Podcast Summary: Building a High Performing Pharmacy Enterprise at MercyOne with Scott Knoer

Podcast: Becker’s Healthcare Podcast
Host: Laura Dearda
Guest: Dr. Scott Knoer, Regional Chief Pharmacy Officer, MercyOne
Release Date: February 7, 2026

Episode Overview

This episode features Dr. Scott Knoer, the regional chief pharmacy officer at MercyOne, in a candid discussion on building a high-performing pharmacy enterprise within a large health system. The conversation covers Dr. Knoer’s career journey, his approach to organizational transformation, the strategic levers that are boosting both profitability and clinical impact, and the priorities and challenges for pharmacy practice in 2026.

Key Discussion Points & Insights

Dr. Knoer’s Career and MercyOne Background

• Career highlights:
  • Previously Director of Pharmacy at University of Minnesota Medical Center.
  • Chief Pharmacy Officer at Cleveland Clinic for nine years—opened hospitals internationally and introduced leading-edge technology.
  • National voice on drug pricing and PBM (Pharmacy Benefit Manager) practices, quoted widely in major media outlets.
  • Turned around the American Pharmacists Association financially and in membership as CEO.
  • Experience in telehealth and for-profit pharmacy via a stint at Hims & Hers.
• Return to Iowa & MercyOne:
  • Returned to Iowa to spend time with family.
  • MercyOne: Part of Trinity Health, 40 hospitals. First-ever chief pharmacy officer at MercyOne, brought in to establish unified pharmacy leadership.
  • Personal joy: “I’m hunting on my family farm in Iowa and just enjoying life.” (03:38)

Building a High-Performing Pharmacy Infrastructure (04:49–10:40)

• Identifying Key Priorities:

  • Inpatient pharmacy is a cost center (DRG reimbursement: focus on stewardship, cost-effective medication, clinical alignment).
  • Ambulatory pharmacy is a true revenue center—“still surprises me how many systems haven’t tapped this.”
  • Established unified regional infrastructure over 19 pharmacies across five regions.

• Financial Impact:

  • “We’re on track... to have $20 million more to the bottom line at Mercy One through what pharmacy’s done. And ... strategies in place... to have another 12 to 18 million [by fiscal year 2027].” (06:21)

• Initiative Implementation:

  • Success built credibility—“the flywheel is moving and success is breeding success like it always does.” (07:38)

Leadership Approach and Team Development (08:32–10:51)

• Building the Team:
  • Found and elevated “raw talent” from within—key example: Craig Ford, promoted to regional director (“the guy’s on fire”).
  • Leveraged “pockets of excellence” for specialty pharmacy (Jason Hansel in Davenport) and 340B strategy (Aaron Brownmiller).
  • “Now I just get out of their way. I remove barriers and I just watch in awe with how they crush everything they touch.” (10:36)

2026 Priorities, Growth, and Headwinds (11:03–14:54)

• Challenges:

  • Market/reimbursement pressure (“you can’t cut your way to success, you have to grow your way to success”).
  • System-wide goal for “several hundred million dollars of cost containment stewardship.”

• Revenue & Clinical Balance:

  • “We’re going to continue to reinvest in the areas that are successful... bringing real revenue and control costs, improve quality and safety.” (12:12)
  • Growing ambulatory pharmacy presence. Recently placed pharmacists in neurology and endocrinology clinics:
    • “We’re just seeing... amazing things with our patients and patient education.” (13:10)

• Policy Advancement:

  • Iowa’s new pharmacy practice act (“standard of care”) removes the need for individual collaborative agreements and expands pharmacist clinical autonomy.

• Pipeline & Residency Programs:

  • Plan to deal with pharmacy talent shortage by building residency programs and promoting from within (“you can buy it or build it—we’re going to build it”).
  • “Students become residents, residents become pharmacists. While residents are pharmacists, they become employed pharmacists.” (14:36)

Building and Expanding Pharmacy Residency Programs (15:22–17:23)

• Accreditation Easier Than Before:
  • “It’s not so onerous to start a residency. ... We’re... going to add residencies where the growth is—in the ambulatory world. All of our hospitals will have them.” (16:10)
  • Personal note: “I’m passionate about pharmacy. ... I’m really loving growing the team we’ve got and seeing others succeed.” (17:13)

Growth, Not Cuts: What’s Next for Pharmacy at MercyOne (17:34–20:45)

• Fortunate Situation:

  • “Because of the success we're having, I'm not going to have the hard things... sometimes hospitals... have to cut staff... I'm not going to have to deal with that because we're making money.” (17:34)

• Outlook and Targets:

  • Focused on continued optimization in Des Moines and leveraging infrastructure across regions.
  • Exploring tactics like shifting clinics to “provider based” status for better revenue.
  • Considering internal mail order for employee scripts to capture savings.

• PBM (Pharmacy Benefit Manager) Critique:

  • “PBMs are... middlemen that suck all the profit out, leading to crushing retail and community independent pharmacies. ... How do we take on more and more of that ourselves and eliminate the middleman?” (19:48–20:16)

Notable Quotes & Memorable Moments

• On Success and Flywheel Momentum:
  “The flywheel is moving and success is breeding success like it always does.” (07:38)
• On Empowering Teams:
  “Now I just get out of their way. I remove barriers and I just watch in awe with how they crush everything that they touch.” (10:36)
• On the Real Impact of Pharmacy:
  “The clinics in my previous job where I put pharmacists, the quality metrics were better everywhere. ... That team-based care that we’re starting to do here at MercyOne.” (13:53)
• On Growth vs. Cuts:
  “It’s a lot more fun to grow than it is to cut.” (18:15)
• On PBMs:
  “PBMs are... middlemen that suck all the profit out, leading to crushing retail and community independent pharmacies.” (19:48)

Key Timestamps for Important Segments

• 01:41–04:07 – Scott Knoer’s career journey & MercyOne overview
• 05:02–07:51 – Strategy: Creating a profitable pharmacy enterprise
• 08:32–10:51 – Leadership philosophy, talent identification and development
• 11:03–14:54 – Financial/clinical priorities & headwinds for 2026
• 15:22–17:23 – Residency building for future pharmacy pipeline
• 17:34–20:45 – Growth focus, PBM critique, and where MercyOne pharmacy is heading

Tone & Closing

Dr. Knoer’s tone throughout is dynamic, candid, and passionate—balancing clinical excellence, business savvy, admiration for his team, and a strong desire to build sustainable success.
The episode wraps with optimism for growth:

“We’re going to grow... We’re going to just keep that flywheel moving and doing what we do in pharmacy.” (12:38)