Letter from the Chief Pharmacy Officer
Robert Pellechio, RPh, MPA
Senior Vice President and Chief Pharmacy Officer
Welcome to the eighth Annual RWJBarnabas Health Pharmacy Enterprise annual report. The Pharmacy Enterprise is an integrated system of divisions with responsibility for clinical, financial, quality, safety, and social outcomes related to medication use across the continuum of care at RWJBarnabas Health. Our enterprise has 24 divisions comprised of 14 hospital divisions and 10 integrated service divisions. A detailed summary of each of these divisions is enclosed within the pages of this annual report. This report is intended to highlight and explain many of the incredible achievements our team has realized over the last year. These extraordinary accomplishments are attributed to the talents and relentless drive of our group in actively seeking excellence for our health system with the mantra of “One System-One Family” philosophy, always in mind.
With Mark E. Manigan at the helm as President and Chief Executive Officer and John W. Doll as Chief Operating Officer at RWJBH, we continued to enhance integration across all its divisions, facilities and service lines in 2023. This service line approach includes a clinical and business executive supported by interdisciplinary teams to create goals and tactics to enhance and track patient care and financial performance. A system Epic roll-out continued throughout the system in 2023 with great collaboration and success. We also went through a Group Purchasing Organization (GPO) change that is projected to have future additional value for our system, both clinically and financially.
The year was not without some external complexities for our system. A nearly 5-month job action by the nursing union in New Brunswick contributed to unbudgeted costs for our system. However, our system pharmacy family pulled together to support a tremendous effort by our New Brunswick pharmacy colleagues. Adding to these challenges were governmental funding cuts, increases in drug costs and supply chain shortages.
The acute care facilities were hard at work on a wide variety of clinical initiatives including order set and practice guideline development, shortage mitigation, creation and maintenance of standardized system policies and procedures, and increasing biosimilar medication utilization. Pharmacy Enterprise Collaboratives continued to work with Service Line leaders to promote clinical excellence across the organization. Collaboration with infectious disease, neurology, oncology, emergency medicine, critical care, pediatric and quality service lines have continued to be a major focus for pharmacy and will continue in 2024. As the service lines have become more established, Pharmacy has served as a critical bridge on projects and initiatives that cross multiple service lines. As in previous years, education and post-graduate pharmacy training was a major focus for the Pharmacy Enterprise. Over 580 student rotations occurred across our organization in 2023. The RWJBH Residency Leadership Forum graduated its 7th class and started training its 8th class in various leadership topics to create a pool of highly qualified clinicians with leadership expertise. Over 168 pharmacy residents have received this training since the program’s inception in 2016. The Pharmacy Enterprise continues to align with Rutgers University to provide faculty and real-world training opportunities across our organization.
Corporate Pharmacy supported the Cerner-to-Epic conversion of eight hospitals by project management and scheduling of over 200 System pharmacists in addition to directly participating in 5 dry runs, 2 backload events, and provided over 30 shifts of on-site, live participation. Order set development, project management and issue resolution are a few of the many ways that the Pharmacy subject matter experts ensured the success of the project. Pharmacy’s focus on patient safety and professional excellence will be the backbone for providing ongoing support for all our service lines and the evolution of Epic.
In Ambulatory Pharmacy, our four embedded ambulatory pharmacists continue to focus on improving outcomes in chronic disease state management in our primary medical group. They collaborated with Population Health, Employee Health and Ambulatory Care to ensure that diabetic employees in our practices are followed for A1C reduction. There was also further collaboration with Population Health on A1C reduction in alignment with the value based Horizon contract.
Our retail pharmacy network continued to excel in their support of patient care and education. Dispensary of Hope provided approximately $400K in free medication to our patients who need assistance. This was over 500,000 doses in five of our retail sites. Our relationship with Rutgers School of Pharmacy, through nationally recognized professor Lucio Volino, contributed 143 programs to over 1500 outreach patients within our catchment areas.
In 2023 Qualitas was the National winner of the MMIT Specialty Pharmacy Patient Choice award for Hospitals & Health System Pharmacies. Edging out Parkland and Vanderbilt systems for this honor. Qualitas also changed their name to “RWJBarnabas Infusion and Specialty Pharmacy”. This will better align our specialty pharmacy with our national brand.
The 340B Division was involved with the successes of the Epic roll out in five 340b facilities with little-to-no WAC impact to the pharmacy budget. They assisted with the conversion to the new GPO and finalized a contract pharmacy P&L statement process with accounts payable. The division’s work also led to a dramatic increase in split-billing and contract pharmacy revenue.
The Pharmacy Reimbursement Division (PRD) recovered millions of dollars in potentially lost medication reimbursement for our system through their talent along with relentless and persistent effort. Their ongoing work with Revenue Integrity, Managed Care, Epic Willow and Hospital Billing teams have contributed to additional savings and revenue generation, as outlined later in this report. This team oversees all the drug replacement programs in the system.
The Pharmacy Enterprise was instrumental in the successful inaugural year of the RWJBH System Formulary Committee. The RWJBarnabas Health System Formulary Committee is a joint effort between pharmacy and the System Quality and Standards Division and is comprised of physicians, nurses, pharmacy, executive and quality leaders from across the RWJBH IDN. The purpose of the RWJBH Formulary Committee is to integrate all individual site formularies to enhance drug selection and procurement; standardize medication ordering within the electronic health record; improve patient care, outcomes and safety; and decrease medication related costs. The work of this committee has highlighted the importance of the RWJBarnabas Health service line model and the impact that aligning mission and vision can have across disciplines. The committee gathered for four meetings throughout the year to support the work of the Formulary Committee. Seven drugs were added to the system formulary. Seven clinical excellence initiatives reduced practice variability with two of those initiatives providing tangible cost savings to the system.
Throughout the 2023 corporate pharmacy continued its efforts with drug cost-avoidance and recovered over $8 million related to better medication NDC selection, identification of incorrectly loaded contracts and overcharged invoices which was aided by the implementation of a data surveillance tool. The success was due to interdepartmental collaboration and persistent communication with hospital-based pharmacy buyers. Another $23 million in spend was avoided by prudent planning and pharmacy interventions that resulted in conversions to biosimilar medications.
The RWJBarnabas Health Plan has transitioned from our own mail-order pharmacy to a national outsourced pharmacy in 2023 for employees. The Pharmacy team has helped with this major transition by supporting our employees with our in-house retail and specialty pharmacy networks. We will continue to assist the health plan with future formulary decisions and changes in medication therapies to help reduce costs and maintain the health of our employees and their families.
I am tremendously excited to continue to collaborate with our internal and external partners into 2024 and beyond. With our system mantra of One System, One Family, and our commitment to being the best place to deliver and receive excellent care, our focus is clear. As healthcare continues to evolve, pharmacy is poised to thrive in our relentless pursuit of clinical and financial excellence.