Latest / Becker’s Healthcare Podcast / Mark Makhinson PharmD, Senior Director of Outpatient Pharmacy at Mount Sinai Health System

Transcript

Mark Makhinson PharmD, Senior Director of Outpatient Pharmacy at Mount Sinai Health System · Becker’s Healthcare Podcast

0:00
Welcome to the Becker's pharmacy leadership podcast. I'm
0:02
Ella Jeffries, pharmacy reporter here with Becker's Healthcare.
0:06
Today, I'm joined by doctor Mark Mackensen, senior
0:08
director of outpatient pharmacy at Mount Sinai Health
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System.
0:12
In this episode, we'll be exploring digital innovation
0:14
in specialty pharmacy, how technology is transforming operations,
0:18
driving better patient outcomes, and creating new opportunities
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for pharmacy leaders. Doctor Mechenson, thank you so
0:24
much for joining me today. To start off,
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can you please introduce yourself and share a
0:27
bit about your role and how specialty pharmacy
0:30
fits within your organization's overall pharmacy strategy?
0:33
Thank you, Ella. Good to be here with
0:35
you. So my name is Mark Mackensen. I
0:37
am the senior director of outpatient specialty pharmacy
0:38
for the
0:41
specialty pharmacy for the Mount Sinai Health System
0:43
in New York City. We're a large academic
0:44
medical center, consisting of seven hospitals and approximately
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500
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outpatient
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specialty clinics
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across the New York City area, New York,
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New Jersey, Connecticut.
0:57
And I I oversee all the outpatient
1:00
pharmacy
1:01
activities across the system. We have seven
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pharmacies,
1:05
across New York City,
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three of which are specialty accredited pharmacies. We
1:11
have a you know, we started in
1:13
about 2020,
1:14
so pretty young operation,
1:18
as a whole,
1:19
but we've been we've grown,
1:21
exponentially over the last five years.
1:24
So we service the system as a whole.
1:27
So all the the practices across system, we
1:30
are integrated
1:31
in about 90% of practices with our specialty
1:34
services.
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So
1:37
the overall goal of the the outpatient pharmacy
1:40
department is is really to
1:43
keep the care of the patients
1:45
within the continuum of the health system.
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And, you know, we we see when patients
1:50
stay within the health system and all of
1:52
their care originates in the same place,
1:54
they get they get better outcomes.
1:57
And we can drive system level initiatives such
2:00
as, like, the stay challenges,
2:03
decreasing length of stay
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and increasing compliance,
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increasing adherence,
2:08
and decreasing readmission.
2:10
Great. Amazing to hear about your background. With
2:13
that perspective in mind, I'd love to dig
2:15
into how your team is approaching innovation. You
2:17
know, specialty pharmacy continues to evolve quickly. So
2:20
what does digital innovation look like at Mount
2:22
Sinai right now?
2:24
Absolutely.
2:25
So right now, we are in the middle
2:27
of some really big changes.
2:30
We are actively
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engaged with with several
2:33
vendors to to bring on some some automation,
2:36
AI technologies,
2:38
which I'll I'll get into in a little
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bit.
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But, you know, our our pharmacy platform is
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currently operating on on a legacy platform that
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has very little
2:48
digital reach, to our patients.
2:50
Right. So if you can imagine a retail
2:53
pharmacy, an independent retail pharmacy with an independent
2:55
system
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where a patient needs to call in,
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and
2:59
interact with a legacy IVR system or speak
3:03
to a member of the pharmacy staff to
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get a status on a prescription,
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that's where we're at now. We but we
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are
3:09
really quickly
3:11
moving towards a digital first strategy. Right?
3:15
So in trying to meet our our goal
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of keeping as many patients within the system,
3:21
we need to offer
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a similar level of service and similar experience
3:25
that patients get elsewhere. Right? So when patients
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go
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online,
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for a typical shopping experience, whether they're going
3:33
to Amazon or they're going to CVS or
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to any other retailer,
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they're used to a a digital experience that
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is easy
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and streamlined and and meets their needs and
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meets them where they are.
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And that's where we're trying to go. So
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developing a front end digital platform where a
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patient can
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log on, interact with their medication,
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refill,
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check out,
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schedule delivery,
4:01
things of that nature. But then
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going a step further, right, we wanna bring
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in the clinical aspect. So
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where can they get their clinical information?
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Can they access their
4:13
their
4:13
their discharge summary in one place and have
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that linked to their medications that they got
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from the pharmacy
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to understand what the side effects are on
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the medication and when to take the medication?
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And, you know, how can they use the
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the
4:28
health systems
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digital presidents
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to answer all their health care needs?
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That's that's where we're trying to go. So
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digital first strategy from a patient experience perspective.
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But then on the back end, right,
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there are a lot of workflows that we
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have that are very manual and legacy workflows
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that require a lot of people to to
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do
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repetitive tasks day in and day out, which
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is what we're we're trying to
4:58
streamline and and automate at this moment. Right?
5:01
So there there's a few main processes
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that we we do every day, including benefits
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investigation, prioritization,
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financial assistance,
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and delivery coordination.
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We are currently
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able to automate two of those, two out
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of four, but we are in the process
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of trying to bring them all into
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a single ecosystem
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so that everything lives in one place and
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everything is
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is automated and streamlined.
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And at the end of the day, we
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we really want to
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focus
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on our employees, whether it's our technicians, our
5:37
pharmacists,
5:38
working at top of our license and being
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able
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to have those conversations
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with patients
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that are are value add for patients. Right?
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We want our people to be a resource
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for our patients
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somewhere that they can go to, that they
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trust for information
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versus
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individuals that are doing repetitive tasks day in
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and day out.
5:59
For sure. That's all really interesting and very
6:01
important changes that sounds like your team has
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embraced a lot in a very short amount
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of time. I'm curious, you know, what specific
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new technologies or you mentioned those workflows or
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just any digital tools that have had the
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biggest impact on your specialty farmer pharmacy operations
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or patient outcomes?
6:17
Yeah.
6:18
So I think the first big one that
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that we really piloted and and implemented was
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prior authorization support. So being able to
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have technology
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pull
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the correct answers for prior authorizations out of
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the medical record and populate
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the prior authorization form.
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Previously, this was a fully manual process. So
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you can imagine a patient gets a prescription.
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It needs a prioritization.
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The that liaison has to go into the
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medical record,
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pull a diagnosis code, pull previous
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therapies that the patient has failed,
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answer the multitude of questions that that
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come from a a payer.
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And every payer is different, and every payer
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has different questions and different criteria.
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So the these prior authorizations
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take up a lot of time and take
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a lot of expertise to handle.
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So by bringing in a ace an AI
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solution,
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it's integrated into the medical record. And once
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a prescription needs a prioritization,
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the software
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pulls the appropriate form
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and populates it. So answers the questions,
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with reference for the individual.
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So now, the liaison, instead of having to
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dig through a medical record, whether whether it's
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digital,
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media or or legacy media that's been uploaded,
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the liaison just needs to verify the answers.
7:43
Right? So
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the question is populated. Liaison verifies that the
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answer is is appropriate, checks the the reference,
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and then submits the prior authorization.
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This leads to a
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significant decrease in the time to complete a
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prior authorization.
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We were trending at twenty to twenty five
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minutes per PA.
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That's come down,
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by at least 50%. We're we're targeting at
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least a 75 to 80% decrease in time
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to complete PA.
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But, secondarily,
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our first pass approval of prioritizations
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has increased significantly.
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Right? So reducing the
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the work of a pharmacist writing a letter
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letter of medical necessity or going back to
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a provider to ask
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additional questions.
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All this
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gets the patient to therapy sooner
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with with less with with less interference,
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which which is the ultimate goal. And like
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I said previously,
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those those liaisons are now doing more patient
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facing work and and
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being of more value to the patient,
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in their care journey.
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So that that's the first one,
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which really utilize AI.
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And then the second one is the the
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digital
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front door. So developing a digital marketplace
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for a patient to to interact with their
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medications
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that's fully integrated
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within,
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the MyChart experience.
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So, basically, if a patient gets a prescription
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and they get a text message,
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they'll
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click the link there. It'll take them into
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the MyChart experience,
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and they'll have a similar
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shopping experience as they would anywhere else on
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the Internet.
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Those are great examples.
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And I love hearing about those, success outcomes
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that you described.
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Kind of on that, you know, same note
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of the metrics, how are you and your
9:35
organization defining success when it comes to digital
9:38
innovation as a whole for pharmacy?
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So I think it all comes back to,
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number one, the patient experience,
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and whether
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they are have a a an experience that
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that they like and that they they can
9:52
keep coming back to. Right? Keeping that patient
9:55
engaged with with the health system,
9:58
on an ongoing basis is is beneficial. Right?
10:00
So it the patient engagement, but then secondarily,
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you know, what what is our efficiencies
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on the back end. Right? Can we
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repurpose staff to do more beneficial work for
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the patient?
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You know, one example is, you know, we
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have 20 liaisons just doing
10:19
GLP one prior authorizations.
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What does the world look like when we
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can bring that work work from 20 down
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to five?
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You know, maybe we can repurpose
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those 15 liaisons to do
10:30
more financial
10:31
navigation
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for the patient. Right? If we can get
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patients more financial assistance
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so that they can continue on therapy and
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have access to more therapies,
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we have better outcomes. Right? If we can
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get those employees to
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to do outreach to patients to ensure adherence,
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then they can have better outcomes. So at
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the end of the day,
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any any goals that we set for ourselves
10:58
is always with the patients at the heart
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of it and ensuring that the patients'
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outcomes and experience are are best.
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For sure. And I think those are important
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things that any health system should be keeping
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in mind as well. So thank you for
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sharing.
11:13
And, of course, with any new technology, there
11:15
are always a few bumps along the way.
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What challenges have you encountered in implementing digital
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tools, and how have you addressed these issues?
11:23
Yeah. So anyone that's that's worked in a
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health system or a large matrixed organization,
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knows the word governance.
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So there is a lot of governance that
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that happens
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especially within a health system,
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for for many reasons. And, you know, many
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many of these reasons are are are valid.
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But it just it takes a lot of
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time and effort and persistence
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to
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to to get any anything
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live within the health system.
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And then
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secondarily,
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you know, the the the difficulty of of
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such an endeavor
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increases when you start talking about AI,
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because, you know, the governance is being built
12:04
as we speak. So,
12:07
really working with
12:09
your partners within your organization,
12:12
specifically your your IT partners,
12:15
your legal partners,
12:18
is
12:19
is so important
12:20
in order to
12:22
to be efficient and get some of these
12:25
products to, to market and to to a
12:28
live state.
12:30
You know,
12:31
a lot of times,
12:33
vendors come to us with with new ideas
12:36
and and
12:38
and not really fully baked,
12:41
products.
12:42
And, you know, we we a lot of
12:44
times, we we just do not move forward
12:47
with them because, you know, we know that
12:49
in in order to be successful in in
12:51
a health system setting,
12:54
we need to have something that that is
12:56
is fully baked and
12:58
ready to be deployed and and has a
13:01
proven
13:02
use case. So
13:04
partnering
13:05
internally,
13:06
as well as externally and and being fully
13:08
transparent with with everybody that's involved,
13:12
on on the process and timeline.
13:15
For sure. That's a really helpful perspective, and
13:17
it's clear that your team has learned a
13:18
lot from the digital implementation process.
13:21
I'd like to shift now to the patient
13:23
side of things for a moment. How are
13:24
digital tools changing the patient experience in specialty
13:27
pharmacy at Mount Sinai for you guys?
13:30
Again, it's it's going back to
13:33
transparency
13:34
and access.
13:36
I think
13:38
with with our digital offering, now we're able
13:42
to to give them
13:44
a more
13:45
streamlined
13:46
way of of interacting with us. But then
13:49
secondarily,
13:50
you know, it it comes down to
13:53
a patient's ability
13:55
to access a medication, whether that's a prior
13:57
authorization, whether it that's a payer putting
14:01
some limitations on on access to medication or
14:04
whether that's cost.
14:06
A lot of times, the cost of a
14:08
medication is
14:10
is too high,
14:12
and the patient doesn't have any any way
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of
14:15
accessing.
14:17
So
14:18
utilizing our our digital
14:20
landscape
14:22
to to to give them the the tools
14:24
to, to find the financial assistance. Right? Whether
14:27
it's linking to a
14:29
manufacturer discount card, whether it is
14:32
giving them a,
14:34
information about a foundation.
14:37
Those those things are so important. So really
14:40
utilizing the the digital
14:43
front door,
14:44
to to give that patient that trust trusted
14:48
source
14:49
for financial information,
14:51
and then backing that up with with our
14:53
liaisons
14:54
who can do that financial navigation.
14:57
That's the thing that I'm most excited about.
14:59
I think that's something that is a very
15:02
gray area within pharmacy, specialty pharmacy especially,
15:06
and that there are a lot of different
15:08
funding options,
15:10
outside of the traditional payers that patients are
15:14
not aware of. So being able to
15:16
to direct the patients to to these options
15:19
so that they have access to these really
15:23
expensive therapies. Medications are not getting any cheaper.
15:26
You know, they're may getting more complex and
15:28
more expensive.
15:29
So it's so important to have that that
15:32
ability.
15:33
For sure. That's such an important point, especially
15:35
as, you know, patient expectations continue to evolve.
15:39
Now looking ahead, where do you see the
15:40
greatest opportunities for digital transformation in specialty pharmacy
15:44
over the next few years?
15:46
You know,
15:47
the landscape,
15:49
especially now,
15:51
with direct to consumer
15:54
becoming more and more of an option, the
15:56
landscape is changing.
15:58
And there is a lot of
16:01
untrustworthy
16:02
information
16:03
out there. And a lot of times when
16:07
a patient
16:08
goes online to to search about their medical
16:11
condition
16:12
or about their medication
16:14
or anything health related,
16:16
they're they can be led astray.
16:19
So having a
16:22
trusted source that they can always come back
16:25
to,
16:26
that is
16:28
is is fully,
16:29
you know,
16:30
fully capable of of
16:32
leading the patient on that care journey, is
16:35
is so important. So I I see health
16:38
systems
16:39
and health system pharmacies
16:41
being that source of truth in the future.
16:43
Right?
16:44
Imagine a world where a patient
16:46
can log on to their their health system
16:48
portal
16:49
and and access
16:51
any kind of information that they want about
16:53
their their health,
16:55
whether it's a question about an acute condition,
16:58
whether it's a question about medication access, or
17:02
or, you know, something about a a side
17:05
effect
17:06
for their long term condition?
17:09
What if it's a a
17:11
a drug interaction with an herbal medication that
17:14
they're taking?
17:16
There are a lot of resources out there,
17:18
but it's it's unknown which ones are to
17:21
be trusted and which ones are not. But
17:23
the health system name and logo
17:26
is is always a trusted resource. So
17:29
having a one stop shop for a patient
17:31
to to go for all their health care
17:33
needs, that's where I see the future,
17:36
of
17:37
of digital
17:39
specialty pharmacy within health system.
17:42
Gotcha.
17:43
Well, thank you so much, doctor Mecheson. This
17:45
has been such an insightful conversation, and thank
17:47
you for sharing your perspective and experience
17:50
with us.
17:51
That's all for today's episode of the Becker's
17:53
Pharmacy leadership podcast. A big thank you again
17:55
to doctor Mackensen for sharing his insights on
17:58
digital innovation and specialty pharmacy. Thanks for listening,
18:01
and we'll see you next time. Thank you,
18:03
Ella.