Today, we're hear a conversation between Rebecca Grandy, Director of Pharmacy at CHESS and Debi Hueter, Executive Director of WakeMed Key Community Care, a clinically integrated network focused solely on primary care. Discover how integrating pharmacy services is transforming provider workflows, reducing emergency visits, and improving patient outcomes.

Debi Hueter 0:00

to me, the the access to medication, the barriers that have been put up to get medications these days is really challenging and if we can, if we could lower those barriers and allow patients to be able to get their medications at a lower cost or a generic instead of a name brand or something like that, then you know that's what we should be doing. Accountable care organizations should be just that. They should be accountable for the care of the population they serve.

NARRATOR 0:37

Welcome to the Move to Value Podcast. Today, we're hear a conversation between Rebecca Grandy, Director of Pharmacy at CHESS and Debi Hueter (Hewter), Executive Director of WakeMed Key Community Care—one of the most forward-thinking clinically integrated networks in the Raleigh area. They discuss pharmacy partnerships, rising drug costs, and how WKCC is tackling medication access head-on to keep patients healthier and out of the ER. It's a real-world look at value-based care in action—and why the right collaboration c an save lives. Let’s get into it.

Rebecca Grandy 1:08

So, Debbie, welcome to the Move to Value podcast.

Debi Hueter 1:11

Thank you.

Rebecca Grandy 1:12

Just to start, you know, for our listeners who may not be as familiar with WKCC or you and your team, can you kind of tell us a little bit about your organization and your background?

Debi Hueter 1:23

Sure. WKCC is Wake Med Key Community Care. It is a joint venture between Wake Med Hospital System and a very large independent group of primary care physicians called Key IPA.

MSSP program for a little bit and then moved deeply into the commercial space probably in 2016 and have been very successful in in our journey. Since then we are, we are a clinically integrated network only of primary care physicians.

With a what I call a concentric circle of high-value specialists that we refer to who have been vetted out based on quality and cost and other criteria. And then our purpose really our mission and vision is really to.

Make sure that our physicians are supported with the tools and resources that they need in order to take care of their patients and also to support their patients and make sure that they have access to care management, to clinical information and things like that.

And that's just the the surface.

Rebecca Grandy 2:54

I know just through working with you all, I know there's a lot of services you provide in that community. And so very thankful that we've had the opportunity a little over a year now, almost a year and a half to have a partnership with you. So just curious, like how have you seen your relationship with CHESS supporting the goals that you have for WKCC and for the community there in the Raleigh area.

Debi Hueter 3:19

I would say that CHESS having a partnership with CHESS was probably one of the best decisions that we made. We know that that pharmacy spend in a clinically integrated network is rising every day, every month with high cost drugs.

And and other types of things. And we also know that while those drugs are those high cost drugs are expensive that people can't afford them. And so when we were in the decision making process of what do we do about pharmacy, we discussed do we buy or build.

And we looked at both sides and we decided to to buy and partner. We looked at several companies and we felt that CHESS had the same mission and vision that we did to take care of patients to help support practices.

And things like that. So how has it helped us? It is the the stories are incredible that of patients who had could not afford their medications, who have found alternatives ways through CHESS to do that.

With physicians who have been educated on new new prescriptions or maybe a change in a prescription, I know chess has worked really closely with some of the pediatricians on some of the new drugs that are coming out to explain to them exactly what they are, what they mean and how they can be used and things like that. So I I would say that this has probably been one of the best, best partnerships and best ideas that we've had.

Rebecca Grandy 5:04

Well, thank you. That's very kind. I know you know our team specifically Gwen, the pharmacist and Aubrey, the technician, you know who do a lot of the support for WKCC are fabulous. And you had mentioned you could think of some patient stories. Just curious if there's any patient stories that have stood out to you or the team that you would like to share.

Debi Hueter 5:21

You know, I I I thought about that and I try not to think of specific patient stories because they're also individual and they're also personal to that patient. But one of the one of the things that I like most about this program is.

This is very personal to patients and yes, it does help us with our our stars ratings and things like that. But what's more important is that patients are getting.

One-on-one care, they're they're actually talking to a pharmacist. They are communicating with somebody who really knows their their medical record and really can they can relate to. And so the stories that that come to mind for me are where patients are maybe cutting back on their medication because they can't afford it and that cutback in the medication then spurs an ER visit and you know that's what we want to try to avoid. We want to try to make sure that our patients have.

Have everything that they need in order to not go to the ER or go to the urgent care and and and do things like that. But it's there's been a couple patients that either they stopped taking their medication because they couldn't afford it or they just, you know, they were cutting back on their medication, cutting their scripts in half and things like that. And they were going to the ER because the episodes that they were having. So to me that is that is just the the sole purpose of why we do this.

Rebecca Grandy 7:01

Thank you for sharing that. And you know, in my career I've been a huge fan of team based care and had the opportunity to practice in a lot of places that valued that. So I always like to hear. I'm just curious for you Debbie, for WKCC. Like when did y'all start thinking about incorporating pharmacy into the team? Because I know y'all have had a very successful care management program, nurses and all of that. And I'm just curious kind of like when you drunk the Kool-Aid, that's what I like to say. You know, people have drunk the pharmacy Kool-Aid. So when did that happen for you? What was that WKCC or was that in a previous life or just more about that?

Debi Hueter 7:41

No, actually it was here and we've, it's been on our radar for several years. We just never pulled the trigger on it because because it's just doing the due diligence it takes to find the right partner and think through all the specifics that you know the financial, the budget wise and things like that, but it's been on our radar for a while and especially since as we get reports from payers and as we look at our own reports in Arcadia, we see that pharmacy spend just rise and rise and rise and rise and it was it was because of that that we finally decided that we needed to pull the trigger and go and say, all right, now is the time, you know, we're going to we're going to partner with somebody on this rather than try to hire a pharmacist internal and things like that. And so it's it's actually been on our radar probably for three or three years, maybe four years. But you know, last year was the year that we actually pulled trigger with you guys and and don't regret 1 minute of it.

Rebecca Grandy 8:51

Thank you. We've enjoyed working with you all too. I think it's been a great partnership and you know anytime you bring in new team members, I think there's always a challenge of how do you have care that's patient centered, that's coordinated. And so I would love for you just to speak about you know bringing in pharmacy and again you already had a great. Great care coordination program. You obviously have your providers from all kinds of primary care spaces, including Pediatrics. You have specialists. How did you all make sure that we were going to be able to work together as seamlessly as we have to provide care to those patients?

Debi Hueter 9:28

I think, you know, throughout my career I've always looked at things from a pretty holistic perspective and in in picking partners a lot of times. But honestly, I go with my gut and I go with who do I think is going to be the best partner for us, who has the same vision that we do who is not trying to sell us something new and shiny, but who is very grounded and and and really thinks the same way we do. And so we found that with CHESS. We did not find that with others, some of the other companies we looked at were more salesy and and that's really not what I was interested in. I was interested in partnering with a company who had the same philosophy that we do and that you know we just, we really want to take care of our patients and our providers.

I agree. I mean, like you said, it's definitely, you know, we want to improve patient care and patient health, but we want to make sure that our providers and staff are well supported and we allow them to do the things that only they can do, right. And so one of the things, you know, we've tried to implement at WKCC and at CHESS as well is education for providers, for staff. And I think I can remember this question actually when I interviewed at CHESS, everyone was like, how do you get providers engaged? I think there's like, that's like the magic question, right? So I know we have been doing some education initiatives for your providers. What kind of responses have you been getting from staff, from providers, from your practices with the new incorporation of pharmacy?

You know, anytime you introduce something to a physician, they never take it right off the bat, not unless it was going to, you know, create lots of money for them or whatever. But I do think that this with everything else, just like with our care management programs, it takes time for physicians to understand.

And that this is something that they have access to that they don't have to pay for and that is there to help them and their staff with helping their patients. And so getting physicians engaged is really just a matter of repeating, repeating, repeating and communicate, communicate, communicate. And I have been surprised at some of the practices who I thought were going to be naysayers have come around and have engaged with CHESS and the pharmacy program. And I mean we don't, we hear nothing but great things about this. And so we are and so we use those providers kind of as our sounding board to to talk at different meetings and things like that so that they would encourage other practices and other physicians to at least ask the question, how do I get involved in this? What do I how do I, how do I have my my patients get involved in this and what do I need to do? So physician engagement is always slow at the start, but if you can show them that this is something great and it doesn't take their time and in fact it gives them time back for both them and their staff, then I think that's that's when they become engaged.

And it's like, how do you get your foot in the door, right? How can you show them that you're going to be helpful? And so one of the things that I found, and I would say this is true throughout my career and all the places I've worked, is physicians love when you're able to help their patients get medications, right? Medication access. How can, how can you help my patient afford this medicine or remember to take it. And so you know beyond adherence, which as you mentioned earlier is part of value based contracts, you know they measure us very closely on adherence. One of the services that we do provide is medication access. So just navigating formularies, signing up for patient assistance programs. Just connecting them with community resources, I guess how important for you all, Debbie, at WKCC was that piece when you were thinking about pharmacy services? So again, just sort of going beyond the traditional medication adherence, but trying to think through things more comprehensively even though, you know, I mean you're paying for our services.

But things like medication access, you know, you may or may not see a direct return on that. And if you do, it's further down the line or maybe it is like you know, you said people are prevented from going to the ER. So just curious how like that holistic view of medication access played into your decisions to partner with us.

Well, I think it's, I mean I I think that's kind of the basis of everything and and with healthcare costs rising, with everything cost wise rising, the most important thing is for patients to make sure that they take their medications and if they can't afford it, they won't take it. Period. End of story and so I know with our clinical team they had, they have a lot of information on on all this but certainly not as much that not as much as you all have. And so you I know you all work really closely with Catherine and her team and and to identify those patients who need that help but to me, the the access to medication, the barriers that have been put up to get medications these days is really challenging and if we can, if we could lower those barriers and allow patients to be able to get their medications at a lower cost or a generic instead of a name brand or something like that, then you know that's what we should be doing. Accountable care organizations should be just that. They should be accountable for the care of the population they serve.

And whether it it, whether there's an ROI on it or not, you can't put an ROI on a patient calling and thanking somebody for saving their life. So that to me is everything.

I love that. I mean, you know, a lot of times being in the value-based care space, you get carried away with data, right? You get carried away with data and metrics and it can be really easy to lose sight of the people that you're helping. So I guess just thinking about that, Deb, because I know you're you're caught up in the world of data and metrics and everything as well, how do you keep your team and your partner sort of grounded in that? OK, it's actually about patient care. It's improving health. You know, we know we're doing the right things. So in the long run, you know, this is going to, you know, benefit the community. Like how do you keep people grounded in that thought when you're seeing all this data and metrics and finances?

So I am very blessed because I have a a staff that we all are on the same we all have the same vision. We all feel the same way that the reason we are here is to serve our providers and our patients.

Yes, you can get caught up in the in the weeds, in the in the data and you know this doesn't look right or that doesn't look right. But at the end of the day, and I know a lot of people talk about this, but at the end of the day we truly believe that what we do and and how we do things.

Is for the purpose of the patient and supporting our providers. And a lot of times you make decisions based on, like I said, you make the decisions based on gut feelings. You make the decisions based on what's best for the providers.

Might not have an ROI to it and you can't, you know, but you do things for patients specifically that will help them to be the healthiest they can be. And so I'm like I said, I'm, I'm really lucky because I have 100% of my staff. We are all on the same page when it comes to that.

And it's been great to partner you with you all and work with your staff and just see, you know, that vision, you know, playing out for Raleigh and the surrounding areas. So if someone like if someone's listening and they're in the Raleigh area or in your sort of catchment area, Debbie, what is it that you would want them to know about WKCC being part of your CIN, any any information you want to share with anyone listening who may be interested in what you can offer?

Yeah, that's a great question. I I would say to somebody who is who is listening and are interested in looking for the highest quality, most cost-effective providers in the area, then look to the WKCC providers.

I have said since the day I got here, which was almost eight years ago, that these primary care physicians are hardwired to think about value-based care. They they amaze me every day and how they think about do I really need that test or do I really need that prescription or you know, how, how can I, how can I give the highest quality of care to my patients without excess costs? And so that's what that's what we're here for. And you know, there are costs of things that have to be done. There are tests that have to be done. There are prescriptions that have to be written and things like that. But you know, when you think about patients getting.

A lot of imaging studies and and and all that it's it's is it really necessary? Are things like that really necessary? And like I said, these physicians just amaze me with the way they think about healthcare holistically and about their patients, not about.

Oh, I, you know, I want to do this test because I can earn more money or something like that. They really don't think that way. And that's that's what I say. If you're gonna, if you're looking, if you're new in town and you're looking for a provider, that's the type of primary care that you want.

Well, Debbie, this is great conversation. I would love for you to stick around so we can continue.

I'd be happy to.

This has been The Move to Value Podcast, powered by CHESS Health Solutions. We hope you enjoyed this episode. Join us next time for the conclusion of the conversation between Debbie Hueter aand Rebecca Grandy

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