← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Tracey Spangenberg, Associate Chief Pharmacy Officer at UC San Diego Health
00:17:07
Loading summary
Transcript18 lines
- [00:00]
A
This is Laura Dardo with the Beckers Healthcare podcast. I'm thrilled today to be joined by Tracy Spangenberg, Associate Chief Pharmacy Officer at UC San Diego Health. Traci, it's a pleasure to have you on the podcast today.
- [00:14]
B
Laura, thanks so much. I'm excited to be here. I appreciate the invite.
- [00:18]
A
Absolutely. Now, I'm looking forward to our conversation and digging a little bit deeper into some of your recent initiatives, as well as how you're thinking about the future. But before we dive in, can you tell us a little bit more about yourself as well as UC San Diego Health?
- [00:33]
B
Well, thank you so much. Yes, I'm a pharmacy graduate. Actually, I'm a foreign pharmacy graduate. I graduated from The University of KwaZulu Natal in South Africa and had the distinct honor of being able to work over in the US came over in the 90s and started my career in retail operations, was a regional retail director for one of the third largest chain drug stores, which gave me a tremendous perspective about just how hard it is in that retail setting both to run a business model with very slim margins, but also to make sure we don't burn pharmacists out. After that, I moved over into mail order operations with the third largest mail order facility and was VP of operations there for mail service and then was just super excited to come over into health system pharmacy, bringing those different perspectives and backgrounds into running the outpatient retail pharmacy operations for UC San Diego Health. So that's, that's it in a nutshell.
- [01:59]
A
I love that. What great experience in learning lessons you've had throughout your career and then to be able to bring that to your current role, I can imagine is really beneficial. I'm curious, can you tell us a little bit more about a project or initiative you led in the last year? What did you do and what were the results?
- [02:15]
B
You know, obviously many health systems are so complex and that's what makes them so exciting and interesting. But I think the most important one, which has long term impact for the health system is establishing a central prior authorization team for pharmacy benefit. As you know, prior auths are just the bane of existence for providers and for patients. And our pharmacy technicians with their knowledge and experience, do it better, you know, just for having years of experience in navigating that prior space. So we were able to get executive support to start the first phases of our prior authorization team. And I think really the complexity of our integrated EMR workflows was probably one of the biggest learnings as you try to centralize something that is connecting multiple clinics Multiple business models into one collective unit. It requires a huge amount of change management, a lot of stakeholder investment and time. And we really focused the first six months of 2025 on foundational things like developing standard work, really truly understanding the workflows and the workload variability, a lot of focus on technology, trying to move everybody onto one prior authorization platform, lots of training, lots of communication for that trench management component. And so it took us about seven months before we did our initial launch and have worked very hard and closely on understanding what's working, what's not working, process improvement. And excited to say we've really launched and supported now four of the biggest, largest clinic areas at UC San Diego with full prior authorization support, and excited to see that it is both providing tremendous improvements in patient access. It's relieved a huge burden of, you know, providers and having to handle a lot of that administrative functions with prior authorization. But in addition, it's providing us an opportunity to have our health system pharmacies fill the prescriptions for these patients, and so has been very beneficial in revenue growth and prescription growth for, for the system. So early days, we've got a lot to do and learn, but so far the initial numbers are looking fabulous and the initial feedback is very positive. So excited for the next phases and for us to continue growth on this initiative.
- [05:46]
A
That's fantastic to hear. You know, really impressive to think about the scope of a project like that and being able to actually put something together that makes a measurable difference in a short period of time is incredible. And so, you know, when you think about that process, and I know you mentioned being able to learn and iterate along the way, what was the most important thing you learned and adjusted as you were in the development phase?
- [06:13]
B
You know, it's a good question. And I think our biggest adjustment was bringing in multiple teams together in one unit that had never operated as a team before, and so disparate platforms that they were working on, disparate, you know, standard work, disparate perspectives about, you know, what the mission was and, you know, really the criticality of being very prescriptive and deliberate in change management. And I think the key for our success in that area, and I think it's still work in progress, was really having those that are directly doing the work be a big part of the planning and of the input to make sure we were really listening and understanding before implementing change, which we knew it was going to be big, but I don't think we understood really how really huge that change was in so many areas. So I think that would be the
- [07:30]
A
biggest piece that's helpful to understand. Thank you for digging a little bit deeper there. Now, looking ahead to 2026, what are some of the big priorities, headwinds that you're most focused on right now?
- [07:44]
B
I think there is probably three, you know, areas to answer that question. It's the continued growth and implementation of our central prior AUTH team. It is such an impactful initiative that, you know, we need to keep on pressing forward and learning and implementing more msot, which is multi step order transmittal and learning how to nuance that in the workflows. The second is really massive impacts going on in the payer space with the maximum fair price. The first 10 drugs rolled out in January and we've got another slew of drugs for 2027 to look forward to. That has huge margin impact. And then also biosimilars. It's a swirling space with certain payers picking and choosing winners and losers in that biosimilar space. And it's how to navigate that from a procurement perspective and making sure that we're not disrupting patient care as we try to figure out which payer is going to pay for what, how we procure it and understanding the business implications. And then I think the third thing which is always that elephant in the room is 340B changes. It seems like weekly. There's some sort of curveball, you know, in that 340B space. And so keeping abreast of that and you know, blocking and tackling, you know, as, as that is such a meaningful program for the entire health system and for patients care. It's, it's really important that we understand and keep abreast of those changes.
- [09:44]
A
Absolutely. And that's such a great point. I think all of the elements that you mentioned there are top of mind for so many hospitals and health systems right now. But especially thinking about that 340B with all the changes and you know, I a lot of uncertainty attached to it. But at the same time it sounds like, you know, being able to stay on top of the news and have the nimbleness to adjust is so important. Do you, how do you see the team being able to sustainably think about continued development with that program in such flux? How are you kind of guarding against whatever impacts you need to absorb?
- [10:26]
B
You know, I think it's, it's really a full team approach. We are very disciplined around initiatives that we are implementing, making sure that we are measuring results and adjusting course should results not be meeting expectations or if there has been a change in the 340B space. Understanding what that change and implication might be and then looking for other initiatives that can counterbalance it. And it really does take a full team to be able to tackle the complexities of that. And so we have the fortunate blessing of just incredible leaders that are all bought into a common vision about the, the importance of what we do in our outpatient setting and the importance of what we do to the entire organization. So really engaged leaders which really help us drive multiple initiatives and own those initiatives and bring home the results. It's really, I think, our secret and how we'll tackle, you know, 20, 26 and 27 on the, on the go forward. I think really also being open minded about adopting new tools, AI tools, automation tools, you know, things that can help us not not only do the, the analysis and the diagnoses, but also help us with efficiency, you know, and help us mitigate some of these erosions.
- [12:15]
A
That's helpful to understand. And you know, I appreciate the technology piece too is evolving as quickly as everything else. And so that's great to hear. What do you think the hardest thing you'll have to do in the next year will be?
- [12:28]
B
I think it's really balancing these eroding margins and these onslaughts, you know, into our business model with investments that we need in order to grow and where we invest in order to grow. So I think that's going to be a continuous tightrope we need to walk and making sure that we're maintaining that operational discipline. I also think one of the hardest things for the coming year is to continue to press and elevate the dialogue around the value that our outpatient retail pharmacists have in the continuum of care in a health system. Our retail pharmacies are truly the connective tissue across multiple clinical disciplines. We have the ability to access the entire EMR and are able to really drive outcomes and results. But I do believe it's a, a perception that is still not fully understood and not fully appreciated. So really socialization and advocacy for what the, what the impact is of health system retail pharmacies in so many places. So
- [13:58]
A
that's helpful to understand and I think especially looking at how I know many of those hospital retail pharmacies and other, you know, new and interesting ways to provide access to care are certainly making a difference. And so it'll be interesting to see what kind of rises to the top as being, you know, those spaces that can make the biggest positive impact on the community. And to that point, I'M curious for your perspective, what do you how are you thinking about growth? What do you see as being some of the biggest opportunities for the next year or so?
- [14:32]
B
You know, growth for us as we are a closed network pharmacy, really, our mission is to serve as many UCSD health patients with pharmacy services as possible. Our best growth opportunities are continued partnership with the health system and health system leadership and continuing to talk about the value that we provide not only for the patients, but also with patients using our retail pharmacies. We have extremely high NPS scores, which helps the overall health system and we have a distinct impact on readmission rates. So again, beyond our own profit and loss statement, it has a significant impact on the metrics that matter for the health system. And then pharmacies are one of the most sticky businesses or business models because we serve the patients so well, because we have such high scores, because we are able to do so much more than the average corner drugstore. Patients remain wanting to use UCSD health pharmacies and that will then, you know, initiate them wanting to stay with the health system as their health system of choice. So I think we add a lot of value to the overall growth of the system and the metrics and I think it's a synergy and partnership with the health system leadership that can help us in our, in our own growth.
- [16:18]
A
I love that. Tracy, thank you so much for joining us on the podcast today. This has been such an informative and fun conversation and it looks like forward to seeing you as well at our Chief Pharmacy Officer Summit in April. I know you'll be speaking on a panel and really digging deeper into some of the themes we talked about here, as well as expanding the conversation and connecting with colleagues and more. So I look forward to seeing you there.
- [16:41]
B
Well, Laura, thank you so much. It was a great conversation and I hope you have a wonderful day.