- Welcome everyone to the Becker's
Healthcare podcast series.
I'm Maria Moham, writer
and moderator with Becker's Healthcare.
I'm absolutely thrilled to have with me today Dr.
Nick Capi, director of Infusion Oncology
and investigational drug pharmacy services at the University
of California San Francisco.
Doctor, it's very nice to have you on the podcast today.
To get us started, would you mind please introducing
yourself and telling us a bit about your background?
- Absolutely, and thank you for having me.
As you mentioned, my name is Nick Capote,
and, uh, I live in San Francisco
and I'm fortunate to work at UCSF Health.
Uh, I am one
of the pharmacy directors within the pharmacy department.
We have a, a rather large pharmacy department supporting the
overall institution, uh, for clinical services
as well as research.
And fortunate to be able to call myself a team member
and oversee oncology infusion and investigational drugs.
You know, fortunate is a word I used when associating myself
with UCSF Health in terms of my background.
I'm also fortunate to have experienced a diversity
of practice environments, uh, and leadership styles.
Uh, being in leadership, the ability to gain a variety
of perspectives is really important to me.
Way back when I was doing my pharmacy school training,
the didactic portion of pharmacy, uh, I was in Memphis,
Tennessee at University of Tennessee Health Science Center,
and it was there that I gained a really just immense
appreciation for the clinical application of pharmacy.
It really opened my eyes to what pharmacists could do, uh,
on the healthcare team, uh, elbow to elbow with other,
uh, practitioners.
Uh, after that, I completed two years
of pharmacy residency training in Madison,
Wisconsin at University of Wisconsin Health, uh,
the big academic medical center there in Madison,
and that was a residency program focused on practice
and effective implementation
of change management and leadership.
After that, I took my first role managing acute care
pharmacy operations at Tufts Medical Center.
Uh, essentially what that means is getting the, uh,
medications and managing the processes for those medications
to our patients that are in our embedded inpatient units,
as well as to some of our outpatient areas, whether they're
procedural, uh, or, uh, infusion
or other outpatient clinic areas.
Um, during my time at Tufts Medical Center, I was able
to take on more responsibility over those three years within
the pharmacy department
and began the formation
of the first home infusion service for the system.
And then most recently, in 2022, I made the transition
to director of pharmacy role at UCSF Health.
So just over 3000 miles from Boston
where I've been for the past six years.
Uh, now I call San Francisco home,
and I'm fortunate to serve
as several pharmacy teams that I represent.
- Wonderful, wonderful.
Thank you so much for giving us that background on yourself
and what you're currently doing right now.
Um, two really jump into the questions today.
The first thing I really wanted to ask you is
what are the biggest issues you're following in
healthcare in 2024?
- Sure. Well, there's a lot of them, uh,
but I'll focus on a couple, uh, for the, uh, purpose
of time, uh, one of which is workforce trends,
and secondly, uh, what's going on in the payer space.
Uh, payers and insurance, uh,
and health plans are always keeping us on our toes.
Uh, so I'll start with workforce trends.
Um, specifically focusing on the pharmacy workforce is
that really is where I focus
and spend my day to day, um, within the pharmacy department.
Um, some trends to take note of is that applicants
to schools and colleges of pharmacy are down as well
as applicants to residency training programs.
So that, that's our pipeline.
And it's so important that we're not only making sure that
we have larger number
of applicants per fair within our schools
and colleges of pharmacy, making sure that we are, uh,
training the, the best and the brightest,
but also making sure that we have, um,
our training programs constantly fed
with those high quality, uh, applicants going
through our schools and colleges of pharmacy.
So, interestingly enough, uh,
there has been an obvious shift in other sectors
of pharmacy, uh, as well that are, it's just kind
of going in parallel with the trend
that I just mentioned in terms of applications being down
to schools as well as training programs.
Traditional areas of pharmacy have been, uh, hospitals
and health systems as well as community
and independent pharmacies, um, independence
and chains, I should say.
Um, but less traditional, uh, yet emerging.
More and more are pharmacists going to work
for drug manufacturers?
This isn't anything new,
but it looks like the, the trend is increasing,
and this is great.
We want to have pharmacists represented in the
pharmaceutical industry.
Uh, however we are seeing
that shift from the more traditional practice areas, one
of which i, I work in myself,
and so we're just trying to make sure that we have
a good sense of how that is affecting, uh, the pool
of applicants that we are ultimately looking for, uh,
for our needs, uh, in the health system to take care
of our patients within our practice model.
Um, I'll also note that management
and application of pharmacy services are more complicated
than ever, thus needing to, to bolster, um,
with high quality applicants and, and pharmacists.
And then another interesting
and related trend in the workforce is the regular closure
of train of chain
and independent pharmacies, uh, though
for different reasons when you compare chain versus
independent, so independence, uh, it seems like a lot of
that is related to the closures of, related
to if those locations are, continue
to be financially viable.
Um, there's a lot that goes into it.
Reimbursement models as well as competition in addition
to the availability of pharmacists and pharmacy technicians.
And then second to that, focusing more on the change.
You're seeing a lot of consolidation of locations, brick
and mortar locations.
You're seeing, uh, various pain pharmacies,
specifically I'll, I'll call out Walgreens,
leveraging robotics automation and central fill.
Uh, in fact, in 2022 in October,
there was a Wall Street Journal article pointing out about
Walgreen's strategy to centralize and leverage automation
and robotics to, uh,
support their pharmacy operations, uh, nationwide.
And what that's translated into it looks like is, uh,
some consolidation of some physical pharmacy locations, uh,
potentially threatening access pharmacy services.
And then the second trend that I'm monitoring has to do
with payer activity, specifically as it relates
to shifting patients to sites of care that payers, uh,
deem to be lower cost.
And my position is that there should be incentives in place
for a shared provider and patient decision when a patient
is, say for example, getting an infusion,
the health system should be doing everything it can
to promote access while ensuring safety
and effectiveness of therapy.
Um, however, when a payer has a policy that places a lot
of risk on the health system, by shifting those patients
and their infusions to a, uh, say, site of care
that's lower cost for the payer, um,
while the health system is still acquiring
and handling an incredibly expensive, uh,
and complicated drug, uh, the safety profile of that episode
of care has to be considered.
We are seeing more and more monoclonal antibodies, uh, types
of medications that produce a higher immunogenic response
than most other class of medications being forced decisive
care that are typically less equipped to manage or
or less familiar with these therapies.
So these shifts can be prob problematic as the bottom line,
uh, when mandated, uh, without that shared provider
and patient decision making.
My hope is that we can establish our own infrastructure fast
enough to minimize any negative impacts to our patients.
The silver lining in all
of this is health systems are incentivized more than ever
to invest in their own infrastructure
to meet the patient where they are.
I just wish the patient provider could decide which resource
that the health system they should
utilize rather than the payer.
But we are moving in the direction
of making a more well-rounded side
of care strategy in the example that I gave.
So those are a couple trends that I'm watching,
but many more that
we probably don't have time for today.
- Yeah, yeah, absolutely. Thank you so much for sharing.
That is very insightful, um, especially
to me in our audience.
The next thing that I wanted to ask you about,
and maybe you kind of answered it already in the,
in the last question,
but what are you most excited about right now
and what does making you nervous,
whether it's something you're dealing with, um,
in your job description or something that you're watching?
- So I'm a bit of a technology nerd,
and I really like the technical side of any process.
Um, in fact, before I was a pre-pharmacy major,
I was a mechanical engineering major,
and I still have that technical interest today, uh,
that drove me to potentially consider an engineering major.
So I guess I'm most excited about technology
and what promises it might hold for healthcare.
Hospitals and health systems have traditionally been slower
to adopt these technologies for a myriad
of reasons we don't have to get into.
But the bottom line is artificial intelligence,
what everyone is talking about it,
it will impact healthcare in one way or another
and hopefully for the better.
Um, the reason I'm
so confident in this projection is I understand the iter
iterative cycle of this technology
to be much faster than any technology we've seen before.
While other technologies have iterated on themselves
o over the course of years,
this one is iterating on itself over the course of months
and will probably continue to get faster,
um, to maybe weeks.
Uh, it seems like so many people are working on solutions.
Uh, a friend of mine who lives in the Bay Area, um, close
to me who I was with just this weekend,
is working on an AI enabled technology
that would allow practitioners in the primary care
environment specifically
to research the most evidence-based options
for patients faster than ever, sift through the guidelines,
sift through the evidence, and integrate those decisions,
uh, into their practice, into the health record, uh,
technologies that we are adopting, uh,
as soon as they hit the market.
So not so much the artificial intelligence probably being
slow to adopt in healthcare,
but technologies that we are adopting that make me excited,
uh, are promising and very complex drugs, uh,
specifically in the oncology world, bispecific antibodies
and chimeric antigen receptor t-cell therapies
while CAR T has been around since 2017 with the introduction
of Kymriah, we literally have hundreds
of these in the drug pipeline now for, while we only had
to worry about a couple, we have many coming at us in the
coming years that are looking at FDA approval potentially.
Uh, and for many disease states more than just cancer.
Uh, at UCSF, we are working on improving the care journey
for the patient by allowing an outpatient episode
of care for these therapies.
So that's specifically, uh, what we're working on,
not only adopting these as fast as we can
where they make sense within our care portfolio, um,
but also allowing an outpatient episode
of care rather than keeping
that patient confined to a hospital bed.
So those are just some examples of things I'm excited for,
things that we're working on, um,
and what's to come hopefully in the future.
- Yeah, yeah, absolutely. Thank you so much for sharing.
And doctor, before I let you go, the last thing I wanted
to ask you is, what would the most effective healthcare
leaders need in order to be successful in the next two
to three years, would you say?
- I think the biggest thing for me is I think about the team
that I support and
as I observe friends within my own organization
and the organizations that I've been fortunate enough
to be a part of and serve, is willingness for leaders
to invest in their people through the development
of transferable skills.
So more specifically,
what worries me is the continued exodus from certain sectors
of healthcare or healthcare altogether by folks
who have simply become disengaged from their current roles
and see no way through, uh, their current role
because either they've maxed out, uh, in terms
of their advancement or they just don't have the skills
to self-perceived more than anything
that they don't have the skills to advance in a way that
they would want to, or they just don't know
what the next step for them could be.
So, you know, some examples of transferable skills
that I'm talking about are, it sounds simple,
but it's actually quite complex, is how to implement change,
how to take a process or problem, identify the root issues,
and put together a team
and a scoped approach for that team
to tackle, uh, and improve.
And it doesn't have to be done in a vacuum,
but to be able to take a problem, break it down
to its simple parts and move forward.
And effective change is I think one
of the most important things
that our healthcare system needs.
And that transferable skill is incredibly important.
I think also how to navigate the politics
and bureaucracy of an organization.
Every organization has them, whether we want to admit it
or not, but few people are equipped
to handle these effectively.
Uh, it's stressful situations,
but there are also potential high opportunity situations.
A mentor of mine once told me
to never let a good crisis go to waste.
Um, so you've seen a lot of good advancements come out of
what initially seemed like a crisis.
Uh, you can see the covid situation as an example.
While of course it was detrimental society
to society in a myriad of ways,
there had been some really significant practice
changes that have come from it.
Uh, and finally the, the last transferable skill
that I'll touch on is how to establish
and build a network over time.
A lot of people aren't taught this, uh,
but it's really effective in bringing back new ideas
for consideration and keeping
that engagement within your own practice
or profession really fresh.
So I'll just reiterate that I think the most effective, uh,
healthcare leaders need to be successful,
or whether it's healthcare leaders
or aspiring healthcare leaders, it's that willingness to,
to find or if you're a leader, to invest in their people
through the development of transferable skills.
- Wonderful. Yeah, I really appreciate you talking about
everything that we discussed today
and for those final thoughts.
It's definitely been an amazing and informative discussion.
So again, I wanna thank you so much
for coming back on Becker's Healthcare, um,
and I look forward to connecting with you again soon.
- Thank you so much. It's been my pleasure. .