Latest / Becker’s Healthcare Podcast / Building a High Performing Pharmacy Enterprise at MercyOne with Scott Knoer

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Building a High Performing Pharmacy Enterprise at MercyOne with Scott Knoer · Becker’s Healthcare Podcast

• 0:00
  This is Laura Dirda with the Becker's healthcare
• 0:02
  podcast. I'm thrilled today to be joined by
• 0:04
  doctor Scott Knorr, who's the regional chief pharmacy
• 0:06
  officer at MercyOne.
• 0:08
  Scott, it's a pleasure to have you on
• 0:09
  the podcast today.
• 0:11
  Thanks so much, Laura. I've, done a lot
• 0:13
  of things with Becker's over the years, and
• 0:15
  I always enjoy,
• 0:17
  you know, your your different venues, your your
• 0:20
  meetings, and your podcasts, and your daily emails.
• 0:23
  So it's it's fun to be part of
• 0:24
  it. Oh, absolutely. Plus I plus I got
• 0:27
  a picture with Wayne Gretzky at the last
• 0:29
  meeting, so that was super cool.
• 0:31
  Oh, that's fantastic. How fun and exciting. I
• 0:33
  know,
• 0:34
  just a legend, Wayne Gretzky and, you know,
• 0:36
  an inspiring person as well. So glad you're
• 0:39
  able to to see him and get the
• 0:40
  picture. Are you a big hockey fan?
• 0:43
  Yeah, well it was pretty brief, you know,
• 0:44
  I was in line.
• 0:46
  But yeah, it was it was pretty cool.
• 0:47
  So, you know, it's and that's something laura
• 0:50
  Is exciting because there's someone who is the
• 0:52
  absolute best at what they do in the
• 0:55
  world So it's just always fun
• 0:57
  to to spend any amount of time and
• 0:59
  and listen to the wisdom of of folks
• 1:01
  who really are the best in the world
• 1:03
  at what they do.
• 1:05
  Absolutely. That is, a 100%,
• 1:08
  the case, and I always enjoy listening to
• 1:10
  those athletes and and great business leaders and
• 1:13
  minds and speakers that we have at our
• 1:14
  annual meeting. And I know you'll be speaking
• 1:16
  at the annual meeting as or well in
• 1:18
  our chief pharmacy officer summit coming up. So,
• 1:21
  we'll be excited to dig a little bit
• 1:23
  deeper there. But for our podcast today, I
• 1:25
  know we've got some things we're gonna talk
• 1:26
  about,
• 1:27
  great products you're doing at MercyOne and, you
• 1:29
  know, how you're thinking about the future. But
• 1:31
  before we dive in and for those especially
• 1:33
  who have just discovered our podcast or or
• 1:36
  may not be as familiar with you, can
• 1:37
  you tell us a little bit more about
• 1:39
  yourself, background, and MercyOne?
• 1:41
  Yeah. Yeah. I sure can.
• 1:44
  So I'm I'm I've been around,
• 1:47
  pharmacy
• 1:47
  quite quite a bit. So I took a
• 1:50
  break from not for profit health care, but,
• 1:53
  I was director of pharmacy at University of
• 1:55
  Minnesota Medical Center, part of Fairview in Minneapolis.
• 1:59
  I got recruited to Cleveland Clinic. I was
• 2:01
  the chief pharmacy officer there for nine years.
• 2:03
  We opened hospitals in Abu Dhabi and London
• 2:06
  and and,
• 2:08
  did some amazing things, had some of the
• 2:09
  first chemotherapy
• 2:11
  robots in the country.
• 2:12
  And I I I really leveraged the position
• 2:15
  of the Cleveland Clinic. You know, it's one
• 2:16
  of the, you know, top health systems in
• 2:18
  the world, Mayo Clinic Hopkins.
• 2:20
  And, the media cared a lot, not about
• 2:23
  what I thought, but about what the chief
• 2:25
  pharmacy officer at Cleveland Clinic thought. So I
• 2:27
  became a voice
• 2:29
  of, I I hopefully, a voice for good
• 2:31
  on some of the egregious drug pricing issues
• 2:34
  we've got and, you know, was quoted over
• 2:35
  a 100 times in the Wall Street Journal
• 2:37
  and Post and the Times.
• 2:39
  And, that and also on PBMs and advocacy
• 2:42
  against the egregious practice of PBMs. And I
• 2:45
  got the attention of American Pharmacists Association who
• 2:48
  recruited me to be the CEO there.
• 2:50
  And the American Pharmacist Association is kind of
• 2:52
  like the AMA of pharmacy.
• 2:55
  And, you know, they'd had some challenges financially,
• 2:58
  and some membership issues.
• 3:00
  And we turned the organization around and
• 3:04
  dramatically, in two years, membership went up. Our
• 3:06
  our margins were were positive for the first
• 3:09
  time in quite a while. And and, but
• 3:11
  then I I went
• 3:13
  to the I went to industry. I I
• 3:15
  was recruited,
• 3:16
  during my time at the Cleveland Clinic. I
• 3:18
  knew Toby Cosgrove, who was one of the
• 3:20
  he was a frequent guy on on Becker's.
• 3:22
  He was one of the best known hospital
• 3:23
  CEOs in the last twenty years. He was
• 3:25
  on the board, hims and hers. And, so
• 3:28
  he introduced me to Andrew, and I I
• 3:29
  became their chief pharmacy officer for a bit
• 3:32
  of time and learned about,
• 3:34
  the for profit world and telehealth, and it
• 3:36
  was an amazing experience.
• 3:38
  But now I'm back. I'm originally from Iowa.
• 3:40
  Haven't been here for about forty years, and
• 3:41
  this opportunity came up. And my mom, she's
• 3:44
  82. She's doing great.
• 3:46
  She's healthy,
• 3:48
  spending time with her and my brother. I'm
• 3:49
  hunting on my family farm in Iowa and
• 3:52
  just enjoying life. And MercyOne's part of Trinity.
• 3:54
  It's we've got 40 hospitals in Iowa, part
• 3:56
  of, Trinity,
• 3:58
  which is one of the
• 3:59
  largest,
• 4:00
  health systems in in the country.
• 4:02
  But yeah. So that's a little bit about
• 4:03
  me and and MercyOne.
• 4:07
  Well, that's amazing to hear. You know, as
• 4:09
  a fellow Iowan, I can definitely attest to
• 4:11
  being able to be back and be home
• 4:12
  is always an amazing thing. So, the emergency
• 4:15
  one is, really lucky to have you.
• 4:17
  Well, it's it's a good place to be.
• 4:20
  It's a good place to be. And they've,
• 4:22
  you know, they had some turnover in leadership.
• 4:24
  I'm the first, chief pharmacy officer they've had,
• 4:28
  that it that everything reports solid line to
• 4:30
  me. And, you know, taking some learnings we've
• 4:33
  done before,
• 4:35
  it's not my first trip to the rodeo.
• 4:37
  So we were able to
• 4:39
  really rapidly
• 4:40
  develop some programs and some,
• 4:43
  some profitability
• 4:44
  on the ambulatory side.
• 4:48
  That that's great to hear. And I would
• 4:50
  love to to dig a little bit deeper
• 4:52
  into that. I mean, especially thinking about the
• 4:54
  last year or so.
• 4:56
  You know, what has been some of the
• 4:57
  most important initiatives you led? How did you
• 4:59
  drive that profitability? What did you do, and
• 5:01
  what were the results?
• 5:02
  Yeah. Well, Laura, you know,
• 5:05
  pharmacy and everyone if this is primarily a
• 5:07
  pharmacy,
• 5:08
  audience,
• 5:09
  pharmacy lives in two worlds in health care.
• 5:11
  Right? On the inpatient side, we're reimbursed by
• 5:14
  DRG, so it's all about cost.
• 5:16
  So there, we're stewards of the drug budget.
• 5:18
  And, you know, I've got a couple $100,000,000
• 5:21
  drug budget. It's got us 1,250,000,000.00
• 5:23
  at Cleveland Clinic.
• 5:25
  But but managing that that's not using cheap
• 5:28
  medications. Right? That's using cost effective medications, and
• 5:30
  that's where the clinical practice fits in. That's
• 5:33
  where having pharmacists, you know, rounding with your
• 5:35
  physicians,
• 5:36
  changing things from IV to PO,
• 5:38
  doing renal dosing,
• 5:40
  formulary management. That's where we are stewards of
• 5:44
  that drug budget. But
• 5:46
  pharmacy on the ambulatory world is still a
• 5:48
  true
• 5:49
  revenue center,
• 5:51
  and it surprises me because I've been doing
• 5:53
  it for a long time.
• 5:55
  I actually trained with the godfather of specialty
• 5:57
  pharmacy. Bob Beecher was my mentor at University
• 6:00
  of Minnesota. So when I got the Cleveland
• 6:01
  Clinic, I built a 100,000 square foot state
• 6:04
  of the art specialty pharmacy.
• 6:06
  And when I got here,
• 6:09
  MercyOne is a little different with Trinity.
• 6:12
  So we didn't have that capital.
• 6:15
  So with existing infrastructure,
• 6:18
  we created my my main goal is create
• 6:20
  ambulatory infrastructure. We did not have anyone in
• 6:22
  charge of our 19 all 19 pharmacies. There
• 6:25
  were five different regions. Created the infrastructure.
• 6:28
  And we're on track,
• 6:30
  net profit right off the income statement,
• 6:32
  to have
• 6:34
  fiscal year twenty six versus '25, we're gonna
• 6:37
  have $20,000,000
• 6:37
  more to the bottom line at MercyOne through
• 6:40
  what pharmacy's done. And I've got strategies in
• 6:44
  place,
• 6:45
  to probably fiscal year twenty seven to have
• 6:47
  another,
• 6:49
  another 12 to
• 6:51
  18,000,000.
• 6:52
  So it's really
• 6:54
  leveraging our providers. Right? Because our doctors and
• 6:57
  and, you know, pharmacy, we just we have
• 6:59
  to provide amazing service and prior authorizations,
• 7:02
  and work with our medical staff. And and
• 7:04
  we've got great relationships
• 7:06
  with doctor Olsen here, it our our,
• 7:10
  who's in charge of the medical staff, and
• 7:11
  my boss, doctor Carryon, is super supportive. So
• 7:15
  and the other thing with that, Laura, this
• 7:17
  is a universal truth of management. I've been
• 7:19
  doing this for a long time.
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  Success breeds success. So you come in, you
• 7:24
  establish credibility,
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  senior leadership team says, hey. Scott said he's
• 7:28
  gonna make us $12,000,000, he's gonna make us
• 7:29
  20. So then more initiatives come and bring
• 7:33
  us initiatives. So that's kinda where we're at.
• 7:35
  It's kinda like the flywheel,
• 7:37
  just starts spinning. It only took,
• 7:39
  I got here.
• 7:41
  About six months later, we got the business
• 7:42
  plan established.
• 7:43
  We're crushing it. The flywheel is moving, and
• 7:46
  and success is breeding success like it always
• 7:48
  does.
• 7:50
  Well, that's Megan here. You know, really,
• 7:53
  helpful to understand that kind of concept of
• 7:56
  creating that flywheel, getting things off the ground.
• 7:58
  And then, those are big numbers to be
• 7:59
  bringing into the health system, and something that
• 8:02
  is impressive to see.
• 8:04
  I'm curious,
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  having the business plan in place is great,
• 8:07
  but then it only works as well as
• 8:09
  the people in the team that you're working
• 8:10
  with are able to,
• 8:12
  you know,
• 8:14
  embrace it and bring that into their day
• 8:16
  to day, operating workflows and the way mindset
• 8:19
  and how they're thinking about things. So, you
• 8:21
  know, how do you approach that, especially with
• 8:23
  the new team when you're coming in, to
• 8:25
  help them see the vision and be able
• 8:27
  to make the necessary adjustments so that you
• 8:29
  can realize what you're trying to do?
• 8:32
  That's a great question, Laura.
• 8:34
  And, you know, I've started new jobs as
• 8:37
  as the leader,
• 8:39
  University of Minnesota Medical Center,
• 8:41
  Cleveland
• 8:42
  Clinic, American Pharmacy Association, where, you know, sometimes
• 8:46
  you come in
• 8:47
  and you have to fundamentally transfer. Sometimes you
• 8:50
  have to see who's good and who's not,
• 8:52
  and,
• 8:53
  you have to move some people and get
• 8:55
  rid of some folks.
• 8:57
  Here,
• 8:58
  I was really fortunate, and I've always been
• 9:00
  fortunate.
• 9:02
  I have an eye for finding
• 9:04
  raw talent,
• 9:05
  so I was able to within the people
• 9:08
  we have, I have
• 9:09
  a leader, a young guy,
• 9:11
  Craig Ford. He was the manager of the
• 9:14
  three
• 9:15
  pharmacies in Des Moines. He was there about
• 9:17
  a year before I was. And Craig had
• 9:19
  a background in regional management, especially pharmacy at
• 9:22
  Walgreens. So I had someone with that expertise
• 9:24
  here, and he'd already made really good changes
• 9:27
  in Des Moines, which was actually losing money
• 9:29
  in our retail pharmacies, if you could believe
• 9:31
  that. He stabilized that.
• 9:33
  So part of the business plan I had,
• 9:35
  I said, I can capture this, but I
• 9:36
  can't do it with nothing. K? I have
• 9:38
  to have I've got 19 pharmacies
• 9:41
  and, you know, little regional leaders who are
• 9:43
  doing a great job,
• 9:44
  but but put Craig into a regional director
• 9:47
  role,
• 9:48
  and he is just rocking. The guy's on
• 9:50
  fire,
• 9:52
  and he's great at developing his team. The
• 9:53
  other thing I had is
• 9:55
  pockets of excellence.
• 9:58
  Our Dubuque specialty pharmacy group not Dubuque. I'm
• 10:02
  sorry. Our, Genesys, which is in Davenport,
• 10:05
  Jason Hansel there, had really
• 10:08
  you know, and I did a big bang
• 10:09
  at Cleveland Clinic. I built a 100,000 square
• 10:11
  foot pharmacies.
• 10:12
  He did it incrementally a little bit over
• 10:14
  time and has the credibility with the physicians.
• 10:17
  So I put him in charge of all
• 10:18
  specialty pharmacy here. So we have the it's
• 10:20
  all about infrastructure.
• 10:22
  K? Craig is in charge of all pharmacy.
• 10:24
  Jason reports to him as in charge of
• 10:25
  all specialty.
• 10:27
  And,
• 10:28
  we didn't have the three forty b infrastructure.
• 10:30
  So Aaron Brownmiller, who,
• 10:32
  started with our accounting team in Mason City
• 10:34
  and did so, I put her in charge
• 10:35
  of all of it. And these guys are
• 10:37
  just running with it. I mean, I I
• 10:39
  can't even keep I now I just I
• 10:41
  get out of their way. I remove barriers,
• 10:44
  and I just
• 10:45
  watch in awe with how they crush everything
• 10:48
  that they touch.
• 10:51
  Oh, that's amazing. It's like you've got a
• 10:53
  dream team there that, you know, is really
• 10:54
  making big difference. So that's awesome to hear.
• 10:57
  Now looking ahead for 2026, what are some
• 11:00
  of the big priorities and headwinds that you're
• 11:02
  focused on?
• 11:03
  Yeah. You know,
• 11:05
  health care stuff, all your members. Right? I
• 11:07
  mean, you guys know that.
• 11:09
  The big beautiful bill, the Medicaid cuts, those
• 11:11
  those challenges,
• 11:13
  you know, and I'm not taking sides politically
• 11:16
  in anything if it's right or wrong. It
• 11:17
  just is. Right? And and folks are gonna
• 11:20
  have a challenge with premiums with the,
• 11:22
  Obamacare subsidies and all. Again, not saying it's
• 11:26
  right or wrong, but but it's challenging. So
• 11:30
  we you know, MercyOne has a pretty big
• 11:33
  goal of of,
• 11:35
  you know, several $100,000,000
• 11:37
  of of cost,
• 11:39
  containment stewardship
• 11:41
  over the next few years. And
• 11:44
  my experience
• 11:45
  is that,
• 11:48
  we can't
• 11:49
  cut our way to success.
• 11:52
  We have to grow our way to success.
• 11:53
  Now you can and I had to do
• 11:54
  this when I was at American Farm Association.
• 11:56
  They were losing money every year. I cut
• 11:58
  my way to short
• 12:02
  term making it financially and not having to
• 12:04
  make an offer manager or ours. But that's
• 12:06
  not sustainable. Then you have to grow, and
• 12:07
  we're growing
• 12:09
  the business,
• 12:10
  by tens of millions of dollars. So we're
• 12:13
  gonna continue to
• 12:15
  reinvest
• 12:16
  in,
• 12:17
  the areas that are successful
• 12:19
  and help MercyOne and Trinity
• 12:22
  achieve their financial goals. And, you know, it's
• 12:25
  great being part of Trinity,
• 12:27
  because,
• 12:28
  Damon Redding is our chief pharmacy officer there,
• 12:31
  and I've got great counterparts. I got people
• 12:33
  in Michigan who are doing really good,
• 12:37
  in specialty pharmacy and Loyola there in Chicago.
• 12:41
  And, we all help each other out, and
• 12:43
  we share things. And and I think the
• 12:45
  things we're learning and demonstrating here, we're gonna
• 12:47
  share with the rest of Trinity. And, we're
• 12:49
  gonna just keep that flywheel moving and and
• 12:52
  doing what we do in pharmacy. And that's
• 12:54
  that's bringing real revenue and control costs, improve
• 12:58
  quality,
• 12:59
  and safety. And I think the other thing,
• 13:01
  Laura, is I've talked a lot about the
• 13:03
  the revenue because that's the times we're in.
• 13:05
  Right? We we have to do that.
• 13:08
  But pharmacy
• 13:09
  is a clinical profession,
• 13:12
  and we did not have any pharmacists in
• 13:14
  our ambulatory clinics. And I just put one
• 13:16
  in neurology and endocrinology,
• 13:19
  and we're just seeing,
• 13:21
  you know, amazing things with our patients and
• 13:23
  patient education.
• 13:25
  Iowa passed a very important,
• 13:29
  practice act where
• 13:31
  we can now they call it standard of
• 13:32
  care. So
• 13:34
  I can,
• 13:35
  have worked with our medical staff, our system
• 13:37
  P and T committee, and say our pharmacists
• 13:39
  in these ambulatory clinics are going to do
• 13:41
  this for our physicians. And I don't have
• 13:43
  to have a collaborative where every physician has
• 13:45
  to sign off. We can just go through
• 13:47
  p and t, and those those pharmacists can
• 13:49
  now adjust doses.
• 13:51
  Eventually. We're gonna be doing refill authorizations. We
• 13:53
  did that when I was a Cleveland Clinic.
• 13:55
  And we're gonna really help our physicians,
• 13:58
  who are, you know, overwhelmed with lots of
• 14:01
  work. We're gonna take workload off them. And
• 14:03
  pharmacy actually,
• 14:07
  how do I say this? The the clinics
• 14:09
  in my previous job where I put pharmacists,
• 14:12
  the quality metrics were better. Everywhere we put
• 14:14
  a pharmacist in a medicine clinic,
• 14:16
  timed,
• 14:17
  therapeutic and hypertension was better, hemoglobin a one
• 14:20
  c's were better, everything was better. So that's
• 14:23
  that team based care that we're starting to
• 14:25
  do here in MercyOne. A lot of people
• 14:27
  have been doing it for a long time,
• 14:28
  but we're gonna be doing it here and
• 14:30
  growing that clinical presence, expanding our residency program.
• 14:33
  It's hard to recruit in pharmacy right now.
• 14:36
  You can buy it or build it. We've
• 14:38
  been buying it, hiring people. We're gonna build
• 14:40
  it. We're gonna we're gonna,
• 14:42
  create our own infrastructure where people wanna,
• 14:45
  do do be students with us. Students become
• 14:48
  residents. Residents become pharmacists.
• 14:51
  Well, residents are pharmacists. They become employed pharmacists.
• 14:54
  Yeah. Yeah. Absolutely. Wow. That's, you know, amazing
• 14:57
  to to think about that type of growth
• 14:59
  and building that type of internal pipeline as
• 15:01
  well, in building talent. I can imagine that
• 15:04
  will create a huge, huge
• 15:06
  influx of the right type of people, especially
• 15:09
  if they're brought up through the program and
• 15:10
  through the health system as well. What does
• 15:12
  it take, to to put together a residency
• 15:15
  program and, then expand it into something that
• 15:18
  you can, you know,
• 15:20
  I guess, grow your pipeline more meaningfully?
• 15:22
  That's a great question. And, you know, so,
• 15:25
  the American Society of Health System Pharmacists credits
• 15:27
  residencies,
• 15:28
  and they've got a lot of rules. I
• 15:30
  I'll be honest.
• 15:31
  They used to be really, really onerous. But
• 15:33
  then,
• 15:34
  Sam Calabrese, who is my associate chief pharmacy
• 15:37
  officer at Cleveland Clinic, he went to ASHP,
• 15:40
  and he's in charge of residency accreditation now.
• 15:42
  And he's like, guys, your rules are
• 15:44
  ridiculous. And, you know, in a community hospital,
• 15:47
  you don't have people who have written in
• 15:48
  peer reviewed journals. Some of their residency,
• 15:52
  requirements for preceptors were kinda silly and way
• 15:54
  too academic. So Sam's helped them become a
• 15:57
  little more rational, so it's not so onerous
• 16:00
  to start a residency.
• 16:01
  You know, so at the clinic, we had
• 16:03
  11 residents when I got there. Nine years
• 16:05
  later, we had 66.
• 16:08
  We're not as big.
• 16:09
  We're we added our work. We're gonna add
• 16:12
  residencies
• 16:13
  where the growth is in the ambulatory world.
• 16:16
  All of our hospitals will have them starting
• 16:19
  a residency.
• 16:21
  So yeah. So it's, in
• 16:24
  because now we've got corporate
• 16:27
  infrastructure
• 16:28
  consolidate some of that. At, you know, at
• 16:30
  Cleveland Clinic, Manning Leonard
• 16:32
  ran all my education, and she helped the
• 16:34
  sites with that. Yeah. I I'm passionate about
• 16:37
  pharmacy. I've been doing it a long time.
• 16:40
  You know, it's good also, Laura. I'm at
• 16:41
  a stage in my career where I've been
• 16:43
  around the block. I'm not trying to make
• 16:45
  a name for myself. I'm really loving
• 16:48
  growing the team we've got and seeing others
• 16:51
  succeed. I've been there. I've done it. There
• 16:53
  aren't many things I haven't done in pharmacy.
• 16:56
  So now,
• 16:57
  you know, I've done the Cleveland Clinic. I've
• 16:59
  done the CEO thing. I've done hims and
• 17:01
  hers. I can come to MercyOne and just
• 17:03
  help hardworking
• 17:05
  people,
• 17:06
  make a difference. And the the people here
• 17:08
  are just working their butts off and, you
• 17:10
  know, it's just great to to come in
• 17:13
  and bring my experience to to help elevate,
• 17:16
  our practice at MercyOne. It it feels good
• 17:19
  professionally to be at the stage of my
• 17:20
  career.
• 17:23
  That's great to hear. And, you know, definitely,
• 17:26
  fantastic to have that type of flexibility and
• 17:29
  credibility in the space. What do you think
• 17:31
  is the hardest thing you'll have to do
• 17:32
  next year will be?
• 17:34
  Well, you know, I'll be honest.
• 17:36
  Because of the success we're having,
• 17:39
  I'm not gonna have the hard things. The
• 17:41
  hard things, and I've had to do that
• 17:43
  when I was at Minnesota,
• 17:45
  are
• 17:45
  because of these,
• 17:47
  reimbursement challenges. Sometimes hospitals and systems
• 17:50
  have to cut staff, and that's, like, the
• 17:53
  worst thing you can do from a personal
• 17:55
  perspective because it's a tough economy. Right?
• 17:58
  And I'm not gonna have to deal with
• 17:59
  that because we're we're making money.
• 18:02
  So, I'm,
• 18:05
  really,
• 18:06
  limiting the negative by by accentuating
• 18:09
  the positive. So
• 18:11
  so, you know, we're gonna have that doesn't
• 18:13
  mean we don't have to be efficient. That
• 18:15
  doesn't mean we have to don't have to
• 18:16
  question every FTE.
• 18:18
  But,
• 18:19
  we're not gonna have to do the terrible
• 18:21
  things,
• 18:22
  because of the success
• 18:23
  that pharmacy is bringing to MercyOne
• 18:27
  and to Trinity. So it's a lot more
• 18:29
  fun to grow than it is to cut,
• 18:31
  Laura. So we're gonna grow.
• 18:36
  That's great to hear. It's always nice to
• 18:38
  be in growth mode. And and speaking of
• 18:39
  that, I can imagine there's a lot of
• 18:40
  different opportunities out there,
• 18:43
  for MercyOne to keep growing, especially in the
• 18:45
  pharmacy space. But is there anything you're zeroing
• 18:47
  in on where you see the most opportunities
• 18:49
  or or the biggest ways that you'd like
• 18:51
  to grow in the next year or so?
• 18:54
  Yeah. You know? So
• 18:59
  our regional areas ministries had been doing pretty
• 19:02
  good, but Des Moines was the it's our
• 19:04
  800 pound gorilla,
• 19:07
  and it had not been maximized
• 19:09
  at all for for,
• 19:11
  helping fill our specialty prescription. So that's where
• 19:14
  all my energy's been. But now that we've
• 19:16
  got the infrastructure,
• 19:17
  it's optimizing. It's it's looking at different clinics.
• 19:20
  It's looking at,
• 19:23
  if we change,
• 19:25
  some of our,
• 19:27
  family practice clinics to provider based,
• 19:30
  that gives us more opportunity
• 19:33
  to,
• 19:34
  maximize
• 19:35
  some of our our capture there. So now
• 19:37
  it's working with our dedicated medical staff leadership
• 19:42
  on what is the strategy and and how
• 19:44
  do we how do we grow more.
• 19:47
  You know, at some point,
• 19:49
  it'll be do we create mail order,
• 19:53
  to fill our employee health prescriptions? Because those
• 19:55
  are not revenue. Right? Revenue is outside
• 19:58
  its cost because we're self employed. So and
• 20:01
  that's more of Damon's job at corporate trinity
• 20:03
  is how do we maximize value.
• 20:06
  I've done that at Cleveland Clinic. We save
• 20:08
  $20,000,000 a year by filling our own scripts
• 20:10
  and not letting
• 20:12
  Caremark
• 20:13
  siphon our money off. You know, PBMs are
• 20:16
  I gotta be a little careful there. I've
• 20:18
  fought PBMs for so many years. I'm not
• 20:20
  a big fan.
• 20:21
  They offer really no value. They're middlemen that
• 20:24
  suck all the profit out leading to crushing
• 20:27
  retail and community independent pharmacies. So it's how
• 20:29
  do we take on more and more of
• 20:31
  that ourselves,
• 20:33
  and,
• 20:34
  eliminate the middlemen. So but that's more of
• 20:36
  a corporate thing. I can't do that at
• 20:37
  MercyOne because we're part of Trinity, but that's
• 20:39
  that's something Damon is looking at doing and
• 20:42
  that I've done at Cleveland Clinic.
• 20:45
  Got it. Absolutely. That's helpful to see. And,
• 20:47
  definitely, it seems like it can be a
• 20:49
  great way to continue to bring,
• 20:52
  the the pharmacy into the organization and keep
• 20:54
  the profits there. So,
• 20:57
  thank you so much for joining on the
• 20:58
  podcast today, Scott. This has been a fantastic
• 21:00
  discussion. I I really learned a lot as
• 21:02
  well as, you know, enjoyed speaking with you
• 21:04
  that your passion for what you do is
• 21:05
  very clear, and it comes through,
• 21:07
  in our conversation. So I I really appreciate
• 21:09
  this. I'm looking forward to seeing you in
• 21:11
  person in April.
• 21:13
  We'll see you in April. Thank you so
• 21:14
  much, Laura.