Transforming pharmacy care at Baptist Memorial Health Care
“My vision for the acute care pharmacy is to maximize the automation our pharmacy teams have so they are able to perform more cognitive services that benefit our patients and our health care system.”
Many talk about transformational change. Jillian Foster is leading it, transforming a pharmacy team to strengthen inpatient care delivery and develop new outpatient services for a diverse patient population across 22 hospitals and hundreds of clinics in three states.
Q: Aside from your COVID-19 response, how is your pharmacy service line changing?
A: Five or ten years ago, I would have told you that inpatient pharmacy focus was key for a healthcare system pharmacy leader. Now, in the last few years, outpatient pharmacy services are where I spend a good majority of my time.
As a profession, we have such great evidence-based and practice-driven care models for inpatient pharmacy and it takes effort for continuous improvement.
But as a health system pharmacy leader, a lot of my work is spent around outpatient services development. We’ve grown outpatient pharmacy services significantly in the past several years, including infusion centers, home infusion, specialty pharmacy, mail order pharmacy, community pharmacies, and supporting programs.
Often, what's best for patients is to have a transition option where they can go back home or into the community. Also, that's where the payors are leading us.
Q: What was your impetus for developing outpatient pharmacy services?
A: Baptist, like other health systems, is in all facets of patient care now. With Epic as our EHR system, which canvasses all of those areas, we see all aspects of patients’ care.
For pharmacy, we wanted to close that gap. We don't want to take care of patients just in the hospital.
Now, if the patient chooses to—and we encourage them to—we have the opportunity to service them for all their pharmacy needs.
We still have a lot of growing to do to really maximize our offerings, but we’re pleased to have a foundation and infrastructure in the outpatient arena.
Q: What have been some of your biggest learnings while developing outpatient services?
A: The payor models for inpatient and outpatient pharmacy are very different.
In the acute care setting, with medical plans and patient health insurance plans, the main goal is straightforward; it’s to treat the patient with quality care but keep costs down.
In the outpatient setting, it’s very complex with regards to payor enrollment and payor agreements. Instead of just looking at cost, revenue and margin also are important. We’ve come a long way in the pharmacy service line in educating ourselves, in understanding the payor models, and in building relationships with different payors.
Q: What challenges do you face by managing pharmacy services across parts of three states with multiple payors and regulatory bodies?
A: It adds layers of complexity, especially for some services, such as outpatient, mail order, and specialty pharmacy when we’re shipping across state lines.
Some instances may cause us to vary some of our work streams or our preferred standardizations. We try to keep those to a minimum, or we spend a little more time communicating internally about where we differ.
Also, I'm not averse to picking up the phone and reaching out to our three boards of pharmacy. They’re very supportive of us, knowing that we’re yearning to do the right thing.
Q: Your patient population is quite diverse, ranging from densely populated urban areas to sparsely populated rural areas. What commonalities do you look for to deliver quality care efficiently?
A: Our hospitals and our pharmacy services feel a little different in each setting to reflect the towns, cities, and metro areas we serve. Some hospitals have 700 beds, others have under 100. And the pharmacies and service lines that support patients are similar and different. Some are open 24 hours a day, while others close at night but are supported with after-hours order verification and other services.
But no matter what Baptist facility you visit, you can expect a core group of services that all of our pharmacies offer, because we have a common electronic medical record that allows for standardized services, workflows, and lists.
Having a common electronic health record like Epic has been one of the most helpful things in standardizing the care that we provide. It’s helped us really behave more like a health system.
Q: What is your vision of the Autonomous Pharmacy?
A: My vision for the acute care pharmacy is to maximize the automation our pharmacy teams have, so they are able to perform more cognitive services that benefit our patients and our healthcare system.
And in the main pharmacy, we want to ensure technology, which has been configured by humans to be as safe and efficient as possible, is clicking on all cylinders without human interaction.