- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Neil Gilchrist,
vice President of Pharmacy Business Operations at Beth
Israel Lahey Health.
Neil, it's a pleasure to have you on the podcast today.
- Great. It's exciting to be here.
- Absolutely. You know, I'm looking forward
to our discussion because I know there's
so much happening in the pharmacy space right now,
and it, it is really such a important aspect of healthcare
and evolving quickly, and so I'm looking forward
to learning more about what you're doing at
Beth Israel Lay Health.
But before we dive into my questions,
can you tell us a little bit more about yourself,
your background, and the health system?
- Absolutely. Um, as you mentioned, my name is Neil Goku.
I'm currently in the role of Vice President
of Pharmacy Business Operations
for Beth Israel Leahy Health Pharmacy.
Um, I've been in health system pharmacy really
for the past 20 years.
A number of different roles from direct patient care roles
and varying leadership roles.
Most, uh, recently as Chief Pharmacy officer
for a multi-hospital health system, um, I believe my, my,
you know, my background in direct patient care role
as a critical care clinical pharmacist really gave me the
opportunity, um, to develop some of my leadership skills.
Uh, it's, I think, think really important
as a healthcare leader to understand
and see the other roles, uh, in a health system
and working side by side with physicians, nurses,
radiologists, respiratory therapists,
many other healthcare providers,
really influenced me early on in my career to see how
that teamwork is so important to the delivery of healthcare.
- Absolutely. I love that. And definitely, you know,
is such a, a fascinating way to, um, get that experience
and, and certainly carry it into the leadership roles.
Now, I was wondering if you could tell me a little bit about
the pharmacy program at Beth Israel Lehe
Health, what makes it so unique?
- Absolutely. So Beth Israel, Lehe Health, um, just
to give you, uh, an overview
of our system is a 14 hospital health system that's
geographically located in the Boston Metro Boston area,
Massachusetts, and in Southern New Hampshire, uh,
our system employs approximately 39,000 caregivers,
including 4,700 physicians.
Um, the system overall has about 2,500 inpatient beds,
and we see over 4.1 million outpatient visits
and 407,000 ed visits a year.
So a fairly large health system, um,
that also is complimented by our pharmacy program.
Uh, our pharmacy team is, uh,
over 1500 team members across the system.
And what makes us unique really is
how our pharmacy department is structured.
Uh, each of these hospitals,
the 14 hospitals have a dedicated inpatient pharmacy along
with some sites operate outpatient
infusion pharmacy services.
Um, those local pharmacy teams are focused on the acute care
patients that are in the hospital,
in the emergency department, inpatient beds
or critical care or areas.
Um, but beyond that, the acute care programs, uh,
really roll up under the system pharmacy corporate team.
We have approximately 350 team members focused on
the ambulatory care programs.
These programs really span across ambulatory clinical
pharmacy services, so seeing patients in the clinic,
specialty pharmacy program, our retail pharmacy services,
and then our additional services included medication access,
that could be prior authorization, financial assistance,
renewal services.
Uh, if I could talk a little bit more about our,
our corporate office as well, which is based out
of a 120,000 square foot office
and central service center dedicated
to these pharmacy programs.
Um, we have a fairly large fulfillment area,
20,000 square foot fulfillment pharmacy with automation
that can fill up over 10,000 prescriptions per day.
And then we, uh, complimented as well
by a large distribution center with a warehouse
that really allows us to navigate drug shortages
and make strategic purchases.
So those are kind of the, the i, the, um, ideas
that are the areas that really are unique to our program.
- Yeah, absolutely. That's amazing to hear.
And certainly as you mentioned, so many of those different,
um, aspects of the program can be essential
and I know health systems are looking at ways to continue
to optimize and really combat, as you mentioned, trying
to figure out processes
around prior authorizations especially, as well as, um,
drug shortages and leveraging technology to automate more
and, and really become more efficient.
From your perspective, which projects
and initiatives are you most
excited about for the next year?
What do you see as being really, um, essential in order
to continue your success?
- Yeah, we have a lot of projects
and initiatives underway, um,
and I think of them in really three categories.
Um, the first is really what have we already developed
or built and how do we grow those programs.
Um, the second is more focused on our, um, clinical programs
and go more into the space of health equity.
And then third would be around business development.
So if I could take a few minutes to kind of walk through
what some of those projects are, um,
I think would be helpful, uh, for listeners, the,
the first is around, um, our current business lines,
and so that would be our specialty pro program
and our retail pharmacy programs as well.
We have seven retail pharmacies across the system.
Um, and, uh, these programs really, uh,
are in their growth phase right now where we're able
to extend our services to more of our patients
that we serve, uh, as well as our, our caregivers, our,
our team members across the system.
Um, we're excited to launch, uh, as well
to complement these programs, uh, pharmacy based app
with a partner, uh, this year
and that will really help
to drive an optimal di digital experience
for our patients and and colleagues.
Um, under the category of clinical programs,
we have over 40 ambulatory clinical pharmacists
that are supporting our primary care and specialty clinics.
Um, and the past year really has been a focus
around a cardiometabolic space
and how do we ensure that patients have access to some,
uh, pretty innovative drugs in the space of SGLT twos
and GLP ones,
and how do we reduce some
of the disparities in health equity to make sure that some
of these underserved communities
or populations of patients can have access
to these therapies.
And so there's been a lot of focus on that.
We're really excited to move into the space of
a pharmacist led system-wide anticoagulation program
over the next year, as well
as a remote patient monitoring program that's managed, um,
by pharmacists and working closely
with our physician colleagues.
Um, so those are two clinical programs
that are really just coming together, um,
over the next, uh, six months.
Um, and then last, uh, is really exciting is
around business development.
Uh, we will be launching, uh,
later this year our own pharmacy benefits management
or PBM uh, product.
Our team really has built out that infrastructure
and data analytics to support our health system
initially with this solution.
And then looking further at
how we can support other health systems
and plan sponsors to maximize financial management.
So there's that aspect
of business development is is a PBM solution.
And then lastly is the area around rare diseases,
which really is a, a growing space.
If you look at 2023,
there were about 40 new rare disease
therapies that came to market.
Um, and these range from a few thousand dollars up to two
to $3 million for a single dose.
And these therapies can be life changing, life saving,
however the population size that, uh, are eligible
for these drugs can be anywhere from under a thousand
patients to under a hundred patients.
And how do you connect that lifesaving therapy,
a life changing therapy to this really small population?
It's, it's a different model here
where you can't just have pharma send out a large sales team
to educate everybody about them,
but as health systems, we have this data about patients
that, uh, may have been diagnosed with the disease state,
that single patient at your health system,
or, uh, they may have tests
or biomarkers that could be indicative of the disease.
And we're in a position as health system to connect those so
that we're looking at a solution to be able to help navigate
that rare disease space.
- Well, that's fascinating to hear
and certainly, you know, some great things
as you mentioned that are happening.
I wanted to question just one bit further.
Looking at the business development side,
especially in developing
and then now be need to offer the PBM, um, what was it like
to build that infrastructure out, um,
within the health system?
What did it take, how long I,
I guess were you working on building that
and then too, you know, on the data analytics side,
how do you see that really, um, coming to fruition
and what does it take to build this, I guess, product that,
um, is now beneficial for the health system
and you're ready to, um, work with others on as well?
- I, I think I would answer both of those questions kind
of together, is that it's all really built off
of the foundation of a strong
pharmacy dedicated infrastructure.
And this is really important is that you need
to have those internal data analytics team.
We have our own data warehouse
where our electronic health record feeds into, um, so
that we can really, um, pull that data much more nimble
and quickly and be able to make decisions based on that.
It also is complimented, uh, in our program,
which I think is unique, is having a strategy
and business development team within pharmacy
with project management team members.
We have a marketing communications team in finance,
and how do you pull all that together under pharmacy
to be able to, um, use data to quickly make decisions,
develop a strategy around that data,
and then activate the team to be able
to implement those objectives.
And so thinking about the, the PBM aspect
or the rare diseases, um, is you really need to, um,
have those, the, those resources available to move quickly
and that it's a two year journey or so,
but um, if you have the right pieces to pull together,
you're able to move much quicker.
- Absolutely. I, I love that. And it's just so helpful
to understand and see kind of that process
and like you said, that strong, uh, pharmacy department
and strategy background.
Now, before we wrap up our conversation here,
I was wondering, um, if you could speak to, you know, some
of the different headwinds that you're keeping your eye on,
um, right now, what's really top of mind for you?
- Sure. Um, I, I think for all many,
if not all health systems across the country, uh,
I think top of mind is financial challenges
of health systems with reduction in reimbursement,
the inflation costs for supplies, medications, and,
and labor as well.
Uh, I think everybody is faced
with these financial challenges,
and so that really influences a lot of the decisions, uh,
that are going into health systems today.
Uh, that may also, uh, is influencing, um,
capital investment decisions.
And so how do you build out programs when there's such a
tight capital environment right now?
Um, so financial challenges is definitely top of mind.
Um, it's hard to ignore kind of the, the, uh,
what's occurring right now over the past week
or so with the significant change, healthcare, cyber attack
and thinking about cybersecurity.
Uh, I do think that that that is a headwind
that we will continue to be challenged with.
And how do our health systems, uh, navigate
that moving forward with this current landscape?
Um, drug shortages continue to be a challenge.
They have been for the past 15 plus years,
and they've only gotten worse
where drug shortages may not be, uh, as many new ones,
but the shortages that are occurring are continue to occur
still primarily in the generic sterile injectable product
space where it's impact
and it inpatient care really challenging
for acute care pharmacy services.
Um, on the ambulatory side, we still see shortages.
Um, right now we continue to see amphetamine products
for A DHD and then the surgeon in demand
for medical weight loss with GLP one medications
that's impacted care for diabetes patients as well
as those trying to access this drug class
for weight loss, um, therapies.
The last couple headwinds really, um, PBMs
and DIR fees is definitely an area that
continuing to look at.
There is a lot of bills and discussion around PBMs
and discriminatory pricing, uh,
and any willing provide laws.
And so continue to watch PBMs on the DIR fees.
We are in kind of this first quarter phase of 2024
where we are seeing DIR fees assessed from the end
of last year as well as at the point of sale now
with the change of how that program works.
And the final headwind, which is a significant one,
is really the evolving landscape of the three 40 B program
and how pharma PBMs state Medicaid programs
and health systems, uh,
are gonna navigate the three 40 B program changes,
um, for the years coming.
- Absolutely. I, I think, you know, you such hit,
hit the nail on the head so well, in terms of some
of the ongoing challenges,
whether they're the financial challenges
or the shortages that have plagued the healthcare system
for a while and being able to deal with those plus,
you know, some of the new cybersecurity issues
and the evolving three 40 B program.
How do you really make sure your team, um, stays focused
and energized and motivated amid such change
and transformation and uncertainty too within the landscape?
- Yeah, it's very challenging in the landscape.
Um, I, you know, I, I think we need to make sure
that we're connecting back with our, uh, team members
that are doing the work every day.
We often refer to frontline team members
or direct patient care team members.
We need to ensure that we're connecting
with our team members at all levels
and that information is flowing up to leadership
and that we're also effectively communicating to all
of our team members to make sure that there's alignment.
Um, we can't change the direction
of the ship if we're not communicating to our team.
Um, and so that's critical to, uh,
being successful in this environment.
- Absolutely. Well, Neil, thank you so much
for joining us on the podcast today.
This has been such a fascinating and insightful conversation
and I look forward to connecting with you again soon.
- Thank you for having me on. Appreciate it.