With a career spanning over 15 years in health system strategy, our guest today has a unique vantage point on the seismic shifts reshaping healthcare. Having held multiple leadership roles overseeing a diverse portfolio of businesses catering to U.S. health systems, he has been at the forefront of moving pharmacy from a peripheral department to a central, strategic asset. We’ll explore the pressing challenges and transformative opportunities facing pharmacy leaders today, from retaining specialty pharmacy patients and launching home infusion services to preparing for the wave of cell and gene therapies. This conversation will delve into how health systems can move beyond simply adapting to change and instead begin to actively shape the future of care delivery through innovation and collaboration.
Given that many specialty pharmacy patients have prescriptions filled outside their health system, what are the primary barriers causing this leakage? Please outline the key operational changes leaders can implement to improve patient retention and continuity of care, providing a step-by-step example.
It’s a deeply frustrating reality for many leaders to see that, even with mature specialty pharmacy programs, a staggering 50% of their patients are still getting prescriptions filled elsewhere. The primary barriers are a tangled web of payer restrictions that dictate where a patient can go, financial inefficiencies within the system that make the process cumbersome, and often, a simple lack of staff bandwidth to provide the high-touch navigation these patients need. To reclaim this, leaders need a methodical approach. First, they must conduct a deep-dive analysis to pinpoint exactly where and why the leakage is happening—is it a specific payer, a certain therapeutic class, or a breakdown in the referral workflow? Second, armed with that data, they can redesign the patient journey. This means embedding pharmacy liaisons directly into clinics to capture prescriptions at the point of care, streamlining the benefits verification and prior authorization process to remove delays, and creating a robust communication loop between the provider, the pharmacy, and the patient so no one feels lost. Finally, they must invest in the technology and people to support this seamless model, ensuring they can manage the complexities of specialty medications while providing unparalleled, personalized care that external pharmacies simply can’t match.
The home infusion market is poised for significant growth, yet two-thirds of health systems currently lack such programs. For a leader looking to establish this service, what are the first three critical steps, and what key metrics should they track to ensure both financial sustainability and positive patient outcomes?
The fact that the home infusion market is set to double by 2034 while two-thirds of health systems are sitting on the sidelines represents a massive, missed opportunity. For a leader wanting to build this service, the first step is a comprehensive feasibility study. This isn’t just about market demand; it’s a hard look at your payer mix, state-level regulations, and the specific clinical needs of your patient population. The second critical step is to build the operational foundation. This involves securing the right clinical expertise, particularly specialized nurses and pharmacists, and developing rigorous protocols for sterile compounding, logistics, and in-home patient care. The third step is forging strategic partnerships. You cannot do this alone. Collaborating with an experienced industry partner can provide the specialized resources, supply chain expertise, and operational support needed to navigate the complexities and accelerate implementation. For tracking success, leaders must monitor a dual set of metrics: financially, keep a close eye on referral capture rates, cost-per-case, and revenue cycle efficiency. Clinically, the most important metrics are patient-reported outcomes, hospital readmission rates, and therapy adherence rates, which ultimately prove the value of keeping care connected to the health system.
With only 4% of health systems fully prepared to integrate cell and gene therapies, what are the most significant operational and financial hurdles preventing wider adoption? How can strategic industry partnerships help bridge this readiness gap and accelerate the integration of these groundbreaking treatments?
The number is jarring—only 4% feel fully prepared. It really highlights the chasm between the scientific promise of cell and gene therapies and the current operational reality. The hurdles are immense. Financially, these are multi-million dollar treatments with complex, often uncertain, reimbursement pathways that create significant financial strain and risk for an institution. Operationally, the challenges are just as daunting. These therapies require ultra-cold chain logistics, highly specialized clinical teams, and meticulously coordinated care pathways that cross multiple departments. Most health systems are simply not built to handle this level of complexity on their own. This is precisely where strategic partnerships become essential. An experienced industry partner can de-risk the process by providing the logistical backbone for handling these sensitive products, offering expertise in navigating the labyrinth of payer negotiations, and sharing proven operational blueprints. This collaboration allows a health system to focus on the clinical delivery of these life-altering treatments while relying on a partner to manage the intricate operational and financial infrastructure, dramatically accelerating their ability to bring these therapies to their communities.
You describe a fundamental shift where pharmacy is moving from a cost center to a strategic asset. Beyond dispensing, what specific, innovative roles can pharmacy departments play in driving institutional performance and what does that look like in practice? Please share a real-world example.
This shift is the most exciting thing happening in our field. For decades, the pharmacy was seen as a necessary expense to be managed. Now, it’s being recognized as a powerful engine for institutional success. Beyond just dispensing, pharmacy departments are becoming central to managing total cost of care, improving quality outcomes, and enhancing patient access. For example, a health system pharmacy can launch an antimicrobial stewardship program that not only reduces drug spend but also lowers rates of hospital-acquired infections, directly impacting patient safety and the system’s quality scores. In practice, this looks like pharmacists rounding with clinical teams, making real-time recommendations on drug selection and dosage, and using data analytics to identify prescribing trends. A concrete example is a health system that leverages its pharmacy’s expertise to manage its employee health plan drug benefits. By actively managing formularies and promoting the use of their own specialty and mail-order pharmacies, they not only reduce their own healthcare spending as an employer but also create a new revenue stream and showcase their ability to manage population health effectively.
Widespread issues like drug shortages and supply chain complexities require industry-wide collaboration to solve. Can you describe what a truly transformative partnership looks like? What specific commitments must health systems and industry partners make to create a more resilient and transparent healthcare ecosystem?
A truly transformative partnership goes far beyond a transactional, buyer-seller relationship. It’s a deep, strategic alignment where a health system and its industry partner are co-invested in solving problems for the long haul. It looks like shared data platforms that provide unprecedented visibility into the supply chain, allowing for proactive, predictive management of potential shortages rather than reactive scrambling. It means a commitment from the industry partner to leverage their scale and resources to secure alternative sources and buffer supply for the health system. On the other side, it requires a commitment from the health system to be transparent about their utilization data and clinical needs, enabling the partner to better forecast demand. This level of collaboration allows us to move from just navigating today’s crisis to building a truly resilient ecosystem for tomorrow. Both sides must commit to shared governance, joint planning, and a mutual understanding that success isn’t just about the price of a drug, but about ensuring that care is never compromised because a critical medication is unavailable.
What is your forecast for the role of the health system pharmacist in the next five to ten years?
The role of the health system pharmacist will become even more integral and specialized. They will be less defined by their proximity to the physical pharmacy and more by their impact on patient care across the entire continuum. We’ll see pharmacists leading population health initiatives, using predictive analytics to identify at-risk patients and design medication management programs. They will be the go-to experts for integrating high-cost, high-complexity treatments like cell and gene therapies, serving as the central hub coordinating everything from procurement to patient monitoring. Furthermore, as care continues to shift toward the home, pharmacists will be pivotal in designing and overseeing remote monitoring programs and ensuring the safe and effective use of complex therapies outside the hospital walls. In essence, they will be recognized and utilized not just as medication experts, but as essential strategic leaders in designing and executing the future of care delivery.
