Healthcare Leaders Are Redefining Hospital Pharmacy

Faced with pharmacy closures and struggling to make ends meet, health system executives are innovating pharmacy operations to cut costs, reduce waste and give the pharmacist a bigger role in care management.

KEY TAKEAWAYS

- Some 375 independent pharmacies and 1,000 chain pharmacies closed in 2023, and experts expect similar numbers this year.

- Healthcare organizations are reacting to these numbers in two ways: They’re automating pharmacy services to reduce costs and waste and using pharmacists instead as a member of the care team.

- Executives say the pharmacist can help clinicians better understand what medications a patient should be taking and help with medication adherence and management.

For an increasing number of hospitals, the path to healthcare innovation leads through the pharmacy.

Whether it’s to keep the doors open in a rural region or address care gaps brought on by retail pharmacy closures and disruptor drawbacks, healthcare leaders are taking a closer look at hospital pharmacy operations. Some are eyeing a hub-and-spoke drug distribution model to cut costs and waste, while others are making the pharmacist a more active member of the care team.

“We’re definitely more involved in patient care,” says Jason Tipton, inpatient operations supervisor at Carle Foundation Hospital, part of the Illinois-based, eight-hospital Carle Health system. “Basically, what it boils down to is safety.”

Carle Health turned to digital health company DrFirst to improve medication management through the pharmacy. The AI-enhanced tech platform helped health system executives boost efficiency by at least 16%, cutting down on long hours spent in front of a computer or on a phone talking to doctors and retail pharmacies, searching through patient histories and matching the right prescriptions and drugs to the right patient.

Tipton says the health system has not only reduced medication errors, but identified the barriers that keep patients from filling out their prescriptions or following doctor’s orders. By integrating that platform into the EHR, pharmacists were able to work with the care team to identify the right medications, including doses and frequency, check for side effects and potential interactions, even make sure the patient fills out the prescription.

According to the health system, the technology has helped Carel Health improve medication management and reduce stress on its pharmacy staff, to the tune of roughly 1,209 acute care hours saved annually.

[Also read: Is Pharmacy Expansion an Effective Rx for Health Systems?]

While the issue of pharmacy closures and deserts has hit the front pages recently, Tipton notes the problem began during the pandemic, when pharmacies were struggling to keep up with the surge and patients were looking to their providers for help. Health systems like Carle Health saw the opportunity not only to improve patient engagement then, but to plot a long-term strategy to boost that business line.

Hospital pharmacists and pharmacy technicians “have always been involved in that process,” he says, “but this was a chance to be more of a part of the care team. And physicians liked that as well. After all, if [patients] aren’t getting their medications [or they’re not following doctor’s orders], they’re going to show up in the hospital.”

TAKING ON PHARMACY INNOVATION IN A RURAL HOSPITAL

In Virginia, a reimagined pharmacy was the key to the July 2021 reopening of Lee County Community Hospital, which had closed its doors in 2013.

Executives say the hospital in Pennington Gap, which is part of the Ballad Health system, reopened due to public pressure: There just weren’t that many healthcare options in the rural region dividing southeast Kentucky and southwest Virginia. But with that opening, which cost the health system roughly $15 million, came pressure to cut expenses, reduce waste and improve care delivery.

And that meant an automated virtual pharmacy.

“In pharmacy, we've really learned [that] everything that we do is expensive,” says Trish Tanner, vice president and chief pharmacy officer for the 20-hospital health system. “My people are expensive. My drugs are expensive. My equipment is expensive, [and] it's really hard to recruit here, so [we are] trying to find ways to be innovative and bring that same level of care to patients regardless of where they're located.”

Instead of having a pharmacist on site, Lee County Community Hospital has an automated drug dispensing system and a remote order entry platform, as well as a telehealth platform that includes medication management.

Eighteen of Ballad Health’s hospitals are now on this platform, with the last two expected to go live by January of 2025. From a central pharmacy, drivers visit each hospital to refill drug cabinets, check expiration dates, and do any other tasks needed.

“We can’t put a pharmacist in there,” Tanner says of Lee County, though she could be talking about any of the small hospitals in the health system. “We're able to redeploy the pharmacist who would be there to other tasks that aren't currently being met, our greatest one being medication reconciliation.”

Through a telehealth platform and a focus on community engagement for the providers who do work at each hospital, Ballad Health officials say they’re able to improve quality of care and keep each hospital’s doors open.

“What is [important] is that we really know our patient population and the drugs that they're typically on,” Tanner says. “And while I don't have a pharmacist physically at bedside at Lee County, we do have them virtually.”

The telehealth platform gives providers an opportunity to dig into the data on a patient’s care management needs and find ways to close care gaps, whether it’s finding a more affordable prescription or developing a routine to ensure that a patient takes their medications when expected.

“50% of the country is not following doctor’s orders right now,” Tanner points out. “That’s a huge outlier for any hospital, especially a rural hospital that is trying to watch its costs. So we've worked really hard to make pharmacy services [as] seamless as possible for our patients on their journey [and] for our physicians across the organization.”

Marvin Eichorn, Ballad Health’s vice president and chief administrative officer, says the pharmacy is the ideal use case for today’s digital health innovations.

“In today's world it's very difficult to recruit almost any position,” he says. “So if we can maybe do it [with] robots or other technology or maybe off-site somewhere, that can provide [a benefit] to the hospital. And then we can use [the money saved] to focus on other areas of care, to make care better.”

EXPLORING PAYER COLLABORATION

At Baptist Health in Kentucky, officials recently cut the ribbon on a new, 102,000-square-foot central pharmacy aimed at reducing costs and clutter in the nine-hospital network and improving the supply chain. The health system took a good look at how UPS handles things to develop its central pharmacy strategy.

Baptist Health also launched a partnership with Clearway Health, a company that focuses on improving specialty pharmacy operations.

With independent and chain pharmacies struggling and patients wondering where they’ll get their next prescription, Nilesh Desai, Baptist Health’s chief pharmacy officer, says it was imperative to look at each patient’s entire pharmacy journey, not just the part that intersects with the hospital.

“It's better for them because they're coming to see our physicians, our providers, and they're like, ‘Hey, you know what? I'd rather see my own pharmacist,’” he says. “So then maybe we can answer their questions or make a phone call. It really makes it easier on all fronts.”

Key to the Clearway Health partnership is access to the payer market, which is also keeping a wary eye on the pharmacy turmoil. Desai notes that health plans are affected just as much when a member can’t or chooses not to fill a prescription.

He says it’s important for health systems and hospitals to work with payers to make sure patients/members have access to pharmacists. That includes understanding payer networks and adjusting to give hospital pharmacists and pharmacy technicians more opportunities to impact care management.

“There is a provider shortage, there is nursing shortage, [and] medication management in general has become very, very complex,” he says. “You need someone who's an expert, who understands medication all the way through. Who better than the pharmacist?”

Desai says the workforce shortage will only get worse over the next three to four years – there’s a 65% shortage in pharmacy school applications now. It’s up to the healthcare industry to address that, not only by working with medical schools to boost the pharmacy tech pipeline but to take on more pharmacy services.

“Sometimes we do the reverse,” he says. “We've called the patients at home to say, ‘Hey, how's the medication working on you? Are you having any issues?’ So, having that continuous dialogue is going to be very, very important.”

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