Letter from the Chief Pharmacy Officer

Indu LewIndu Lew, PharmD
Senior Vice President and Chief Pharmacy Officer

I am honored to present the 2019 Annual Report for the RWJBarnabas Health Pharmacy Enterprise. This annual report highlights the outstanding work our team achieves on a daily basis and the successful initiatives that transform the quality of care for our patients. These exceptional accomplishments are attributed to the philosophy of our group, “Actively Seeking Excellence.”

Overview and Philosophy

The Pharmacy Enterprise is an integrated system of divisions with accountability for clinical, quality, safety, social and financial outcomes related to medication use across the continuum of care in our health system. The Pharmacy Enterprise has 25 divisions across two distinct service lines, Acute Care Services and Integrated Services.

Our Acute Care Service Line is comprised of 13 hospital divisions and our Integrated Service Line is comprised of 12 divisions: 340B Drug Pricing, Ambulatory Care, Rutgers Cancer Institute of New Jersey, Corporate Pharmacy, Informatics, Pharmacy Reimbursement Division, Retail Pharmacy Network, and Qualitas, our wholly owned pharmacy services company. Qualitas provides five unique services; Home Infusion, Hospital Services [Centralized Warehouse and Hospital Compounding/Repacking], Employee Mail Order Prescriptions and Specialty Pharmacy.

Effective leadership is predicated on clear communication. Pharmacy Enterprise leadership has taken this fundamental tenet and distilled it to one word that is chosen each year to guide performance. Asking a diverse group of pharmacy stakeholders to focus their annual priorities through one word is a strategy that has accelerated unity and execution of goals and tactics. Recognizing, that healthcare is shifting from volume to value based, our 2019 word was “re-deploy” in order to prepare our pharmacy team for this transition.

Ambulatory Care

One example of redeploy was expanding our footprint within the ambulatory care setting. It was an exciting time for the Ambulatory Care Division as they increased to four faculty Ambulatory Pharmacist Specialists and implemented a Post Graduate Year 2 Pharmacy Residency in ambulatory care within our Medical Group. The physicians within the Medical Group have embraced the pharmacists as physician extenders by entering into collaborative practice agreements with them. Under these agreements, prescribers can delegate patient care functions such as modifying and/or discontinuing drug therapy and ordering laboratory tests or medication refills. In 2019, this division performed more than 11,600 clinical activities within the Medical Group and Clinics, including closing approximately 650 gaps in care for Horizon Blue Cross Blue Shield attributed patients. By closing these quality gaps, our pharmacists will be invaluable within the Patient Centered Medical Home Model.

Acute Care

The Acute Care Division pharmacists and technicians performed over 3.71 million and 1.06 million clinical activities respectively. These activities resulted in cost avoidance of over $ 9.3 million. Our team aspires to provide the safest environment for our patients by recognizing the potential for adverse medication events and preventing them before they occur. In 2019, more than 53,000 adverse drug reactions and over 192,000 medication errors were prevented. Mitigating errors and harm were accomplished by several strategies. For instance, performing accurate medication histories and medication reconciliations ensure patients are receiving the five rights of medications: the patient, drug, dose, route and time. The team performed over 26,000 medication reconciliations and 18,000 medication histories. Another strategy included performing hospital discharge counseling to patients ensuring they are educated about their medications. More than 2,400 discharge-counseling sessions, 6,900 transition of care activities, and 31,800 anticoagulant discharge-counseling sessions were performed in 2019.

Retail Pharmacy

The Retail Pharmacy Division dispensed nearly 182,000 prescriptions in 2019. Ensuring patients leave our hospitals with prescriptions may decrease medication-related readmissions and improve medication adherence. The Meds to Beds program of the Retail Pharmacy Division processed over 11,360 prescriptions for 4,881 patients prior to discharge.

Pharmacists can help ensure that patients without insurance in the community continue to have access to medications. I am very proud to report that the Retail Pharmacy Division has provided over 1,500 prescriptions to approximately 500 patients. This was possible through the partnership with the Dispensary of Hope, a charitable medication distributor. This program will continue to expand in 2020.

Qualitas

The Qualitas Home Infusion Division continues to provide safe and quality care to the community. Our nurse colleagues performed more than 23,500 home visits, maintaining over 89,000 line days and administering approximately 69,000 IV medications. While the national average for line infection rates is 3.5 per 1,000 patient days, Qualitas continues to over perform by decreasing its line infection rates from 0.1 in 2018 to 0.019 per 1000 patient days in 2019. The division provided over $5.6 million in net benefit to the health system.

Eighty percent of new drug approvals are specialty medications. Specialty medications are expected to increase to 50 percent of drug costs and grow to $500 billion by 2020. In order to validate the specialty pharmacy’s commitment to quality management, patient safety, monitoring and prescriber and consumer communications, they must achieve successful accreditation from regulatory agencies. While most have achieved dual accreditation, I am proud to report that Qualitas Specialty Pharmacy has achieved triple accreditation by the Joint Commission, Utilization Review Accreditation Commission (URAC) and the Accreditation Commission for Health Care (ACHC). The team filled more than 89,000 prescriptions for our patients generating a net benefit of over $11 million.

Medication shortages continue to burden health systems. In 2019, in order to mitigate the shortage supply, a centralized warehouse was established. The centralized warehouse strategies further evolved to leverage the buying power of the system in order to purchase medications prior to future price increases. These combined initiatives have realized over $2.2 million savings to the health system.

The Hospital Compounding and Repacking Division prepared over 243,000 intravenous medications and over 389,000 doses of medications for the Acute Care Service Line. Utilization of this division, in lieu of outsourcing saved the health system nearly $3 million.

The Pharmacy Enterprise focuses not only on the patients of the community but on the employees as well. The Employee Mail Order Division filled more than 68,300 prescriptions for employees and their families. They coordinated more than 1,934 medication deliveries, averaging 187 prescriptions per day to employees’ homes. Due to leveraging own use pricing, the division has saved the health system over $2.8 million. In addition, the co-pay card optimization program generated over $2 million in savings to our employees.

Focus on academics

Education is the cornerstone for our patients in the community, so they may be active participants in managing their health. The Pharmacy Enterprise provided over 250 community outreach programs. The partnership with Rutgers continues to foster the importance on education, research and publications. This is evidenced by our education efforts and dedication to pharmacy students and residents. The team provided advanced clinical clerkship rotations for over 600 students in 2019. The Pharmacy residency program has continued sustainability and growth with 18 Post Graduate Year 1 programs and 5 Post Graduate Year 2 programs.

The research principal demonstrated great success as three of the five research platform presentations at the New Jersey Society Health System Pharmacists Annual Meeting were performed by RWJBarnabas Health pharmacists. The sustained research efforts were evidenced at the System Quality Forum where the Pharmacy teammates presented seven platform and nine poster presentations.

The Pharmacy Enterprise team is nationally and internationally recognized as educators and presenters. They completed over 440 formal lectures, locally, regionally, nationally, and internationally, as far as Italy, Netherlands, Spain and Australia. The team also performed over 427 clinical lectures to various practitioners within the health system.

We are very proud to state that one out of every four pharmacists in our system are board certified, with many having double certifications. This year, ten pharmacists achieved Board Certification, five becoming Specialty Board Certified, a new national board certification.

In 2019, the Pharmacy Enterprise completed 70 peer reviewed manuscripts, book chapters, guidelines and articles. A total of 180 abstracts were presented at local, national and international meetings.

Recruitment and Retention

Currently a statewide shortage exists with recruitment and retention of pharmacy technicians. In order to fill this gap, the Pharmacy Enterprise created a Technician Training Program consisting of 168 hours of education and training. The program provided employees from various departments within the health system such as environmental services and security, an opportunity for a career path within the Pharmacy Enterprise. The talented educators were technicians and pharmacists from across the system. The program successfully graduated 19 technicians in the spring of 2019, with employment in our facilities.

Additional Milestones

Our 340B Division’s compliance team completed 198 audits of our facilities ensuring a net benefit of more than $70 million to help offset the over $900 million of in kind care the health system offered.

Our Pharmacy Reimbursement Division performed over 3,300 billing, coding, charge capture and reconciliation activities, resulting in payments of over $2.6 million.

The Pharmacy Informatics Division made over 3,500 safety enhancements of our health system’s clinical information systems, which serves as the foundation for all health care providers.

Building on Excellence

Pharmacy leadership has chosen the word “foundation” for 2020. Foundation centers on the essential principles of harmonized workflows, policies and procedures and competencies in anticipation to the migration of the health system’s universal electronic health record.

On behalf of my teammates of the Pharmacy Enterprise, it is my honor and privilege to submit the 2019 Annual Report.