Keynote: Healthcare Community Transformations: Are Pharmacists the New Primary Care Providers?
Episode 1824th February 2023 • This Week Health: Conference • This Week Health
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 Today on This Week Health.

(Intro)   They're gonna be patients that need to see their physician but can't travel the 150 miles. Particularly a lot of these older patients that may have multiple comorbidities, They're already struggled to find the right transportation even to get to places locally. Now, that may be impossible.  

Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.


  📍 Today we are joined by Frank Harvey, c e o of Surescripts. Frank, welcome to the show.

Oh, thank you so much, bill. It's a real pleasure to meet you.

Well, I'm looking forward to this, we're gonna venture out on thin ice here. We're gonna do predictions, and predictions is always a fun topic, but.

things that have happened in:


appreciate it. Wow. I hopefully if I'd known that, maybe I would've said no. Maybe they know something different.

Different topic. We'll see. Well, let's start talking about the backdrop really before the predictions. What are you hearing? From your clientele, from the pharmacists and others in the industry, what's the backdrop that we're gonna be making these

predictions on?

Sure. Well, our sure description Network Alliance is the pharmacies the practitioners, the physicians, the EHRs, the health systems. So we interact in sort of a a great way with all of those. So these are sort of based on what we're hearing from each of those segments, if you will.

So the challenges we're hearing on this show, cause we've been interviewing a lot of people, we're hearing stuff about burnout. We're hearing staff shortages, we're hearing inflation just in general, financial challenges, four segments of the industry. Not all segments, but for many segments in the industry.

t now than others as we enter:

Yeah and again, I think the individuals that you've heard that from are really good at seeing the future because it's happening now.

I almost call it back to the future, if you will. Yeah. Let me g give you a great example. 70 years ago in your small rural areas, the pharmacist was the primary caregiver. A lot of times you didn't have a physician in the area, or you didn't have one in, in in close proximity. So the pharmacist was playing a big role in primary care.

I think as we move into the future, you're gonna see more of that comeback to being, and the reason is, as pharmacists has proven themselves through the pandemic, that they can step in and take this sort of first level of primary. And do it very well. The reason being is it is that burnout that you mentioned.

So we saw

some of that and this is just about reimbursement, right? So we saw some of that through the pandemic. The pharmacist stepped in and started to provide some of that because there were some relief and there were some funding for it. Are you saying that's probably going to continue in 20.

We believe it's gonna continue, and if anything, get faster. Couple of reasons. Again, the burnout. You mentioned the latest survey showed that 20% of primary care physicians plan to retire over the next two years. 30% of overall healthcare workers are saying they're cutting back on the number of hours

they're spending at their job. Cause of that, we really need a healthcare professional that can help step into that gap and provide some of those roles, some of those functions that those individuals have been providing, the pharmacist are, willing, ready, and able to step into that gap. And so we believe you'll co continue to see an escalation of those roles that pharmacists are playing, not just around vaccinations, but also.

Things. What, when Pax comes to being the ability to prescribe and dispense to start to play a role in more other primary care areas such as, comorbidities, dealing with congestive heart failure, diabetic patients helping adjust insulin dosages as patients get new H B A one Cs that come in.


that's really fascinating. Who will that impact more the pharmacists? That are working for the traditional players, the c v s, Walgreens, Walmart, et ceteras or how will that impact like the traditional IDNs and right academic medical


Well, I think you'll see a lot of ways. First of all, it's the interactions between the medical centers, the health systems, and the pharmacists in the community with transitions of care when patients are transitioning from the hospital setting to a community setting. And you need that continuum of care to continue on.

We have a number of technologies that they utilize in our Surescripts network, clinical direct messaging for. Just in the first half of this year, over 10 and a half million messages have gone back and forth between physicians and pharmacists that in the past may have been a fax, may have been a phone call, but it's really helped streamline that, another record locator in exchange where the physicians or practitioners are able to utilize our technology and systems to locate additional records they may need for that patient care first half of the year over.

20 million clinical case records have gone over the network again to help inform that practitioners, they're in the middle of patient care.

It's interesting because my father-in-law who passed away when he lived with us, my wife used to take care of just all of his appointments and those kind of things, the number of stories.

She came back. She would pick a certain pharmacy because. Because they spend a lot of time with her, this is a time where we don't have a lot of time if there's a shortage of people to spend with people to really look at things. So we're concerned as patients is something gonna fall through the cracks.

And she would pick the pharmacy based on the people that would spend time with her. And a couple of stories, she had cases where they said, Hey, you know what? I'm gonna contact the doctor I, there. There might be a better way to go about this. Based on your father's history and that kind of stuff are we seeing a lot more of that or is that primarily done through messaging or is that still done through phone calls and that kind of stuff?

More and more is being done through messages and as I mentioned earlier, sort of our technologies that they utilize. What we saw during the pandemic is the trust in the pharmacist really escalated what patients were willing to go and ask their pharmacist versus feeling they needed to ask their physicians at certain points in the pandemic.

The pharmacy was the only place open, even emergency rooms closed down in some cases, and the pharmacist was there. On average, the studies show that particularly those high risk patients or patients that are being treated for multiple comorbidities, they'll go to their local pharmacy about 35 times a year.

Those same patients will visit their primary care physicians four times a year and their specialist nine times a year. So if you look at where their most interaction is and the healthcare professional that has the biggest opportunity and the most opportunities to help, it really is that pharmacist. We

I'm sort of baiting you on predictions here cuz by the way, if people are wondering, I don't know what your predictions are.

But I'm just gonna go off of some of the, cuz we do a new show, I'm gonna do some of the news stories that I saw. One is, I think we saw Walgreens actually have to reduce their hours in some markets cuz they didn't have enough pharmacists. Is that a trend that's gonna continue or are we seeing more pharmacists be trained and we're gonna fill that?

Yeah, we are gonna fill that gap. There are some areas, some states where there perhaps aren't as many pharmacy schools or haven't been as many pharmacists go there in the past. If you look at over the us, however, the vast majority of communities, there are enough pharmacists that wanna step into this gap to operate at the top of their license, if you will.

Now there are. , there are a couple of things that have to happen along with just the pharmacist willingness. First of all the reimbursement structures have to come into place. So both, c m s, the federal government and the health plans have to recognize and start to reimburse pharmacists for this activity.

Pharmacists all wanna provide this higher level of care, but again, we've gotta have the compensation structures that continue to evolve to be in place to reward pharmacists for

this. What's the case that you would. To a legislature, to somebody in the regulatory world that this should happen.

Is it still around burnout and lowering the cost of care?

Well, again I think it's threefold. You mentioned the legislature, so it's not just a reimbursement piece. , but it's also, we need to get some of the federal laws changed, both at the state and federal law level to empower pharmacists to provide some of these activities that they're well trained to participate in.

So that's part of the same effort side by side with the reimbursement effort. I think there are two things I would point to in particular, why the legislature, I think, would understand and approve this, first of all, cause of the coming, lack of healthcare professionals. It's not just the burnout today, but imagine when you pull 150,000 additional primary care physicians out of the country, how bad is it gonna be at that point?

You'll see patients that generally had been seen three or four times a year at their primary care physic. May be able to get an appointment once a year, and that gap is gonna need to be taken by the pharmacist stepping up into that to be able to do that monitoring in the interim. That's what I think legislatures will understand.

This is a bipartisan effort. This is really on both sides of the aisle. We all recognize the importance of primary care. We are continuing to age as a society. The needs from the healthcare sector are gonna continue to grow. We have to have those practitioners available to step into that.

Is it a similar or just a slightly tweaked case that you would make to like the c e o of UnitedHealthcare or Aetna or Cigna, to say, look, this is why this makes a lot of


Yeah, it's the exact same case to be made because the managed care plans that really care about their patients, they wanna make sure they're getting the right treatment. If there are no practitioners, if there are no primary care physicians available to be with those, to work with those patients, what you're gonna see is what could have been solved easily, or maybe a minor problem becomes a larger problem because the patients have to go longer without seeing a p.

They end up going to the emergency room instead of seeing a primary care physician. Again, that's additional expense. So to the health plan, I think you would also emphasize not only the need for the patient care, but also the additional expense because patients don't get handled correctly the first time or enough care on a day in day out basis.

One of the interesting stories that I saw recently was one of the major pharmacies is trying to do remote dispensing and essentially dispensing of the pills remotely and the technologies there and whatnot. Now there's some state laws in place that will limit them doing it in some markets.

And this is a national player, but essentially what they're saying, Hey, we're moving. Forward with this because there's things that don't necessarily require a licensed physician to do some very basic things. And if we can take that off their plate, they can do more primary care.

Do you see that as a potential trend as well? Or are there obstacles

there? Yeah, and I think that's continued to evolve, but it's absolutely a trend. They're already a number of. Chain drugstore is that you might see, hey, we, we are using a central fill pharmacy where they'll send the prescription off to a central fill warehouse where it may have 30 or 40 pharmacists and a lot of techs that can move the prescriptions through in a much more efficient manner.

Are the, potentially robotic fulfillment where the pharmacists are checking those medications even after they come off the robotic fulfiller and then sent out to the local pharmacies to be dispensed the next day. That's already been happening, and I think you'll continue to see that happen more and more because that frees the time for those pharmacists to then provide those primary care functions that you mentioned.

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I'll throw a generic question out to you. Next prediction. Do you have another prediction

for us?

Yeah, and it goes hand in hand, I think with the the burnout we're already talking about. I think rural communities will see a number of the health systems will start to shut down just because they can't afford to continue business.

One study shown that there's an estimate that 30% of rural healthcare systems will close within the next year. The impact on that community and on the patients in that community will be dramatic. . A lot of times the pharmacist may be the only healthcare professional left in that community that can provide that care.

There'll need to be great communication between those pharmacists and the health systems that real critical patients end up going to that may be a hundred, 150 miles away. And utilizing our networks. They'll be able to get the information back and forth between those sort of local practitioners, if you will, and the health systems that those patients will eventually have to visit that maybe hundreds of miles.

That's a chilling prediction. I assume telehealth plays a role there. The pharmacist plays a role there. But yeah, I mean, you could see large sections of geography that they are traveling a long distance. What will care look like, I mean, is care. Is the pharmacist gonna be enough in that case .

Great question. I think it's gonna take a team of individuals so the pharmacist won't be able to do it all. But telemedicine is certainly gonna play a role. Cause they're gonna be patients that need to see their physician but can't travel the 150 miles. And if you think particularly a lot of these older patients that may have multiple comorbidities, They're already struggled to find the right transportation even to get to places locally.

Now, if visiting a physician requires a hundred hundred 50 mile trip, that may be impossible. So telemedicine will play a role. The pharmacist will play a role, multiple members of that care team will play roles.

Do you think this where have we said, so Walmart in the state of Florida. Has been standing up now.

They used to do the little clinics inside the Walmart. This is different than that. They're essentially taking parking spaces and they're putting in a box that has multiple things in it. It'll have a pharmacy, but it'll also have primary care. It might have dental, might have ophthalmology, might have imaging.

Do you think a Walmart with that kind of model might be able to step in those rural area?

Certainly I think that Walmart can play a role or, a number of the retailers can sort of play that role. Even independent pharmacies can help set up those type of areas and areas where you may not have a Walmart or another chain drugstore.

So I think those are certainly helpful solutions. And if you look at what a number of the, whether it's MinuteClinic or Village md. Again, I think you've seen a number of a retailer step up and wanna have a closer working relationship between the primary care physician and the pharmacist in those locations as well.

That's interesting.

Let me just throw it out there again. I mean, we could probably go down the rural healthcare for a while, but I wanna get to some of your other predictions. What other predictions do you.



think you'll continue to see interoperability advance. It's something that the federal government did The 21st Century Cures Act is pushing forward. It's something that we, as Surescripts, again, we're only 20, 21 years old now as a company, fairly young in the evolution of some companies. But we have already done a lot around interoperability and we continue to push forward the things I mentioned earlier, record, locator, and exchange where, you know, almost.

A billion transactions have gone through that specific technology that helps interoperability. Interoperability is all about getting the right clinical message in the hand of the practitioner at the right time to make the right decisions, and that's been a focus of ours from the very beginning as a health information network, ensuring that information gets back and forth the right individuals.

I know that 21st Century Cures has some requirements on the providers and even the payers now. , is there some aspect that Surescripts plays in terms of providing that information to patients, to the community? Or is this at a different

level? It's at a different level.

We're more the sort of the practitioners, even though almost 99% of the US population at some point has had one of their health information records go across our networks because a provider. A pharmacist or someone has needed those records or that information. So again, we don't provide that information directly to patients.

We do it through the a r or through the practitioner, through the pharmacy. We provide that information to them. They share it with their patients as needed. Yeah.

21st century cures should be really interesting. Surescripts is primarily the practitioner.

Talking with each other. Is there anything you're looking at that's looking at the patient or the consumer?

We're not looking directly the consumer. Now, the things that we do help the consumer dramatically. For instance, real-time prescription benefit, it provides to the physician, to the practitioner so they can see what are the different therapeutic options, what are the price of each of those.

Those options based on a patient's insurance plan so they can pick the right medication, not just from a therapeutic standpoint but from a cost standpoint as well. And it's often said the most expensive medication is that medication with the patient never picks up and takes cause they never get well.

And a lot of times if the prescription that the physician were to pick were too expensive, the patient will never be able to afford it. So utilizing real-time prescription benefit, they're able to make the right choice for that specific patient. and that

helps with the transparency rules as well.

I mean, to be able to know that information, provide that information I assume you're baking that into the physician workflow. So they're seeing it at the point when they can do the most good.

at the point that they're prescribing, they see that information, they see the therapeutic alternatives, they see the different pricing of each based on that specific patient's health plan, which is so important.

For years that wasn't available. You get to the pharmacy as a patient and find out that the prescription was gonna be, much more than you could afford. You would have to make a choice between, eating that week or taking your medication. Now the physician can pick the right medication based on one, what the patient could afford, as well as therapeutically.

What's gonna be best for the.

Prescriptions is one of those areas, scripts specifically that really has been ahead of the curve with regard to interoperability. It's not, it was one of those areas where, hey, we were, we're sending scripts down the street to all the major pharmacies in our markets a while back.

Leaders like yourself who brought those technologies to market, is there any ways any areas where we're expanding the use of interoperability that, that might have an impact on? Any of the aspects of the quadruple.

Yeah. Again, the important piece of interoperability is the transfer of that, right

clinical information at the right time. So if you think of Surescripts and say, well, it's an e-prescribing company, it's really much more than that. All the clinical messages we send are the 21 billion messages we send are. Back and forth over our networks a year. Only about 20% of those are e-prescribing.

The rest are all the other clinical information, the interoperable information that's needed to go back between practitioners to make the right decisions, make up the vast majority of that those 21 billion messages.

So those pipes exist. Any other predictions?

Yeah, I would say you're gonna see specialty medications play a much larger role.

If you look at what's not only in the pipeline from a development standpoint, what's already on the market and the uniqueness of specialty medications is if you've seen one, you've seen one. Cause they all have certain uniquenesses to them. One of the most troubling things about specialty medications is in general, they're.

Come through prior authorization. And secondly, it generally takes somewhere between two to three weeks for a patient to get on a specialty medication. Which, when you're dealing with something you need to get on medication as soon as possible, that's really troubling and it's because of the link that the prior authorization process takes in making sure you have all the right information, that it is the appropriate medication for patients and our specialty medication modules.

Help shorten that timeline so you can get medication to patients sooner than you would otherwise through the process. So you're gonna continue to see specialty medications play a larger and larger role. I mean, for one they're so effective, they're so impactful. Treating diseases that may have never had a good resolution in the past.

The specialty medications come in. And really have a dramatic impact. One of the other things that I'll say that are similar because there are specialty medications is you're gonna see the biosimilars continue to make a larger and larger impact come into the market where there's more choice available around some of those more costly medications.

see progress in that area in:


ake an impact, because now by:

en quicker, if possible, than:

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 One more prediction if you got one.

You'll see more cooperation and more teamwork between all the different pieces of the healthcare sector.

So whether it's health plans, health systems EHRs, you'll see them working even closer together in the future. Because I think we're all realizing the role that we have to play in healthcare and how important it is that we do work together. Across all of these entities in healthcare to help make it better for patients, particularly when we're facing a crisis in primary care and in healthcare providers.

It's so important, and I think there's really an acknowledgement among all those players in healthcare, and you'll see closer and closer working relationships between those entities. Yeah, I

agree. Agree a thousand percent with that. So you just took over a c e O of Surescripts. Tell us about that about the transition into that.

Well, the transition has been great because I've got such a great team. And for years we've focused on three things since Surescripts very beginning, it's focused on three things. One, continue to improve patient safety. Two, to continue to lower the cost of healthcare, and three, to continue to improve the quality of healthcare and cause we're mission driven as a company.

Our employees are mission driven and our prior c e o Tom Skeleton just built a great team, brought in great people. So they've really helped my transition into the organization. They have some of a similar outlook and a similar desire. It's to help patients and to help do more for the healthcare sector.

Our employees understand that, our time is now because healthcare needs us to do more. They need us to do more than we've done in the past as a company, and we'll continue to do more in the future. Well, that

seems to be a good area of focus, safety, cost, and quality. It's Squarely in the heart of what every health system is looking to do.

For those who don't know, tell us a little bit more about Surescripts. You shared some of it through this but more broadly, I just wanna ask the question, cuz Surescripts is in so many health systems and Absolutely. It's behind the scenes, so I'm not sure everyone knows exactly

what you do.

Yeah. So just to simplify it a little bit, it's electronic. Network that makes it very simple for trusted, protected, secure health information to travel back and forth. Great example, if you've been into your physician and he writes a prescription, sends it electronically to the local pharmacy.

Vast majority of cases that went across our network. If you've got a been to your physician and they need to pull health records from another physician, chances are it came across our network at some point. Or if you've got a physician that checks to see what your insurance verification is to make sure this medic.

Is covered. It's generally gone across our network. So we've tried to build those connections or that interoperability across healthcare, whether it's from the health systems to the pharmacies, to the PBMs, to all members of the care team we've built and Surescripts Network Alliance are all those

players in healthcare working together to improve and focus on our three core things. Again, to continue to improve patient safety, lower costs, and improve the quality of care.

What can we expect in:

You'll see us continue to work on the quality of the prescription and the quality of the clinical information that's going back and forth across the network.

You'll continue to see more and more, practitioners depend upon our electronic networks. To get those clinical records to make sure that they're making the most informed decision at the right time with the patient. We'll continue to work with and help practitioners streamline the conversations they're having with patients because it's easy to see what they need to see clinically about the patient, and then to have the best interaction they can.


Frank, I want to thank you for your time. It's it's great to meet you and I'd love talking to you early on in your tenure. Love to stay in touch and see how things progress. I

would welcome the opportunity. It's been a real pleasure to meet with you today, bill, and let's make this a yearly thing.

Yeah, you know what, we'll come back to the predictions and see how you did.

Okay, great. Have a great day.

All right. Take care.

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