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Expanding Ambulatory Pharmacy Access and Mission Driven Care at UVA Health · Becker’s Healthcare Podcast

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0:38
This is Laura Dierdahl with the Becker's Healthcare
0:40
podcast. I'm thrilled today to be joined by
0:42
doctor Justin Vesser, director of regulatory pharmacy at
0:45
UVA Health. Doctor Vesser, it's a pleasure to
0:47
have you on the podcast today. Thanks, Laura.
0:49
It's great to be here. Appreciate the opportunity.
0:51
Absolutely. Now I'm looking forward to our discussion
0:54
because I know we've got a lot to
0:55
talk about in terms of some of the
0:56
great things you're doing at UVA as well
0:58
as how you're thinking about the future, such
1:00
an interest time in pharmacy. But before we
1:03
dig in, can you tell us a little
1:04
bit more about yourself and your background as
1:06
well as UVA
1:07
Health? Sure. Again, my name is Justin Vester.
1:10
I've been at UVA Health for twelve years.
1:12
This is my twelfth year. And,
1:15
before that, I was in retail pharmacy and,
1:17
brought that over here to work on the
1:19
ambulatory and retail side of the health system.
1:22
And so we have,
1:24
we're fortunate to have nine retail pharmacies soon
1:26
to be 11 as a part of UVA
1:27
Health. We have our our main campuses here
1:30
in Central Virginia in Charlottesville, Virginia. It's our,
1:33
academic medical center, and then we have three
1:34
community health hospitals in the northern part of
1:36
the state. And so our our retail pharmacy
1:39
is kind of spinning all around the Central
1:40
Virginia area,
1:42
kind of adjacent to where UVA has clinics.
1:43
And so the larger pharmacy department, we're very
1:46
fortunate. UVA is extremely pharmacy friendly.
1:49
Really bought into the idea that pharmacists and
1:51
pharmacy technicians can elevate the level of care
1:54
for the entire health system. And so we
1:56
have, just over 270
1:58
pharmacists, almost 300 pharmacy technicians here,
2:01
in in UVA's overall enterprise,
2:03
and I'm I'm very fortunate to be a
2:04
part of that. So, so I oversee those
2:07
those retail pharmacies,
2:08
not our specialty home delivery pharmacy. There's a
2:11
separate team for that, but we,
2:13
but we basically want to be the pharmacy
2:14
of choice for anybody who lives in the
2:17
Commonwealth Of Virginia.
2:18
I also oversee some of our teams that,
2:21
provide clinical pharmacy services,
2:23
manage patients in ambulatory clinics. So we have
2:27
11 pharmacists on my team who see patients,
2:29
manage their chronic diseases, and
2:32
and then also see some support teams who
2:34
help with some of the financial side of
2:36
pharmacy, patient assistance programs, free drug programs,
2:39
helping with prior authorizations
2:41
on expensive medications, things like that.
2:43
So in the last year, what was the
2:45
most important initiative that you led? What did
2:47
you do, and what were the results?
2:50
The the last year, the thing that I'm
2:52
the the the most proud of is what
2:54
we work together to accomplish as teams was
2:56
to really grow into our mission,
2:59
to you know, we spent a lot of
3:00
times in the past saying, you know, we
3:02
would do we would do our practice this
3:04
way or we would do this initiative if
3:06
only we and then fill in the blank.
3:08
If only we had the resources, if only
3:10
we had the time, if only we had
3:11
the funding,
3:12
if only we had the staff. The staff
3:14
has been a big one.
3:15
We we were able to really, you know,
3:17
kinda coming out of COVID and some of
3:19
the chaos that followed along with that, we
3:21
spent a lot of time in the past
3:22
year checking the box on some of our
3:24
if only we's. And so we were able
3:26
to
3:27
grow towards our mission in terms of ambulatory
3:29
clinical pharmacy. We added three additional pharmacists on
3:33
my team to,
3:34
to ambulatory clinics
3:36
that are not in specialty areas. Sometimes it's
3:38
easy to put easier to put, a pharmacist
3:40
in a specialty clinic where the medications come
3:42
with a really high dollar amount. But when
3:45
we talk about places where pharmacists can have
3:46
a huge impact, like in a
3:49
family medicine clinic or a primary care clinic
3:51
where the medications may not be as as
3:53
expensive and don't have the big return on
3:55
investment that they might in a specialty clinic,
3:57
A pharmacist can go in there and get
3:58
attached to a patient, help them meet their
4:00
a one c goals, help them meet their,
4:03
you know, their cardiac goals, their their lipid
4:05
goals, and see some real outcomes. So we
4:07
we expanded our team by to three additional
4:09
clinics this past year, and,
4:11
and and that was just another way that
4:12
we kind of led into our mission.
4:15
We expanded support for our our med access.
4:18
So it is difficult for people to get
4:20
the prescriptions that their doctor says they need,
4:23
because insurance can be a barrier or or
4:25
the cost can be a barrier. And so
4:26
we we expanded our teams that are able
4:28
to do that, again, in non specialty areas,
4:30
particularly in pediatric and and,
4:33
you know, pediatric care so that they can
4:35
they can navigate that process. They can have
4:37
pharmacy experts who can help them afford their
4:39
medications. And so we were able to, again,
4:41
grow into that.
4:42
And then for our retail, our areas, we
4:44
worked very hard. You know,
4:46
COVID kind of exposed a lot of
4:48
how fragile it was out in the world
4:50
in retail pharmacies for people to just be
4:52
able to get a prescription. If you think
4:53
about it, if you've been in the hospital,
4:56
you're trying to get your, you know, yourself
4:58
out of trouble. You know, you've had a
4:59
hospital stay, but then the continuation for most
5:02
people of that of of their care is
5:03
gonna be some kind of a medication that
5:05
they're gonna take after they leave. Or if
5:07
they if you go to see your doctor
5:08
and you're you're trying to deal with your
5:09
chronic issues, obviously, medications aren't the only thing
5:11
that you do. But but every everyone,
5:14
you know, almost everybody who's receiving care, some
5:16
sort of a medication is a is a
5:17
part of that. And getting access to those,
5:20
be able to go to a physical pharmacy
5:21
and get your prescription has been very challenging,
5:24
due to ever since COVID, especially.
5:26
And so our mission has been and we
5:28
really, really leaned into this this past year
5:30
during COVID when when all of the retail
5:32
pharmacies that were were shaving their hours, they
5:34
were make it was more difficult. The lines
5:36
were longer. It's harder to get through. We
5:38
we made, our offerings more. So we offered
5:41
more time, more people, more locations,
5:44
more ways to get in touch with us,
5:46
more ways to have a smoother,
5:48
you know, experience when you came to us.
5:49
And so that that led us being able
5:51
to dispense across all of our sites, including
5:53
our home delivery and specialty pharmacy, over 1,000,000
5:56
prescriptions in in a in the the year,
5:58
within our fiscal year, which is the most
6:00
we've ever done in one year before. So
6:01
and we're showing no signs of slowing down.
6:03
So all of those things, you know, those
6:04
weren't me. Those were things that were part
6:06
of our team. But I was very happy
6:08
to be able to to be a part
6:09
of that for the whole group. Well, that's
6:11
so impressive to hear and, you know, really
6:13
interesting to think about all of the change
6:15
that has happened and
6:17
how you're able to actually grow and continue
6:19
to overcome, challenges in order to meet the
6:21
needs of your community. And when you think
6:24
about how transformative,
6:25
things have been in the last year or
6:28
two, especially,
6:29
how do you make sure your teams are
6:31
are able to adjust and be ready to
6:33
pivot or or jump in on new ideas
6:36
or things that you need to do in
6:38
order to grow?
6:39
How do you make sure you've got the
6:40
right team in place and and continue to
6:43
have that kind of momentum heading into the
6:45
next year where I know they'll continue to
6:47
be,
6:48
changes in evolution. So what does that look
6:49
like from a culture standpoint in your broader
6:51
teams? How do you build that strategically?
6:54
It's it's definitely the right question, and I
6:56
think it's something that we,
6:59
you know, we're very fortunate. I'm a part
7:00
of an absolutely amazing team. The
7:03
the and it goes back to what I
7:04
was talking about about about standing tall on
7:06
your mission. So our our mission is to,
7:08
you know, to transform health and inspire hope
7:10
to all Virginians and and beyond, which that's
7:12
a a relatively new mission statement for UVA
7:14
that, that was created here about about two
7:16
years ago. And I absolutely love it because
7:18
it's, you know, you read a lot of
7:20
mission statements and they all sound the same
7:22
and and you read it. And even though
7:23
I'm relatively well educated, I'll read someone's mission
7:27
statement and not really be really be able
7:28
to understand what it means or or how
7:30
it really might apply to an employee. But,
7:33
but when you talk about inspiring hope,
7:35
that's something that you can sell to your
7:37
team. That's something that you can you can
7:39
put in tangibles
7:41
that you're that you can build a team
7:43
around. And so we have a lot of
7:44
success with what you're talking about, managing change,
7:47
managing headwinds. The, you know, the the term
7:49
headwind has really been everywhere you look lately.
7:52
It's been talking about headwinds, whether financial or
7:53
regulatory, whatever. There's headwinds everywhere. But I I
7:57
feel confident facing these headwinds
7:59
because
8:00
we have built our team around our mission.
8:02
And so so when we are able to,
8:05
go to someone who is, you know, they
8:07
went to pharmacy school or they became a
8:09
pharmacy technician
8:10
so that they could get into health care
8:11
so that they could help make people's lives
8:13
better. They wanna be able to have they
8:15
wanna be able to have their work mean
8:16
something. And then they go find themselves in
8:18
a job that is very financially motivated, that
8:21
is metric motivated to the point of, you
8:23
know, you gotta meet your quotas. You gotta
8:25
be able to do these things. And then
8:26
if you can squeeze in some good health
8:28
care along the way, then, you know, lucky
8:29
you. But that's not really the focus.
8:32
We've had great success in being able to
8:34
go to those people and say, hey. If
8:35
you wanna, you know, if you wanna put
8:36
your time in at a place that can
8:38
really help you do what you thought you
8:40
were gonna be doing when you pursued this
8:41
line of work, come come and work with
8:43
us. And so we're able to recruit those
8:45
pharmacists and technicians who can come to our
8:47
place and say, you know, look. We have
8:48
metrics that are important. We're gonna be able
8:50
to measure our success and make sure that
8:51
we're doing a good job. We have financial
8:54
goals that we have to meet so that
8:55
we can stay solvent and we can, you
8:57
know, we can take care of of the
8:59
you know, we can be good stewards of
9:00
the resources that we have. But that's not
9:03
our mission. Our mission is to,
9:05
transform the lives of the people that come
9:07
to us so that we can be that
9:09
place that says, yes,
9:11
yes, we can provide you your medications. Yes.
9:13
We can make sure that you know how
9:14
to use them. Yes. We can get you
9:16
through these hurdles so that you can have
9:18
this one thing in your life,
9:20
you know, kind of unlock this one thing
9:21
that you can count on, and we're gonna
9:22
do it with a smile. We're gonna treat
9:24
everybody who comes in like royalty,
9:26
you know. And and we don't we don't
9:27
win every time. We we we're certainly not
9:29
perfect. We have challenges.
9:31
But what we all do is we can
9:33
and what what I feel good about about
9:34
our team is we can we can tell
9:35
people everybody knows our mission and everybody believes
9:38
in our mission, and that's why they're here.
9:39
And so, you know, when we come into
9:41
change, which is inevitable, you know, the the
9:43
pace of change is just shocking right now.
9:46
Trying to keep up is is very difficult,
9:48
but I'm confident that we'll be able to
9:49
lead through that change because even though we
9:51
may our work may look very different as
9:53
we go to a new system or we
9:54
go to a new workflow,
9:56
our mission stays the same. And so that
9:58
that helps us get through that change. I
9:59
feel very confident because of the amazing team
10:01
that that I get to work with.
10:03
I love that. And, you know, what a
10:05
great mission and great,
10:07
inspiration
10:08
that, you know, the team has an environment
10:11
to rally around and really deliver great, great
10:13
quality care. And now I know you briefly
10:16
mentioned headwinds there, many of them. So could
10:19
you talk a little bit deeper about those?
10:21
What are some of the big priorities as
10:22
well as headwinds that you're looking at for
10:24
the next year?
10:26
So, you know, the the
10:28
the system that we work in, you know,
10:29
financially is, you know, is changing. You know,
10:32
Medicare is is obviously, you know, our largest
10:34
payer.
10:35
You know, the the folks who are on
10:37
Medicare, the older population are the ones who
10:39
are consuming the most, you know, retail pharmacy
10:41
medications. They're consuming the most health care in
10:43
general.
10:44
And the structure of the reimbursements that, you
10:47
know, that, that we as a pharmacies receive
10:49
or we as health systems receive is changing.
10:52
You know, the medication costs are obviously front
10:55
and center. Those are big campaign
10:57
issues, in all of the different election cycles.
10:59
Those are things that are front and center
11:01
in the minds of Americans right now. You
11:03
know, how how are you gonna be able
11:04
to afford the things that you need in
11:06
your life? And, you know, you talk about
11:08
something like prescription medications. Those are not particularly
11:11
typically
11:12
particularly elastic, you know, when when, you know,
11:14
as people's,
11:16
wallets shrink or the cost of things around
11:18
them and their lives go up, you know,
11:19
there's people start to make choices on what
11:21
they can and can't, you know, live with
11:22
or what they're gonna kind of cut out
11:24
temporarily to be able to get through financial
11:26
tough times. Well, medications are one of those
11:27
things where that might be a life and
11:28
death decision. And we we see people making
11:30
those choices,
11:31
but, but we need to be able to
11:33
keep up with what we are able to
11:34
offer and how we're able to help patients
11:36
navigate these really complicated,
11:39
systems, financial systems that they have to to
11:41
get what they need. That's our job to
11:43
help them navigate that. And so so we're
11:45
trying to keep up. We're trying to first
11:46
understand what those changes are, understand the new
11:48
systems. January 1 is always a busy time
11:51
of year for us to try and digest
11:53
exactly what the new rules or the new
11:54
structure of Medicare Part d plans are. And
11:57
so we're in the middle of that right
11:58
now. But,
12:00
but, again, making sure that our that our
12:01
team knows that all of those things will
12:03
work out. You know, we'll we'll get through
12:05
those things.
12:06
And and then we need to do our
12:08
work both at the, you know, the health
12:09
system level and then beyond that, you know,
12:11
at the organization level, professional organizations, you know,
12:14
advocating
12:15
on behalf of those patients
12:17
to, you know, government bodies that may not
12:19
understand what they may be looking at billions
12:21
of dollars, you know, related to the three
12:22
forty b program,
12:24
and think, oh, we need this is a
12:26
great fertile ground for us to make a
12:27
change or to save money. But they do
12:28
that without understanding, you know, what's the practical
12:31
impact of those, you know, those patients who
12:32
are the most vulnerable, who, you know, who
12:35
would be effective if this program goes away.
12:37
So so we have to,
12:39
we have to, again, lead with our mission,
12:41
and we have to make sure that we
12:42
help that we that we spread that word
12:44
about why, you know, why these things are
12:46
important to to the rest of the system
12:49
so that we can all,
12:50
you know, we can get the results that
12:52
we need for our patients.
12:54
I love that. That's really helpful to
12:57
understand. And, you know, as you mentioned, so
12:59
many hospitals and systems are going through something
13:01
similar when they look at the finances in
13:03
the health care space and figuring out how
13:06
they can continue
13:07
to make sure that their patients in the
13:10
community is covered and has access to the
13:12
type of care that they need. What do
13:14
you think the hardest thing you'll have to
13:15
do in the coming year will
13:18
I think the, you know, for us specifically,
13:20
we have, you know, a big opportunity this
13:22
year, you know, because we have all of
13:24
these retail pharmacies that are just booming in
13:26
growth. We have invested in a central services,
13:29
operation. So we're having a central fill pharmacy
13:32
that's able to, you know, with a lot
13:33
of automation that will that will be able
13:36
to,
13:37
make the the day to day operations
13:40
of fulfilling patients' prescriptions much, much more easy,
13:43
much more efficient for us. That's a huge
13:45
undertaking to go from, you know, nine retail
13:47
locations plus the home delivery that all get
13:49
absorbed into this new, this new facility. And
13:52
so we're very fortunate to have it, but
13:53
it's gonna be a a monster lift for
13:55
all of our teams.
13:56
And so we'll have to integrate all of
13:57
the pharmacies that report to me into that
13:59
workflow. So we're we're we're looking forward to
14:01
that opportunity, but it's also a big workflow
14:02
change. So we're gonna we're gonna spend a
14:04
lot of time focused on that. I think
14:06
the,
14:07
you know, as the financial landscape changes, as
14:10
the you know, where where we are politically
14:12
in the world right right now and how,
14:14
you know, how fast things can change regulatory
14:17
wise,
14:18
and then combined with the supply chain and
14:19
how volatile the supply chain is for prescription
14:21
drugs and other other, you know, supplies that
14:24
we need to do our jobs, You know,
14:25
trying to navigate all of that while still
14:28
standing tall in our mission, it, you know,
14:30
it's it's kinda goes both ways. I get
14:31
I have great confidence about it because we
14:33
we are founded on our our mission. But,
14:35
also,
14:36
you know, we have to be very, very
14:37
careful not to make sacrifices, not to make
14:40
compromises,
14:41
you know, as we deal with all those
14:42
things. And so we always tell our folks,
14:43
you know, if we if we can if
14:45
we can live first for the patients and
14:46
we can make everything we do about them,
14:47
then then all the money will work out,
14:49
you know, and,
14:50
and we firmly believe that. But then that's
14:52
on us as leaders to actually make that
14:53
so, you know, to make it make it
14:55
still work. Yeah. I spend a lot of
14:56
my time on on working with vaccines, you
14:59
know, where our pharmacists, you know, are able
15:00
to administer vaccines,
15:02
both in the pharmacy and also out in
15:03
the in the community. And we do a
15:05
lot of work trying to make sure that
15:06
vulnerable,
15:07
populations
15:08
get access to the vaccines they need. There's
15:10
a lot going on in the, you know,
15:11
the regulatory world right now and in the
15:13
government about vaccines that are making it more
15:14
difficult. They're making it more,
15:16
complicated.
15:17
Basically, making access tougher to get, for patients
15:20
in all settings.
15:21
And so that's a that's something that, that
15:23
I think will be difficult this next year.
15:25
One of the hardest things to to answer
15:27
your question,
15:28
is to
15:29
is to make sure that,
15:31
as those changes happen in, you know, at
15:33
the regulatory level, that we're able to adjust
15:35
and and not in any way let it
15:37
let it
15:39
diminish the amount of protection that we're able
15:41
to get to the people who need it
15:42
the most. So so we'll stay, up to
15:44
date on a day to day basis in
15:46
in, you know, in all those changes, and
15:48
and then we'll just make sure to kind
15:49
of
15:50
reprioritize what we need to do so that,
15:53
so that we're still getting patients the care
15:55
that they need.
15:56
That's such a great point. And, you know,
15:59
important thing to have that visibility.
16:02
I think the
16:03
onus on the leadership team to, create that
16:06
space and, as you put it, make everything
16:09
work out, so that the patients have access
16:11
and can continue to,
16:13
be protected by the the medicine that we
16:16
have and vaccines and everything else,
16:18
is so critical
16:20
despite some of the complexities within the health
16:22
care environment today.
16:24
So,
16:25
a huge, huge undertaking and huge job, but
16:28
I know, you know, something that's so important
16:30
for communities across the board.
16:33
And in light of that, where do you
16:34
see some of the best opportunities for organizational
16:36
growth as well? How are you thinking about
16:39
continuing to expand upon the mission that we've
16:41
talked about today and, deliver great?
16:44
Yeah. I I think that what what we've
16:46
seen, you know, in in my experience, you
16:48
know, I was, again, you know, pretty naive
16:50
to the health system world for prior to
16:52
coming to UVA, but I've spent a lot
16:54
of time here now. And,
16:55
you know, pharmacy is
16:58
one of the
16:59
few parts of the health system that is
17:02
in every part of the health system. So
17:03
our our reach goes, you know, from the
17:05
inpatient to the outpatient world, you know, top
17:08
to bottom. We're a huge financial contributor to
17:10
the organization,
17:12
you know, but also, you know, right in
17:14
the middle of of the, you know, some
17:16
of the highest level clinical care that's given.
17:18
But there's also a lot of leadership and
17:21
and
17:22
kind of
17:23
the the leadership of the pharmacy teams and
17:25
the leadership of the pharmacy collaborations with other
17:28
parts of the health system are very high
17:30
level and very important. You know, mission critical
17:32
pharmacy shows up in every,
17:34
you know, in every aspect. And so what
17:36
that has done
17:37
is
17:38
it's it's made our pharmacy leaders
17:41
able to
17:42
be kind of, like, ideally situated
17:45
to be health system leaders even outside of
17:48
pharmacy. So, what I think is is a
17:50
great opportunity for organizational growth, answer your question,
17:53
is I would love to see more pharmacy
17:55
leaders, you know, kind of move into roles
17:57
that maybe aren't specifically within the pharmacy silo,
17:59
but that take those skills that we learn
18:01
from being a part of of the pharmacy
18:03
team and go on and be a chief
18:04
financial officer, go on and be a chief
18:06
operations officer, or even a a chief executive
18:09
officer or any other role. We have some
18:11
of the informatics and some of the the
18:13
technology that we use in pharmacy that lets
18:15
you take that clinical expertise as a pharmacist
18:17
and then, you know, potentially,
18:19
be able to to have impact in, you
18:21
know, the the IT world. I think the
18:23
sky's the limit, and we're seeing more and
18:25
more of that where we're seeing people come
18:26
out of the, you know,
18:28
fifteen years ago, you might have thought that,
18:30
you know, the hospital pharmacists all lived in
18:31
the basement, and many of us still do.
18:34
But I think our ability to contribute to
18:36
the mission of the organization, to contribute to
18:38
patient care has now gone way outside of
18:41
of that little box. And, in fact, my
18:43
entire
18:44
vertical all works, you know, out in the
18:45
community and now where peep where the patients
18:47
are. And that creates a lot of opportunities
18:49
for
18:50
leadership experience that can be used in other
18:53
settings. And so I I think that's the
18:54
biggest opportunity is to get pharmacists to is
18:56
to see more,
18:58
you know, health system leaders that come from
19:00
a pharmacy background.
19:01
I love that. Justin, thank you so much
19:04
for joining us on the podcast today. This
19:06
has been such a fun conversation,
19:08
inspirational to hear about everything you're doing at
19:11
UVA Health and,
19:12
thinking about the future as well. So I
19:15
appreciate your time, and I look forward to
19:16
seeing you too at our,
19:18
Becker's chief pharmacy officer summit. I know there's
19:21
gonna be a lot of pharmacy leaders there
19:23
that are really focused on tackling some of
19:25
these same issues we talked about today as
19:27
well as sharing the ideas and in concepts
19:29
that they're working on. So it'll be great
19:31
to dig a little deeper with you and
19:32
just, see you there face to face. Thanks,
19:34
Laura.