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Becker’s Healthcare Podcast
Mark Makhinson PharmD, Senior Director of Outpatient Pharmacy at Mount Sinai Health System
00:18:07
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- [00:00]
A
Welcome to the Becker's Pharmacy Leadership Podcast. I'm Ella Jeffries, pharmacy reporter here with Beckers Healthcare. Today I'm joined by Dr. Mark Mackensen, Senior Director of Outpatient Pharmacy at Mount Sinai Health System. In this episode, we'll be exploring digital innovation in specialty pharmacy. How technology is transforming operations, driving better patient outcomes and creating new opportunities for pharmacy leaders. Dr. Mackensen, thank you so much for joining me today. To start off, can you please introduce yourself and share a bit about your role and how specialty pharmacy fits within your organization's overall pharmacy strategy?
- [00:34]
B
Thank you, Ella. Good to be here with you. So my name is Mark MacKenzien. I am the senior director of outpatient specialty pharmacy for the Mount Sinai Health System in New York City. We're a large academic medical center consisting of seven hospitals and approximately 500 outpatient specialty clinics across the New York City area, New York, New Jersey, Connecticut and I oversee all of the outpatient pharmacy activities across the system. We have seven pharmacies across New York City, three of which are specialty accredited pharmacies. We have a, you know, we started in about 2020, so pretty young operation as a whole, but we've grown exponentially over the last five years. So we service the system as a whole. So all the practices across system, we are integrated in about 90% of practices with our specialty services. So the overall goal of the outpatient pharmacy department is really to keep the care of the patients within the continuum of the health system. And we see when patients stay within the health system and all of their care originates in the same place, they get better outcomes and we can drive system level initiatives such as length of stay challenges, decreasing length of stay and increasing compliance, increasing adherence and decreasing readmission.
- [02:11]
A
Great. Amazing to hear about your background. With that perspective in mind, I'd love to dig into how your team is approaching innovation. You know, specialty pharmacy continues to evolve quickly. So what does digital innovation look like at Mount Sinai right now?
- [02:24]
B
Absolutely. So right now we are in the middle of some really big changes. We are actively engaged with, with several vendors to bring on some, some automation AI technologies, which I'll get into in a little bit. But you know, our pharmacy platform is currently operating on, on a legacy platform that has very little digital reach to our patients. Right. So if you can imagine a retail pharmacy, an independent retail pharmacy with an independent system where a patient needs to call in and interact with a legacy IVR system or speak to a member of the pharmacy staff to get a status on a prescription, that's where we're at now. But we are really quickly moving towards a digital first strategy, right? So in trying to meet our goal of keeping as many patients within the system, we need to offer a similar level of service and similar experience that patients get elsewhere. Right? So when patients go online for a typical shopping experience, whether they're going to Amazon or they're going to CVS or to any other retailer, they're used to a digital experience that, that is easy and streamlined and meets their needs and meets them where they are, and that's where we're trying to go. So developing a front end digital platform where a patient can log on, interact with their medication refill, check out, schedule delivery, things of that nature. But then going a step further, right, we want to bring in the clinical aspect. So where can they get their clinical information? Can they access their, their, their discharge summary in one place and have that link to their medications that they got from the pharmacy to understand what the side effects are, the medication and when to take the medication? And you know, how can they use the, the health system's digital presidents to answer all their healthcare needs? That's, that's where we're trying to go. So digital first strategy from a patient experience perspective. But then on the back end, right, There are a lot of workflows that we have that are very manual and legacy workflows that require a lot of people to do repetitive tasks day in and day out, which is what we're trying to streamline and automate at this moment. Right? So there's a few main processes that we do every day, including benefits, investigation, prioritization, authorization, financial assistance and delivery coordination. We are currently able to automate two of those, two out of four. But we are in the process of trying to bring them all into a single ecosystem so that everything lives in one place and everything is automated and streamlined. And at the end of the day, we really want to focus on our employees, whether it's our technicians, our pharmacists, working at top of a license, and being able to have those conversations with patients that are value add for patients, right? We want our people to be a resource for our patients, somewhere that they can go to, that they trust for information versus individuals that are doing repetitive tasks day in and day out.
- [06:00]
A
For sure. That's all really interesting and very important changes. That sounds like your team has embraced a lot in a very short amount of time. I'm curious, you know, what specific new technologies or you mentioned those workflows or just any digital tools that have had the biggest impact on your specialty pharmacy Operations or patient outcomes.
- [06:18]
B
Yeah. So I think the first big one that we really piloted and implemented was prioritization support. So being able to have technology pull the correct answers for prior authorizations out of the medical record and populate the prior authorization form. Previously, this was a fully manual process. So you can imagine a patient gets a prescription, it needs a prior authorization. That liaison has to go into the medical record, pull a diagnosis code, pull previous therapies that the patient has failed, answer the multitude of questions that come from a payer. And every payer is different, and every payer has different questions and different criteria. So these prioritizations take up a lot of time and take a lot of expertise to handle. So by bringing in an AI solution, it's integrated into the medical record. And once a prescription needs a prior authorization, the software pulls the appropriate form and populates it, so answers the questions with reference for the individual. So now the liaison, instead of having to dig through a medical record, whether. Whether it's digital media or legacy media that's been uploaded, the liaison just needs to verify the answers. Right. So the question is populated. Liaison verifies that the answer is is appropriate, checks the reference, and that submits a prior authorization. This leads to a significant decrease in the time to complete a prior authorization. We were trending at 20 to 25 minutes per pa. That's come down by at least 50%. We're targeting at least a 75 to 80% decrease in time to complete pa. But secondarily, our first pass approval of prior authorizations has increased significantly. Right. So reducing the work of a pharmacist writing a letter of medical necessity or going back to a provider to ask additional questions, all this gets a patient to therapy sooner with less interference, which is the ultimate goal. And like I said previously, those liaisons are now doing more patient facing work and being of more value to the patient in their care journey. So that's the first one which really utilized AI, and then the second one is the digital front door. So developing a digital marketplace for a patient to interact with their medications, that's fully integrated within the MyChart experience. So basically, a patient gets a prescription and they get a text message, they'll click the link there, it'll take them into the MyChart experience, and they'll have a similar shopping experience as it would anywhere else on the Internet.
- [09:26]
A
Those are great examples. And I love hearing about those success outcomes that you described. Kind of on that same note, of the metrics, how are you in your organization defining success when it comes to digital innovation as a whole for pharmacy.
- [09:41]
B
So I think it all comes back to number one, the patient experience and whether they have an experience that they like and that they can keep coming back to. Right. Keeping that patient engaged with the health system on an ongoing basis is beneficial. Right. So the patient engagement. But then secondarily, you know, what, what is our efficiencies on the back end? Right. Can we repurpose staff to do more beneficial work for the patient? One example is we have 20 liaisons just doing GLP1 parathorizations. What does the world look like when we can bring that work from 20 down to, you know, maybe we can repurpose those 15 liaisons to do more financial navigation for the patient. Right. If we can get patients more financial assistance so that they can continue in therapy and have access to more therapies, we have better outcomes. Right. If we can get those employees to do outreach to patients to ensure adherence, then they can have better outcomes. So at the end of the day, any, any goals that we set for ourselves is always with the patients at the heart of it and ensuring that the patients outcomes and experience are our best for sure.
- [11:07]
A
And I think those are important things that any health system should be keeping in mind as well. So thank you for sharing. And of course, with any new technology there are always a few bumps along the way. What challenges have you encountered in implementing digital tools and how have you addressed these issues?
- [11:24]
B
Yeah, so anyone that's, that's worked in a health system or a large matrix organization knows the word governance. So there is a lot of governance that happens especially within a health system for many reasons. And you know, many, many of these reasons are valid, but it just, it takes a lot of time and effort and persistence to get anything live within a health system. And then secondarily, the difficulty of such an endeavor increases when you start talking about AI, because the governance is being built as we speak. So really working with your partners within your organization, specifically your IT partners, your legal partners, is so important in order to be efficient and get some of these products to market and to a live state. A lot of times vendors come to us with new ideas and not really fully baked products and we, a lot of times we just do not move forward with them because we know that in order to be successful in a health system setting, we need to have something that is fully baked and ready to be deployed and has a proven use case. So partnering internally as well as externally and being fully transparent with everybody that's involved on the process and timeline for sure.
- [13:16]
A
That's a really helpful perspective and it's clear that your team has learned a lot from the digital implementation process. I'd like to shift now to the patient side of things for a moment. How are digital tools changing the patient experience and specialty pharmacy at Mount Sinai for you guys?
- [13:30]
B
Again, it's going back to transparency and access. I think with our digital offering now, we're able to give them a more streamlined way of interacting with us. But then secondarily it comes down to a patient's ability to access a medication, whether that's a prior authorization, whether that's a pay, or putting some limitations on access to the medication, or whether that's cost. A lot of times the cost of a medication is, is too high and the patient doesn't have any way of accessing. So utilizing our digital landscape to give them the tools to find the financial assistance, right, Whether it's linking to a manufacturer discount card, whether it is giving them information about a foundation, those things are so important. So really utilizing the digital front door to give that patient that trusted source for financial information and then backing that up with our liaisons who can do that financial navigation, that's the thing that I'm most excited about. I think that's something that is a very gray area within pharmacy, specialty pharmacy especially, and that there are a lot of different funding options outside of the traditional payers that patients are not aware of. So being able to direct the patients to these options so that they have access to these really expensive therapies, medications are not getting any cheaper, they're getting more complex and more expensive. So it's so important to have that ability.
- [15:33]
A
For sure, that's such an important point, especially as patient expectations continue to evolve. Now, looking ahead, where do you see the greatest opportunities for digital transformation in specialty pharmacy over the next few years?
- [15:48]
B
The landscape, especially now with direct to consumer becoming more and more of an option, the landscape is changing and there is a lot of untrustworthy information out there. And a lot of times when a patient goes online to search about their medical condition or about their medication or anything health related, they can be led astray. So having a trusted source that they can always come back to that is fully, fully capable of leading the patient on that care journey is so important. So I see health systems and health system pharmacies being that source of truth in the future. Imagine a world where a patient can log on to their health system portal and access any kind of information that they want about their health. Whether it's a question about an acute condition, whether it's a question about medication access or or something about a side effect for their long term condition. What if it's a drug interaction with an herbal medication that they're taking? There are a lot of resources out there but it's unknown which ones are to be trusted and which ones are not. But the health system name and logo is always a trusted resource. So having a one stop shop for a patient to go for all their healthcare needs, that's where I see the future of digital specialty pharmacy within the health system.
- [17:42]
A
Gotcha. Well thank you so much Dr. MacKenzien. This has been such an insightful conversation and thank you for sharing your perspective and experience with us. That's all for today's episode of the Becker's Pharmacy Leadership Podcast. A big thank you again to Dr. MacKenzien for sharing his insights on digital innovation and specialty pharmacy. Thanks for listening and we'll see you next time.
- [18:03]
B
Thank you Ella.