The CHALLENGE

Comprehensive Pharmacy Services (CPS) was approached by a large health system comprising 10+ acute care hospitals. The CEO tasked CPS with analyzing their hospital pharmacy data with the goal of generating as much savings as possible.

CPS teams worked hard to build relationships with hospital leaders and staff across the 10+ sites. The team began by interviewing pharmacy team members to identify cost savings and clinical process improvements across all sites.

Potential Barriers to Success

Potential barriers to success included:

• Physician alignment
• Competing priorities
• Cultural resistance

By directing a consistent change management approach, the team identified top health system objectives:

• Utilization/cost savings
• Continued implementation of opioid program
• Systemization/standardization
  • Drug formularies
  • Policies and procedures
• Maximizing purchasing power and drug shortages
• Further assess 340B contract pharmacy opportunities

Proprietary CPS Tools Utilized

The following CPS tools were utilized to identify and implement Focus Initiatives of Cost Savings (FICS):

• RxResource Solutions
• RxContentHub
• RxAssess
• RxLearning Center
• RxClinical Analytics
• RxTrend Analytics
• Antibiotic Stewardship Program
• Opioid Stewardship Program

SAVINGS IDENTIFIED

The CPS team identified a projected opportunity of over $15 million.

• Optimizing therapy ($9+ million)
• Biosimilars ($4+ million)
• Minimizing waste ($800,000+)
• Optimizing revenue ($160,000+)

Purchasing initiatives, contract opportunities, and CPS affiliation agreements revealed approximately $1 million in savings. Implementing our proprietary Focused Initiatives for Cost Savings (FICSSM) analysis and the RxClinical Analytics tool, the team further facilitated P&T review and approval of $1.65 million in clinical cost savings in the first month alone:

• Over $850,000 realized through consolidation of 20 therapeutic classes with therapeutic interchanges and formulary deletions approved through January 2020 P&T
• Over $700,000 in generic conversion opportunities identified and implemented in January 2020
• Purchasing and WAC analysis completed and opportunities identified, including $100,000 in WAC mapping initiatives implemented at one hospital site in January 2020

EXECUTION

Staffing Analysis and Efficiencies

CPS leveraged proprietary tools to assess clinical demands on staff and then analyzed the data against ASHP benchmarks to determine their effects on staff. The team found that, when challenged to make reductions over the years, original hospital systems relied on over-utilization of pharmacists to perform pharmacy technician duties. By reallocating on-site pharmacy support at three hospitals, optimizing resources to activities such as 340B opportunities, and maximizing existing pharmacy technologies, the hospital system revealed a $2.1 million annual savings opportunity.

Regulatory and Compliance

CPS utilized its RxAssess Comprehensive Pharmacy Assessment (CPA), a web-based tool that generates an in-depth look at pharmacy operations, ensures standards of performance are met, and subsequently implements best practices. The CPA covers criteria across Regulatory, 340B, Administrative, Operational, ISMP Best Practices, Finance, Customer Service, Rx Remote, and Clinical Services. The CPA standards are a collaboration of the Operations, Clinical, and Compliance & Regulatory Services divisions within CPS and serve to drive the strategic plan and goals at each facility.

The CPS team leveraged the CPA to identify and address gaps across the following:

• REGULATORY POLICY STANDARDIZATION
  • Controlled substance utilization review
  • DSCSA requirements
  • Survey readiness
• ISMP (Targeted Medication Safety Best Practices)
  • Injectable promethazine
  • Metric weights
  • Paralytic segregated storage
  • Fentanyl patches
• ADMINISTRATIVE
  • Remove scheduled overtime
  • Suggest change of reporting structure to have managers report to Pharmacy Executive Director
• OPERATIONS
  • Cardboard storage in pharmacy areas
  • Lack of medication mixing areas in nursing units
• FINANCE
  • Lack of process to ensure contract compliance
• CUSTOMER SERVICE
  • Lack of nursing/physician satisfaction surveys

By focusing on best practices related to regulatory and compliance, CPS delivered a program that greatly reduced risk to the health system and helped to bring best practices to life in areas where room for improvement existed. In addition, the programs put in place seek to prevent future unforeseen risks for the health system and patients.

340B

Our team analyzed their sites with our 122-point assessment:
• Evaluated provider practice opportunities
• Established integrated 340B policies and procedures
• Initiated robust program integrity audits
• Identified a savings opportunity approaching $4 million