Letter from the Chief Pharmacy Officer
Robert Pellechio, RPh, MPA
Senior Vice President and Chief Pharmacy Officer
The RWJBarnabas Health Pharmacy Enterprise would like to welcome you to the 7th Annual Report. Although this is my first annual message, I have been involved with and contributed to past reports during my tenure as a member of the Pharmacy Enterprise. I would like to give a sincere thank you to Indu Lew who has been our division’s leader and mentor for the last few years, including the majority of 2022. Indu’s guidance, support and leadership has been instrumental in the success of all pharmacy services within RWJBarnabas Health (RWJBH).
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 in RWJBarnabas Health. Our enterprise has 25 divisions comprised of 14 hospital divisions and 11 integrated service divisions. A detailed summary of each of these divisions is enclosed within the pages of this annual report. Communication continues to be the fundamental principle in driving the success of Pharmacy Leadership at each of our divisions. The results produced by each division over the course of 2022 truly reflect a team effort that combines leadership, clinical, business and financial talents from individual hospital pharmacy department and division as well as a corporate pharmacy perspective. 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 precision focus of our group in actively seeking excellence for our health system.
The past year brought several changes to our organization. Our health system bid a fond farewell to its esteemed leader Barry H. Ostrowsky and enthusiastically welcomed Mark E. Manigan to the helm as President and Chief Executive Officer as well as the appointment of John W. Doll to the role of Chief Operating Officer at RWJBH. Our organization’s new Senior Leadership Team worked diligently to develop and implement a service line approach to align practice and services across our organization. The service line approach includes a clinical and business executive dyad supported by interdisciplinary teams to create goals and tactics to enhance patient care and financial performance. Over the course of 2022, RWJBH continued to enhance integration across all its divisions, facilities and service lines through a “One System-One Family” philosophy.
RWJBH eagerly welcomed Trinitas Regional Medical Center (TRMC) into the RWJBarnabas family of hospitals at the start of the year. The Pharmacy Enterprise transitioned the TRMC contracted pharmacy management staff to RWJBH employees and saved $815K by June 2022. Additionally, the pharmacy enterprise completed the integration and conversion of their 340B and Group Purchasing Organization (GPO) programs into ours, which produced additional savings for the organization. Clinical and operational lines of communication were opened between TRMC and the rest of the system allowing for enhanced collaboration and sharing of best practices.
The COVID-19 virus with all its variants continued to be a strain on our hospitals and pharmacy departments from both a staffing and drug supply perspective throughout 2022. Pharmacy supported RWJBH’s mass vaccination efforts at the Bridgewater Mega Center as vaccines and medication treatments continued to be administered to our patient and employee populations across our organization. Pharmacy also continued to work with New Jersey Department of Health and federal partners to ensure that clinics could provide these essential treatments and meet regulatory requirements. Every facet of health care has been impacted by COVID-19, yet the Pharmacy Enterprise has continued to maintain balance, provide optimal and safe patient care, all while ensuring operational efficiency in health-related areas. The year brought additional challenges to our team members including preparations for a potential Ebola outbreak, a Mpox outbreak and a tripledemic of pediatric respiratory viruses that strained the nation. Our organization was able to overcome many of these challenges with pooled resources and agile decision making. Members of the Pharmacy Enterprise were integrally involved with various teams to ensure providers and patients had access to the best care available.
As in previous years, education and post-graduate pharmacy training was a major focus for the Pharmacy Enterprise. Over 500 students were precepted in 2022 and Barnabas Health Behavioral Health’s PGY2 received a prestigious 8-year accreditation from ASHP. The RWJBH Residency Leadership Forum graduated its 6th class and started training its 7th class in various leadership topics to create a pool of highly qualified clinicians with leadership expertise. Over 145 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.
The acute care facilities were hard at work on a wide variety of clinical initiatives including order set and practice guideline development, creation of 38 standardized system policies and procedures, and increasing biosimilar medication utilization. The Pharmacy Enterprise worked across multiple disciplines to establish standard sedation assessment scoring for all sites, implement new medication therapies for stroke management, and standardize intravenous drug concentrations to promote patient safety. The formation of a system vaccine advisory committee led to standardization of vaccines in influenza, pneumococcal, and hepatitis B across all acute care facilities. In conjunction with the System Quality and Standards Division, the Pharmacy Enterprise developed an interdisciplinary System Formulary Committee that allows the organization to align medication selection and practice to provide optimal patient outcomes at all RWJBH sites.
In Ambulatory Pharmacy, our 4 embedded ambulatory pharmacists continue to focus on improving outcomes in chronic disease state management in our primary medical group. In the Community and Retail Pharmacy Divisions, although we closed two retail pharmacies for consolidation and financial savings, we expanded our Dispensary of Hope outreach to Trinitas patients and Greenville Pharmacy. The organization did elect to close our Employee Mail-Order Pharmacy. Patients that utilized LSC Mail Order Pharmacy were transitioned to Amazon and Accredo.
Qualitas, our Specialty, Infusion and Warehouse Pharmacy Divisions have continued to grow in support of our system hospitals and patients. They have been able to increase the number of limited distribution drugs available to our system and continue to grow 340B contracted pharmacy dollars. We also expect additional increases in this program’s revenue in 2023 as they expand into additional therapeutic areas, aligning with our system’s service line approach.
As Epic roll-out continued in 2022, pharmacy provided on-site and virtual support to the facilities that went live with the new system as well as the Epic teams that develop the system. 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. The Pharmacy Enterprise is enthusiastic about providing clinical content to support the 2023 scheduled Epic expansion phases. Pharmacy team members from across the organization provided consultation and guidance for a myriad of safety enhancements to our Clinical Information Systems, including Epic, Cerner, AllScripts, Pyxis and drug information programs. Pharmacy’s focus on patient safety and clinical/operational excellence will be the backbone for providing ongoing support for all our service lines and the evolution of the Clinical Information Systems we utilize.
The 340B Division had a busy year. Trinitas Regional Medical Center was integrated into the compliance and contracted pharmacy programs with no additional resources. As outlined later in this report, there was a dramatic increase in savings and revenue for the Disproportionate Share Hospitals (DSH) and Hemophilia Treatment Center programs. The Corporate Pharmacy team also worked with corporate and local finance departments to consolidate all 340B Contracted Pharmacy revenue and expenses into local hospital profit and loss reports. Completing this consolidation allows for all facilities to easily account for how this critical program impacts each site. Additionally, the 340B team aided in the implementation of BD Logistics at RWJ University Hospital.
The Pharmacy Reimbursement Division (PRD) identified and recovered potentially lost medication reimbursement for our system through their talent along with relentless and persistent effort. Their ongoing work with our 340B and drug replacement programs has contributed to additional savings and revenue generation, as outlined in this report.
To align with the system service line approach and the “One System-One Family” philosophy guiding our organization, Pharmacy leadership has chosen the word “Unify” again for 2023. While Unify was at the cornerstone of our work in 2022, the pharmacy enterprise will continue to collaborate on unification of strategy, services and initiatives throughout 2023. This word centers on the essential principles of harmonized health system workflows in anticipation of the migration of additional sites onto the Epic Clinical Information System Platform and the continued integration with Trinitas Regional Medical Center.