Latest / Becker’s Healthcare Podcast / Jeffrey Akers, PharmD, MHA, BCPS, CPEL, Vice President of Pharmacy Services at UC Health Corporate Pharmacy Services

Transcript

Jeffrey Akers, PharmD, MHA, BCPS, CPEL, Vice President of Pharmacy Services at UC Health Corporate Pharmacy Services · Becker’s Healthcare Podcast

• 0:02
  - Pharmacy has long been viewed as a cost
• 0:03
  - center, but that framing is starting to shift,
• 0:06
  - and chief pharmacy officers are driving the change.
• 0:09
  - Don Wright, pharmacy is one of the most
• 0:11
  - powerful financial and clinical levers the health system
• 0:14
  - has. The question is whether its leaders can
• 0:17
  - prove it, fund it, and scale it before
• 0:19
  - that window closes.
• 0:21
  - Becker's third annual fall chief pharmacy officer summit
• 0:24
  - is where that case gets built with 500
• 0:26
  - plus attendees,
• 0:28
  - 90 plus speakers, and three days of of
• 0:30
  - candid executive level sessions on pharmacy's financial power,
• 0:34
  - three forty b sustainability,
• 0:35
  - specialty growth, automation, and earning real influence at
• 0:39
  - the top. You can earn up to 6.67
• 0:42
  - CE credits all while being in a room
• 0:44
  - full of peers solving the same problems you
• 0:46
  - are. Join us November fourth through the sixth
• 0:49
  - in Chicago.
• 0:50
  - Register on our events page at beckershospitalreview.com
• 0:53
  - by clicking on the events tab in the
• 0:55
  - upper right.
• 0:59
  - Welcome to the Becker's Healthcare podcast. I'm Ella
• 1:01
  - Jeffries, reporter with Becker's Healthcare. Today, I'm joined
• 1:04
  - by Jeff Akers, vice president of pharmacy services
• 1:07
  - at UCHealth.
• 1:08
  - In this episode, we'll discuss how UCHealth has
• 1:10
  - built a repeatable playbook for expanding retail pharmacy
• 1:13
  - access.
• 1:14
  - Jeff, thank you so much for joining me
• 1:16
  - today. To start, can you introduce yourself and
• 1:18
  - just share a bit about your role and
• 1:19
  - your responsibilities?
• 1:21
  - Yeah. Thank you for the opportunity,
• 1:22
  - to be here. So, again, my name is
• 1:24
  - Jeff Akers. I'm vice president of pharmacy at
• 1:26
  - UCHealth in Cincinnati, Ohio,
• 1:28
  - where I have the responsibility for pharmacy services
• 1:31
  - across our organization and health system, including our
• 1:34
  - hospital, retail, specialty infusion,
• 1:36
  - and our corporate services and operations. And so,
• 1:39
  - you know, my focus is really on building
• 1:41
  - a a pharmacy strategy that improves patient access
• 1:44
  - and care while also
• 1:46
  - creating sustainable financial value for the health systems.
• 1:49
  - One of the areas I've been particularly focused
• 1:51
  - on, as we've discussed, is expanding our retail
• 1:53
  - pharmacy footprint and integrating
• 1:55
  - those pharmacies
• 1:57
  - more closely with the clinical care being delivered
• 1:59
  - throughout our organization. And so we view retail
• 2:01
  - pharmacy as really much more than a dispensing
• 2:04
  - operation. It's an extension of our health system
• 2:06
  - and really an important part of how we
• 2:08
  - keep patients connected to the care.
• 2:11
  - Definitely. Thanks so much for sharing that.
• 2:14
  - And I know you've now have six locations
• 2:17
  - of,
• 2:18
  - the retail pharmacy. Two of those were open
• 2:20
  - in the past thirteen months. When did retail
• 2:23
  - pharmacy expansion become a priority for you guys
• 2:25
  - at UCHealth?
• 2:26
  - So retail pharmacy really became a a strong
• 2:29
  - strategic priority when we recognized that pharmacy could
• 2:32
  - play a much larger role in the patient
• 2:34
  - journey beyond the walls of the hospital.
• 2:36
  - We had an opportunity to to make medications
• 2:39
  - easier for our patients to access,
• 2:41
  - improve our transitions of care program, reduce barriers
• 2:44
  - to obtaining medications,
• 2:46
  - and really create a stronger connection between our
• 2:48
  - clinical providers
• 2:49
  - and our pharmacy teams. And so, when I
• 2:52
  - started at UCHealth in September
• 2:54
  - 2022,
• 2:55
  - UCHealth had experienced some really exponential growth of
• 2:59
  - retail pharmacy volume since then. And we were
• 3:01
  - able to really accurately and effectively monitor our
• 3:04
  - electronic prescription capture rate in the summer of
• 3:06
  - twenty three. And that's really when our,
• 3:10
  - senior leadership team really saw the opportunity. And
• 3:13
  - so once we were, knew we where we
• 3:16
  - were internally
• 3:17
  - with where our prescriptions are going, we're able
• 3:20
  - to implement targeted tactics to really help improve
• 3:23
  - access to our pharmacy services
• 3:25
  - and better connect patients with the pharmacy resources
• 3:28
  - available within the health system. And so that
• 3:30
  - strategy evolved from thinking about retail pharmacy as
• 3:33
  - simply a convenience for patients
• 3:35
  - to a view where it's,
• 3:37
  - is as important component
• 3:39
  - of our health system's overall ambulatory strategy. So
• 3:42
  - as UCHealth has expanded its ambulatory footprint, pharmacy
• 3:45
  - has expanded along with it.
• 3:48
  - Gotcha. Yeah. That's great to see both of
• 3:50
  - those expanding in parallel,
• 3:52
  - to bring so much success to the health
• 3:54
  - system and also for patients.
• 3:56
  - I'm curious if you could, you know, walk
• 3:57
  - me through how the pace of expansion has
• 4:00
  - changed since that first retail pharmacy location
• 4:03
  - and, you know, what made this most recent
• 4:05
  - one the right next move for you guys?
• 4:07
  - Yeah. So our expansion has really become much
• 4:09
  - more intentional and strategic.
• 4:12
  - So early on, we were establishing
• 4:14
  - our foundation and proving,
• 4:16
  - that health system retail pharmacies could deliver both,
• 4:20
  - patient services and financial value. And so as
• 4:22
  - we just demonstrated that model, we became much
• 4:25
  - more comfortable looking at additional locations and expanded
• 4:28
  - operations.
• 4:29
  - That West Professional Pharmacy,
• 4:31
  - that which just opened was a logical next
• 4:34
  - step because of the patient population
• 4:36
  - and the clinical activity surrounding that particular
• 4:40
  - location. So in that building, we do not
• 4:42
  - have a proximal retail pharmacy service
• 4:44
  - there. And so we observe patients receiving
• 4:47
  - psychiatric or primary care who could benefit from
• 4:49
  - having a retail and clinical pharmacy service
• 4:52
  - integrated into that location with those providers.
• 4:55
  - Additionally, we looked closely at where our providers
• 4:58
  - are seeing patients and where there's significant prescription
• 5:00
  - volume, opportunities for medication adherence, and improved
• 5:04
  - our clinical ambulatory care pharmacy services as well.
• 5:07
  - And so by opening the West Professional Pharmacy,
• 5:09
  - we've made really a substantial more convenient
• 5:12
  - for patients,
• 5:14
  - to access,
• 5:15
  - our pharmacy services and obtain their medications
• 5:18
  - from a pharmacy that's integrated with the health
• 5:20
  - system and where they already receive care and
• 5:23
  - to have a greater continuity between their providers
• 5:26
  - and our pharmacists. So we're not just simply
• 5:28
  - asking where can we put another pharmacy, we're
• 5:30
  - asking where can pharmacy have the greatest impact
• 5:33
  - for the patients and for UCHealth.
• 5:36
  - Gotcha. It's a great question to be thinking
• 5:39
  - and putting forefront in your plans.
• 5:41
  - I'm curious,
• 5:42
  - you know, from that first location to this
• 5:44
  - most recent one, was there, like, a
• 5:48
  - lesson, you know, learned with when you guys
• 5:50
  - opened that first location that you've since, you
• 5:52
  - know, taken and applied to the ones that
• 5:54
  - you've opened after that you think other health
• 5:56
  - systems would benefit from from hearing before they
• 5:59
  - start on their journey?
• 6:00
  - Yeah. I I think the you need to
• 6:02
  - go back and look at, you know, obviously,
• 6:04
  - what the cost of opening a pharmacy is,
• 6:06
  - and it's gonna vary, you know, by location
• 6:08
  - and, where it's positioned at. And so I
• 6:11
  - think that's an important part. But like I
• 6:12
  - said, it'd be very intentional and strategic
• 6:15
  - of where you place those pharmacies
• 6:17
  - and and evaluate, you know, where there may
• 6:19
  - be care gaps
• 6:21
  - specifically for pharmacy services
• 6:23
  - that we're,
• 6:24
  - adding a pharmacy
• 6:26
  - specifically in that location can really fill those
• 6:28
  - opportunities.
• 6:30
  - Definitely.
• 6:31
  - And you mentioned, you know, with that first
• 6:33
  - location, it was really about proving,
• 6:36
  - that this would have benefits for both the
• 6:38
  - patient experience, but then also on the for
• 6:40
  - the financial aspect for the health system.
• 6:43
  - So I'm curious, what does that financial case
• 6:45
  - for a new retail pharmacy location look like?
• 6:48
  - How do you convince hospital leadership to invest
• 6:50
  - in retail pharmacy expansion?
• 6:53
  - Well, obviously, financial sustainability is an important part
• 6:56
  - of the equation, but the business case really
• 6:57
  - goes well beyond just dispensing margin. And we
• 7:00
  - look at the entire economic contribution of the
• 7:02
  - pharmacy.
• 7:03
  - So that includes,
• 7:05
  - the prescription volume, obviously, payer mix, reimbursement,
• 7:08
  - or acquisition costs, and labor, operating expenses, and
• 7:11
  - ultimately, the contribution margin. But we also evaluate
• 7:14
  - the downstream value.
• 7:16
  - Things like improving access to medications or medication
• 7:19
  - adherence,
• 7:20
  - clinical
• 7:21
  - service opportunities or specialty pharmacy
• 7:24
  - referrals,
• 7:25
  - and also patient assistance programs or medication access
• 7:28
  - services
• 7:29
  - and the ability to support our ambulatory
• 7:32
  - clinic practices.
• 7:33
  - So when I present a retail pharmacy investment
• 7:36
  - opportunity to our leadership, I don't position it
• 7:38
  - as, again, we need another pharmacy.
• 7:41
  - I position it as an investment in the
• 7:43
  - health systems ambulatory strategy.
• 7:45
  - So I work very closely with my counterpart
• 7:47
  - in our on our ambulatory team. And so
• 7:50
  - we established the expected volume, the revenue, the
• 7:53
  - margin, operating cost, and breakeven timeline, but we
• 7:56
  - also articulate the clinical and strategic value for
• 7:58
  - the patients.
• 8:00
  - So the most important thing is obviously credibility,
• 8:02
  - and leadership needs to know that we're not
• 8:04
  - building locations simply to increase the number of
• 8:06
  - pharmacies. Again, we're building locations where the patient
• 8:09
  - and clinical and financial business cases
• 8:12
  - all make sense to provide a solid return
• 8:14
  - to our patients and the organization.
• 8:18
  - Gotcha. Thank you so much for walking me
• 8:19
  - through that. And then on the patient side,
• 8:22
  - when you're, you know, proving the the patient
• 8:24
  - benefits for that, what was, like, maybe one
• 8:27
  - or two metrics that were really important for
• 8:29
  - you guys to be tracking, to ensure that
• 8:31
  - the retail pharmacy was reaching the patient benefits
• 8:34
  - that you wanted it to?
• 8:36
  - Yeah. Again, I think you you look at
• 8:38
  - your pop patient population and and who's being
• 8:40
  - served there, look at the services that you
• 8:43
  - have. And then like I said earlier, we
• 8:45
  - look at our prescription
• 8:47
  - capture rates and and seeing, you know, if
• 8:49
  - there's opportunity by having a pharmacy there that
• 8:51
  - we can improve our care. And we did
• 8:53
  - that specifically,
• 8:55
  - expanding our ambulatory clinical pharmacy services
• 8:59
  - specifically with our primary care and our psychiatric
• 9:02
  - population in this location.
• 9:04
  - Gotcha. Thank you.
• 9:06
  - And then I know you touched on a
• 9:08
  - small aspect of this earlier,
• 9:10
  - when you were talking about the cost of
• 9:12
  - opening a pharmacy. But is there any other
• 9:14
  - advice that you have for health systems that
• 9:16
  - are just now starting their retail pharmacy journey?
• 9:19
  - You know, those some of those first steps
• 9:21
  - that they recommend they take. Yeah. Again, I
• 9:23
  - think you need to really, you know, understand,
• 9:27
  - you know, again, where where the opportunities and
• 9:29
  - gaps are. So the first step is to
• 9:31
  - understand,
• 9:32
  - you know, who are your patients in a
• 9:34
  - particular location or locations that you're reviewing and
• 9:37
  - then understand your existing prescription opportunities
• 9:40
  - before you really start thinking about locations. And
• 9:43
  - so understanding,
• 9:44
  - you know, again, where your gaps are and
• 9:46
  - to be able to identify
• 9:48
  - how a putting a pharmacy service in that
• 9:50
  - location can benefit.
• 9:52
  - So I would map your ambulatory provider footprint,
• 9:55
  - identify where your, you know, highest volume clinics
• 9:57
  - are and what specialties are located
• 10:00
  - there, understand again where prescriptions are being filled,
• 10:03
  - and identify where patients are experiencing access or
• 10:06
  - medication adherence challenges.
• 10:08
  - Then once you understand that, you build the
• 10:10
  - case, the business case around those opportunities.
• 10:13
  - And I would also recommend starting with one
• 10:15
  - location where you have a strong patient population
• 10:18
  - and a, well engaged physician leadership.
• 10:21
  - You prove that model, establish your operating metrics,
• 10:24
  - and then use those lessons learned to guide
• 10:27
  - in expansion. And that's really what we did,
• 10:30
  - with the the last two pharmacies that we
• 10:32
  - opened. So I think the biggest mistake, though,
• 10:34
  - is thinking retail pharmacy is primarily a real
• 10:37
  - estate decision. It's really a patient care, physician
• 10:40
  - engagement,
• 10:41
  - and pharmacy,
• 10:43
  - economics decision. So our goal when we open
• 10:45
  - a new retail pharmacy is to improve our
• 10:47
  - care and medication access for our patients while,
• 10:50
  - again, providing additional support to our providers.
• 10:53
  - Gotcha. Yeah. And I definitely think that's a
• 10:55
  - great piece of advice, that last part, really
• 10:57
  - putting the patients first.
• 10:59
  - So thank you for sharing.
• 11:01
  - And, you know, looking more broadly in
• 11:04
  - where do you think retail pharmacy fits into
• 11:06
  - the future of hospital based care,
• 11:09
  - you know, touching on that patient aspect? Yeah.
• 11:11
  - I mean, you know, I think what I
• 11:13
  - try to do with my team is to
• 11:15
  - understand that pharmacy is a continuum of care.
• 11:17
  - You know, I think sometimes we get siloed
• 11:20
  - into, you know, hospital pharmacists work in the
• 11:22
  - hospital and retail pharmacists work in the retail
• 11:24
  - pharmacy or whatever. And there's not,
• 11:27
  - you know,
• 11:28
  - the the two don't ever meet. But I
• 11:30
  - think the opportunity what again, what I've tried
• 11:32
  - to bring to my leadership team is understanding
• 11:34
  - is that, you know, pharmacy kinda transcends those
• 11:37
  - silos. And so the things that's done in
• 11:39
  - the hospital has downstream effects to the our
• 11:41
  - retail pharmacy services, and things done in the
• 11:44
  - clinics and retail pharmacy
• 11:45
  - has downstream effects when patients are in the
• 11:48
  - hospital.
• 11:48
  - So I really think retail pharmacy is going
• 11:51
  - to become increasingly integrated
• 11:53
  - into the ambulatory care model as it continues
• 11:56
  - to expand. The traditional concept of a hospital
• 11:58
  - pharmacy
• 11:59
  - primarily serving hospitalized patients is really changing. And
• 12:02
  - healthcare,
• 12:04
  - continues to move outside of the hospital and
• 12:06
  - into the ambulatory settings. And pharmacy needs to
• 12:09
  - evolve with that. Retail pharmacies can become a
• 12:12
  - really important part of that continuum, particularly around
• 12:15
  - specialty medications, chronic disease management, population health. I
• 12:19
  - mentioned medication adherence and again, access to therapies.
• 12:22
  - I also think the distinction between retail specialty
• 12:25
  - infusion and the clinical services, you know, are
• 12:28
  - is going to continue to blur. And so
• 12:30
  - the health systems that are successful
• 12:33
  - will look at pharmacy as one integrated strategy
• 12:35
  - rather than a collection of independent pharmacy businesses.
• 12:39
  - But ultimately, our goal
• 12:41
  - should be to make it as easy as
• 12:43
  - possible
• 12:44
  - for patients to receive the right medication at
• 12:47
  - the right time from our healthcare organization that
• 12:49
  - is managing their care. While at the same
• 12:52
  - time, make it easy as possible
• 12:54
  - for providers
• 12:55
  - to navigate the complexity of payer formularies, utilization
• 12:59
  - criteria, prior authorizations, and all the financial roadblocks
• 13:02
  - that patients have. And so as I often
• 13:04
  - tell my team and our providers, our goal
• 13:06
  - in our UCHealth Pharmacy enterprise is to make
• 13:09
  - it easy on providers and easy on patients.
• 13:12
  - Definitely. Great way to put it. Thank you.
• 13:15
  - And for UCHealth, you know, where does your
• 13:17
  - retail pharmacy footprint go from here? Is six
• 13:19
  - the plan for now? Do you have a
• 13:21
  - seventh already in the works? What's next? Yeah.
• 13:23
  - So six isn't really necessarily the magical number,
• 13:27
  - and we're gonna continue to evaluate our opportunities.
• 13:30
  - We're gonna be disciplined, of course. And, again,
• 13:32
  - taking the same structure, looking for those opportunities
• 13:34
  - in terms of patient care and economic,
• 13:37
  - improvement.
• 13:38
  - But, every potential location has to demonstrate a
• 13:41
  - compelling patient access, clinical, and financial,
• 13:45
  - rationale.
• 13:46
  - So there are certainly opportunities for additional growth
• 13:48
  - as UCHealth continues to expand its ambulatory presence.
• 13:51
  - But I don't want our success to be
• 13:53
  - measured by whether we have seven, eight, or
• 13:55
  - 10 pharmacies. I want it to be measured
• 13:57
  - by whether each pharmacy is improving access for
• 14:00
  - our patients, supporting our clinicians,
• 14:03
  - improving medication outcomes, and contributing,
• 14:06
  - overall value to our organization.
• 14:08
  - Right now, we are evaluating at least four
• 14:10
  - different potential sites that meet our strict criteria
• 14:13
  - for, you know,
• 14:15
  - capital investment. And I would say we're continuing
• 14:17
  - to evaluate the next opportunities.
• 14:19
  - But we're not going to expand simply for
• 14:21
  - the sake of expanding. Our strategy really is
• 14:24
  - to build the right footprint,
• 14:25
  - not necessarily the biggest footprint, but the right
• 14:28
  - footprint that services our patients and benefits our
• 14:30
  - providers. Again, ultimately,
• 14:32
  - UCHealth is not building retail pharmacies
• 14:35
  - for their own sake. We're building an integrated
• 14:38
  - pharmacy network around where our patients can receive
• 14:40
  - the best care possible.
• 14:43
  - Definitely. And it's great to hear about those
• 14:45
  - possible four already in the works. Best of
• 14:47
  - luck as you go forward with those.
• 14:50
  - And, yeah, Jeff, this has been such a
• 14:52
  - great conversation. Thank you so much for sharing
• 14:54
  - your perspective and insights with us. That's all
• 14:57
  - for today's episode of the Becker's Healthcare podcast.
• 14:59
  - A big thank you again to Jeff for
• 15:01
  - joining us. Thanks everybody for listening, and we'll
• 15:03
  - see you next time.