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Improving Pharmacy Business and Patient Care During, Following the Pandemic

December 14, 2020

By Julie Gould  

David Chen, BS Pharm, MBA, assistant vice president for pharmacy leadership and planning, ASHPDavid Chen, BS Pharm, MBA, assistant vice president for pharmacy leadership and planning, ASHP, discusses how pharmacy business has been impacted by COVID-19, new ways health system pharmacies have adapted during this trying year, and what pharmacists can look forward to in the new year, including what can they continue to do or do differently to help with everyday workflow and patient care.  

Can you talk a little about how pharmacy business was impacted by COVID-1?

As you're aware, hospitals and health systems are very complex organizations when it comes to the pharmacy enterprise. It's not only the acute care, it's the emergent and urgent care, too. It's also the ambulatory care. It's the community pharmacies that hospitals and health systems own, and then specialty pharmacy and home infusion. When you look at the full enterprise, we're affected with COVID. 

For our pharmacy leaders, I always like to describe it as there are pharmacy leaders who are dealing on two fronts. It's the challenges that are immediately in front of us. It's dealing with the COVID pandemic, developing and implementing models of care, just manage scarce resources, the medications, and all the emergency use authorizations. As well as managing the health care workforce, their wellness, their tenacity, and all the things that are impacting just the ability to engage, maintain a workforce that is increasingly becoming fatigued. It's also managing the challenges around us.

The more global economy, the general health care recovery for the health system itself, the impact of unemployment, the growing trends of mental health challenges in our society, as well as the IT evolution that went from a conversation to an implementation with things like telehealth. 

Then other marketplace changes that we're all working with and through as non-health-system-based providers are entering the marketplace, especially around the use of medications, in a way that they weren't in the marketplace before. 

We like to frame it when we talk with our leaders is that what we're dealing with a three-pronged process, really. It's the process of recovery, redesign, and reimagining what will practice look like. I like to categorize it really in five categories. 

Our pharmacy leaders are having to look at the business. How do they continue to contribute to the financial stabilization and growth of the organization, based on the circumstances? How do we sustain the pharmacy enterprise through those innovations? The answer is scale. How do we scale through leveraging telehealth, whether it's on inpatient rounding, or whether it's reaching a patient with chronic disease management in their home? How do you scale that up? 

Also, how do you scale up with operations with things like we're dealing with now with the monoclonal antibodies? How do you help support building infrastructure around that, managing it?

As we all know with the vaccine supply, that could be a whole conversation in and of itself of just how to build that supply chain and ensure that it's safe, that supply is where it's going to need to be, and that you're ensuring that the supply is actually, the integrity of the supply, because of all the special conditions around it?

I think the third area is where pharmacists have been really strong advocates for their patients. It's just ensuring that patients have timely and safe access to medications is another part of this, with patients not being able to come in for routine visits in the way they have in the past.

Then also, making sure patients are getting medications and that their care is continuous through refill management, follow-up visits, and all of those type of things, based on what was happening with the hospitals, and hospitals having to, along the way, make decisions about what services they were able to provide all through the COVID pandemic. 

I would say the fourth area is just responding to external factors and just relooking at partnerships and advocacy.  

Then the last is just how do we continue to support the resilience and well-being of the pharmacy workforce. Like all the health care workers right now, it's a pretty tremendous weight that they're all bearing to make sure that our patients, our populations, are being taken care of. 

I guess that's really a high level of how the business is being impacted and the five areas that leaders are really having to think through and develop strategies around in order to really recover, redesign, and reimagine the pharmacy enterprise in today's environment. 

What should these health system pharmacists or owners, if we're looking at a different perspective there, be aware of in terms of just bettering their business and bettering the care for patients?

One, it's, I guess, consistency and constancy of services, with the additional pressures of what's happening in trying to implement all the COVID-related activities.

Going back to the five areas that I just mentioned, one, it's looking at the continued where patients are treated and evaluating how to do that effectively and safely to maintain patient engagement, maintain management of patients within the health systems. 

Really, looking at where those services can potentially even be expanded. Even the federal government's getting involved to try to facilitate this, with Hospitals Without Walls, relooking at payment models for providing medications in the home. 

Health system leaders and the pharmacists caring for these patients are going to need to understand and keep pace with what's happening in those changes and facilitating making sure that patients can actually get the care that they need and serve as those patient advocators, advocates, and serve as those patients' financial counselors and care management counselors for the medication component and the bridging between the other professionals taking care of these patients. 

I'd say looking at how to make best use and integrate the tools that we have in front of us as we have to evaluate patients in alternative sites of care, because patients may not necessarily be able to come to the hospital or health system sites of care to be able to maintain services for those patients.

I think in the area with community pharmacy, because hospitals across the country collectively own and operate hundreds and hundreds of pharmacies associated with these hospitals and health systems, is adapting to things like more home delivery. 

How do you manage limiting campus site visits? How do you manage curbside pickup? All of those types of things, so that you can maintain the business part of managing those pharmacies, but also enabling your patients to be able to reach you and get the care that they need.

The other piece is just the consistent reassessment of just general cost containment efforts as we're looking at how business is being operated. That's tricky, because there's been a lot of conversation about you have increased costs with drugs like remdesivir coming into the health systems. 

You're having some decreased costs on other sides, if their non-essential surgeries are being rescheduled. How do you put all that together to ensure that your cost management is being done? Really, a lot of scrutiny and reevaluation along the way as things change on where you need to manage your costs. Also, where your costs are going up, where your costs are going down, and just trying to make sure that you contain those costs. I think the other area is then how do we continue to work with our students and our residents with a lot of the changes in health systems, is that fortunately, in pharmacy, with a lot of the health care professionals, we have a lot of extenders with our students and residents.

As we look at things as the additional manpower needs for managing, when you look at the steps and the level of high touch that's going to be necessary with the vaccine management, how do we leverage those students and residents to help with these processes and really get them trained up and in position to help support the pharmacists because of all the other care needs that the pharmacists are taking care of? 

I think that's going to be another area that a lot of health systems are looking at. They're building what we like to call layered learning models that were already in place, but how do we further expand that into the needs around the COVID demands? 

This has obviously been a very trying and interesting year regarding new ways on how to adapt. What can pharmacists look forward to in the new year, and what can they continue to do or do differently to help with everyday workflow and patient care? 

One we touched a little bit on is with telehealth. I think what we have to look forward to, although there's a lot of pieces that we need to get into place. 

For example, with telehealth, we need to continue advocating for some of the HHS rules to allow us to have, for example, telehealth physician supervision rules in place to enable things like telehealth. 

How do we further work with our patients that may or may not have the electronic infrastructure to be able to access telehealth, and how do you put all that together, even though we know a lot of telehealth is just some of the rudimentary or basics with phone connectivity? 

I think one big thing is just things that we'll be looking forward to are just further optimization and utilization of distance technologies and becoming more efficient with how workforce engages with our acute care processes, because there'll still be some of that. 

Even though pharmacists are at the bedsides, pharmacists doing rounds, pharmacists are doing the direct patient care, but there's also the need to balance just where your workforce is. There's going to be adjusting to just how work is done in the new paradigm that we call health care being operationalized in the world of the COVID pandemic. 

There's going to be, for pharmacists, a lot more, especially in health systems, looking forward to opportunities around working with populations and continuing to provide the expertise in these very complicated therapies that are coming out with these emergency use authorizations. 

How we continue to provide that expertise with vaccination rollout, vaccination administration, the complex therapies that are involved with monoclonal antibodies, and all the different drugs and comorbidities that come with COVID patients as they're admitted to hospitals. 

What we have to look forward to is all the professions -- physicians, nurses, respiratory therapists, pharmacists -- we're all in the same boat, learning together, on how to manage patients with new technologies and in this new environment. 

I think that that's going to create an opportunity, because everyone's open to how do we get through this? How do we do it effectively, efficiently, and how do we take care of the most patients all the time, under very stressful conditions? I think that's something that may not sound, in a way, looking forward to, but I think it's looking forward to an opportunity to find those solutions. 

I think the other thing that we have looked forward to as pharmacists is just continuing and growing and filling that need as patient advocates and medication access, navigators, and clinicians all rolled up in one as we continue to work with our patients in dealing with what we're dealing with in today's environment. 

Some of the areas that I think we'll be looking forward to continuing engaging in are three. Really, again, continued engagement in the public health components of things that are happening out there. There are things that haven't stopped being part of the stressors in our society. Those are things like the opioid epidemic and the growing behavioral health needs that are resulting from COVID. As I mentioned before, there's going to be the continued growing roles and initiatives like antibiotic stewardship. 

Then the new skills and the expertise that exists with things like ICU and critical care. Then an area I touched on before, just population health. I think there's going to be new opportunities to leverage this newfound mobility of staff and openness of all providers and patients with the use of telehealth. 

It's really going to reach a tipping point that's going to create new opportunities for pharmacists to become more engaged in population health initiatives as we take care of the communities around our health systems. 

About David Chen

David Chen, BS Pharm, MBA, is the Assistant Vice President for Pharmacy Leadership and Planning at ASHP. He works with ASHP members that are with pharmacy practice leaders and that are chief pharmacy officer, pharmacy directors, managers in multiple levels within hospitals and health systems. He also works directly with leaders in hospital and health systems and specialty pharmacy leadership and practitioners.

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