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- This is Laura Dedo with the
Becker's Healthcare Podcast.

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I'm thrilled today to be
joined by Neil Gilchrist,

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vice President of Pharmacy
Business Operations at Beth

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Israel Lahey Health.

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Neil, it's a pleasure to have
you on the podcast today.

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- Great. It's exciting to be here.

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- Absolutely. You know,
I'm looking forward

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to our discussion because I know there's

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so much happening in the
pharmacy space right now,

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and it, it is really such a
important aspect of healthcare

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and evolving quickly, and
so I'm looking forward

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to learning more about
what you're doing at

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Beth Israel Lay Health.

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But before we dive into my questions,

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can you tell us a little
bit more about yourself,

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your background, and the health system?

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- Absolutely. Um, as you
mentioned, my name is Neil Goku.

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I'm currently in the
role of Vice President

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of Pharmacy Business Operations

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for Beth Israel Leahy Health Pharmacy.

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Um, I've been in health
system pharmacy really

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for the past 20 years.

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A number of different roles
from direct patient care roles

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and varying leadership roles.

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Most, uh, recently as
Chief Pharmacy officer

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for a multi-hospital health
system, um, I believe my, my,

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you know, my background in
direct patient care role

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as a critical care clinical
pharmacist really gave me the

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opportunity, um, to develop
some of my leadership skills.

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Uh, it's, I think, think really important

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as a healthcare leader to understand

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and see the other roles,
uh, in a health system

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and working side by side
with physicians, nurses,

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radiologists, respiratory therapists,

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many other healthcare providers,

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really influenced me early
on in my career to see how

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that teamwork is so important
to the delivery of healthcare.

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- Absolutely. I love that.
And definitely, you know,

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is such a, a fascinating way
to, um, get that experience

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and, and certainly carry it
into the leadership roles.

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Now, I was wondering if you
could tell me a little bit about

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the pharmacy program at Beth Israel Lehe

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Health, what makes it so unique?

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- Absolutely. So Beth
Israel, Lehe Health, um, just

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to give you, uh, an overview

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of our system is a 14
hospital health system that's

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geographically located in
the Boston Metro Boston area,

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Massachusetts, and in
Southern New Hampshire, uh,

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our system employs
approximately 39,000 caregivers,

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including 4,700 physicians.

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Um, the system overall has
about 2,500 inpatient beds,

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and we see over 4.1
million outpatient visits

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and 407,000 ed visits a year.

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So a fairly large health system, um,

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that also is complimented
by our pharmacy program.

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Uh, our pharmacy team is, uh,

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over 1500 team members across the system.

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And what makes us unique really is

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how our pharmacy department is structured.

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Uh, each of these hospitals,

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the 14 hospitals have a dedicated
inpatient pharmacy along

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with some sites operate outpatient

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infusion pharmacy services.

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Um, those local pharmacy teams
are focused on the acute care

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patients that are in the hospital,

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in the emergency
department, inpatient beds

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or critical care or areas.

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Um, but beyond that, the
acute care programs, uh,

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really roll up under the
system pharmacy corporate team.

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We have approximately 350
team members focused on

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the ambulatory care programs.

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These programs really span
across ambulatory clinical

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pharmacy services, so seeing
patients in the clinic,

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specialty pharmacy program,
our retail pharmacy services,

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and then our additional services
included medication access,

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that could be prior authorization,
financial assistance,

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renewal services.

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Uh, if I could talk a
little bit more about our,

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our corporate office as
well, which is based out

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of a 120,000 square foot office

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and central service center dedicated

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to these pharmacy programs.

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Um, we have a fairly
large fulfillment area,

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20,000 square foot fulfillment
pharmacy with automation

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that can fill up over 10,000
prescriptions per day.

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And then we, uh, complimented as well

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by a large distribution
center with a warehouse

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that really allows us to
navigate drug shortages

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and make strategic purchases.

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So those are kind of the,
the i, the, um, ideas

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that are the areas that really
are unique to our program.

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- Yeah, absolutely.
That's amazing to hear.

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And certainly as you mentioned,
so many of those different,

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um, aspects of the
program can be essential

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and I know health systems are
looking at ways to continue

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to optimize and really combat,
as you mentioned, trying

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to figure out processes

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around prior authorizations
especially, as well as, um,

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drug shortages and leveraging
technology to automate more

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and, and really become more efficient.

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From your perspective, which projects

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and initiatives are you most

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excited about for the next year?

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What do you see as being
really, um, essential in order

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to continue your success?

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- Yeah, we have a lot of projects

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and initiatives underway, um,

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and I think of them in
really three categories.

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Um, the first is really what
have we already developed

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or built and how do we
grow those programs.

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Um, the second is more focused
on our, um, clinical programs

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and go more into the
space of health equity.

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And then third would be
around business development.

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So if I could take a few
minutes to kind of walk through

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what some of those projects are, um,

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I think would be helpful,
uh, for listeners, the,

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the first is around, um,
our current business lines,

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and so that would be our
specialty pro program

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and our retail pharmacy programs as well.

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We have seven retail
pharmacies across the system.

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Um, and, uh, these programs really, uh,

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are in their growth phase
right now where we're able

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to extend our services
to more of our patients

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that we serve, uh, as well
as our, our caregivers, our,

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our team members across the system.

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Um, we're excited to launch, uh, as well

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to complement these programs,
uh, pharmacy based app

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with a partner, uh, this year

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and that will really help

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to drive an optimal di digital experience

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for our patients and and colleagues.

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Um, under the category
of clinical programs,

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we have over 40 ambulatory
clinical pharmacists

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that are supporting our primary
care and specialty clinics.

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Um, and the past year
really has been a focus

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around a cardiometabolic space

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and how do we ensure that
patients have access to some,

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uh, pretty innovative drugs
in the space of SGLT twos

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and GLP ones,

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and how do we reduce some

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of the disparities in health
equity to make sure that some

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of these underserved communities

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or populations of patients can have access

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to these therapies.

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And so there's been a
lot of focus on that.

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We're really excited to
move into the space of

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a pharmacist led system-wide
anticoagulation program

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over the next year, as well

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as a remote patient monitoring
program that's managed, um,

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by pharmacists and working closely

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with our physician colleagues.

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Um, so those are two clinical programs

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that are really just coming together, um,

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over the next, uh, six months.

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Um, and then last, uh,
is really exciting is

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around business development.

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Uh, we will be launching, uh,

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later this year our own
pharmacy benefits management

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or PBM uh, product.

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Our team really has built
out that infrastructure

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and data analytics to
support our health system

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initially with this solution.

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And then looking further at

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how we can support other health systems

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and plan sponsors to maximize
financial management.

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So there's that aspect

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of business development
is is a PBM solution.

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And then lastly is the
area around rare diseases,

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which really is a, a growing space.

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If you look at 2023,

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there were about 40 new rare disease

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therapies that came to market.

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Um, and these range from a
few thousand dollars up to two

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to $3 million for a single dose.

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And these therapies can be
life changing, life saving,

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however the population
size that, uh, are eligible

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for these drugs can be
anywhere from under a thousand

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patients to under a hundred patients.

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And how do you connect
that lifesaving therapy,

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a life changing therapy to
this really small population?

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It's, it's a different model here

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where you can't just have pharma
send out a large sales team

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to educate everybody about them,

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but as health systems, we
have this data about patients

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that, uh, may have been
diagnosed with the disease state,

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that single patient at your health system,

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or, uh, they may have tests

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or biomarkers that could be
indicative of the disease.

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And we're in a position as
health system to connect those so

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that we're looking at a solution
to be able to help navigate

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that rare disease space.

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- Well, that's fascinating to hear

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and certainly, you know, some great things

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as you mentioned that are happening.

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I wanted to question just one bit further.

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Looking at the business development side,

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especially in developing

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and then now be need to offer
the PBM, um, what was it like

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to build that infrastructure out, um,

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within the health system?

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What did it take, how long I,

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I guess were you working on building that

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and then too, you know, on
the data analytics side,

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how do you see that really,
um, coming to fruition

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and what does it take to build
this, I guess, product that,

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um, is now beneficial
for the health system

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and you're ready to, um,
work with others on as well?

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- I, I think I would answer
both of those questions kind

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of together, is that
it's all really built off

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of the foundation of a strong

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pharmacy dedicated infrastructure.

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And this is really
important is that you need

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to have those internal
data analytics team.

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We have our own data warehouse

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where our electronic health
record feeds into, um, so

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that we can really, um, pull
that data much more nimble

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and quickly and be able to
make decisions based on that.

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It also is complimented,
uh, in our program,

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which I think is unique,
is having a strategy

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and business development
team within pharmacy

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with project management team members.

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We have a marketing
communications team in finance,

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and how do you pull all
that together under pharmacy

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to be able to, um, use data
to quickly make decisions,

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develop a strategy around that data,

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and then activate the team to be able

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to implement those objectives.

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And so thinking about the, the PBM aspect

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or the rare diseases, um,
is you really need to, um,

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have those, the, those resources
available to move quickly

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and that it's a two year journey or so,

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but um, if you have the right
pieces to pull together,

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you're able to move much quicker.

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- Absolutely. I, I love that.
And it's just so helpful

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to understand and see kind of that process

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and like you said, that
strong, uh, pharmacy department

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and strategy background.

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Now, before we wrap up
our conversation here,

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I was wondering, um, if you
could speak to, you know, some

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of the different headwinds that
you're keeping your eye on,

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um, right now, what's
really top of mind for you?

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- Sure. Um, I, I think for all many,

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if not all health systems
across the country, uh,

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I think top of mind is
financial challenges

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of health systems with
reduction in reimbursement,

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the inflation costs for
supplies, medications, and,

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and labor as well.

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Uh, I think everybody is faced

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with these financial challenges,

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and so that really influences
a lot of the decisions, uh,

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that are going into health systems today.

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Uh, that may also, uh, is influencing, um,

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capital investment decisions.

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And so how do you build out
programs when there's such a

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tight capital environment right now?

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Um, so financial challenges
is definitely top of mind.

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Um, it's hard to ignore
kind of the, the, uh,

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what's occurring right
now over the past week

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or so with the significant
change, healthcare, cyber attack

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and thinking about cybersecurity.

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Uh, I do think that
that that is a headwind

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that we will continue
to be challenged with.

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And how do our health
systems, uh, navigate

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that moving forward with
this current landscape?

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Um, drug shortages
continue to be a challenge.

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They have been for the past 15 plus years,

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and they've only gotten worse

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where drug shortages may not
be, uh, as many new ones,

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but the shortages that are
occurring are continue to occur

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still primarily in the generic
sterile injectable product

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space where it's impact

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and it inpatient care really challenging

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for acute care pharmacy services.

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Um, on the ambulatory side,
we still see shortages.

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Um, right now we continue
to see amphetamine products

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for A DHD and then the surgeon in demand

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for medical weight loss
with GLP one medications

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that's impacted care for
diabetes patients as well

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as those trying to access this drug class

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for weight loss, um, therapies.

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The last couple headwinds really, um, PBMs

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and DIR fees is definitely an area that

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continuing to look at.

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There is a lot of bills
and discussion around PBMs

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and discriminatory pricing, uh,

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and any willing provide laws.

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And so continue to watch
PBMs on the DIR fees.

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We are in kind of this
first quarter phase of 2024

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where we are seeing DIR
fees assessed from the end

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of last year as well as
at the point of sale now

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with the change of how that program works.

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And the final headwind,
which is a significant one,

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is really the evolving landscape
of the three 40 B program

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and how pharma PBMs
state Medicaid programs

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and health systems, uh,

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are gonna navigate the
three 40 B program changes,

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um, for the years coming.

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- Absolutely. I, I think,
you know, you such hit,

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hit the nail on the head
so well, in terms of some

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of the ongoing challenges,

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whether they're the financial challenges

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or the shortages that have
plagued the healthcare system

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for a while and being able
to deal with those plus,

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you know, some of the
new cybersecurity issues

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and the evolving three 40 B program.

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How do you really make sure
your team, um, stays focused

307
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and energized and
motivated amid such change

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and transformation and uncertainty
too within the landscape?

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- Yeah, it's very
challenging in the landscape.

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Um, I, you know, I, I
think we need to make sure

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that we're connecting back
with our, uh, team members

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that are doing the work every day.

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We often refer to frontline team members

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or direct patient care team members.

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We need to ensure that we're connecting

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with our team members at all levels

317
00:14:13,565 --> 00:14:16,105
and that information is
flowing up to leadership

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and that we're also effectively
communicating to all

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of our team members to make
sure that there's alignment.

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Um, we can't change the direction

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00:14:24,745 --> 00:14:27,145
of the ship if we're not
communicating to our team.

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Um, and so that's critical to, uh,

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being successful in this environment.

324
00:14:33,225 --> 00:14:34,785
- Absolutely. Well,
Neil, thank you so much

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00:14:34,785 --> 00:14:36,385
for joining us on the podcast today.

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00:14:36,385 --> 00:14:38,945
This has been such a fascinating
and insightful conversation

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00:14:38,945 --> 00:14:40,745
and I look forward to
connecting with you again soon.

328
00:14:42,175 --> 00:14:44,045
- Thank you for having
me on. Appreciate it.