 11:16
  - I think the biggest thing for me is I think about the team
• 11:19
  that I support and
• 11:21
  as I observe friends within my own organization
• 11:24
  and the organizations that I've been fortunate enough
• 11:26
  to be a part of and serve, is willingness for leaders
• 11:30
  to invest in their people through the development
• 11:32
  of transferable skills.
• 11:34
  So more specifically,
• 11:35
  what worries me is the continued exodus from certain sectors
• 11:38
  of healthcare or healthcare altogether by folks
• 11:41
  who have simply become disengaged from their current roles
• 11:45
  and see no way through, uh, their current role
• 11:49
  because either they've maxed out, uh, in terms
• 11:51
  of their advancement or they just don't have the skills
• 11:55
  to self-perceived more than anything
• 11:57
  that they don't have the skills to advance in a way that
• 12:01
  they would want to, or they just don't know
• 12:03
  what the next step for them could be.
• 12:05
  So, you know, some examples of transferable skills
• 12:08
  that I'm talking about are, it sounds simple,
• 12:11
  but it's actually quite complex, is how to implement change,
• 12:15
  how to take a process or problem, identify the root issues,
• 12:18
  and put together a team
• 12:19
  and a scoped approach for that team
• 12:22
  to tackle, uh, and improve.
• 12:24
  And it doesn't have to be done in a vacuum,
• 12:25
  but to be able to take a problem, break it down
• 12:28
  to its simple parts and move forward.
• 12:31
  And effective change is I think one
• 12:34
  of the most important things
• 12:35
  that our healthcare system needs.
• 12:37
  And that transferable skill is incredibly important.
• 12:41
  I think also how to navigate the politics
• 12:43
  and bureaucracy of an organization.
• 12:45
  Every organization has them, whether we want to admit it
• 12:48
  or not, but few people are equipped
• 12:50
  to handle these effectively.
• 12:52
  Uh, it's stressful situations,
• 12:53
  but there are also potential high opportunity situations.
• 12:56
  A mentor of mine once told me
• 12:58
  to never let a good crisis go to waste.
• 13:00
  Um, so you've seen a lot of good advancements come out of
• 13:03
  what initially seemed like a crisis.
• 13:05
  Uh, you can see the covid situation as an example.
• 13:08
  While of course it was detrimental society
• 13:10
  to society in a myriad of ways,
• 13:12
  there had been some really significant practice
• 13:15
  changes that have come from it.
• 13:16
  Uh, and finally the, the last transferable skill
• 13:19
  that I'll touch on is how to establish
• 13:20
  and build a network over time.
• 13:22
  A lot of people aren't taught this, uh,
• 13:24
  but it's really effective in bringing back new ideas
• 13:27
  for consideration and keeping
• 13:28
  that engagement within your own practice
• 13:30
  or profession really fresh.
• 13:32
  So I'll just reiterate that I think the most effective, uh,
• 13:36
  healthcare leaders need to be successful,
• 13:38
  or whether it's healthcare leaders
• 13:40
  or aspiring healthcare leaders, it's that willingness to,
• 13:43
  to find or if you're a leader, to invest in their people
• 13:46
  through the development of transferable skills.
• 13:50
  - Wonderful. Yeah, I really appreciate you talking about
• 13:53
  everything that we discussed today
• 13:55
  and for those final thoughts.
• 13:56
  It's definitely been an amazing and informative discussion.
• 13:59
  So again, I wanna thank you so much
• 14:01
  for coming back on Becker's Healthcare, um,
• 14:03
  and I look forward to connecting with you again soon.
• 14:06
  - Thank you so much. It's been my pleasure. .