Even before the national healthcare reform efforts took shape, leading hospitals had gotten the message from payers and employers that steep medical cost inflation couldn’t continue indefinitely. Much of the reengineering centered on revamping the patient care team at hospitals, a team that increasingly includes the pharmacist.
Bob Carta has been in an excellent position to monitor the change in the pharmacy at one of the more innovative systems. He’s been with Carolinas HealthCare System, based in Charlotte, for 25 years and is now assistant vice president of pharmaceutical services for the 32-hospital nonprofit healthcare system.
At Carolinas, pharmacists are being transitioned to the care team; they actually round with physicians and consult with them on proper dosing based on the disease state the patient may have.
“We’re dispensing information,” he says. “We pay pharmacists a lot of money and they go to six years of school. I don’t need them to dispense drugs. Instead, I need them to dispense clinical information.”
As a system, Carolinas’ pharmaceutical expenses are about $250 million annually, Carta says. That requires a massive build-out of software to meet regulatory and compliance needs, as well as installation of fulfillment machines, such as the dispensing robots and the automated dispensing machines.
In Carolinas’ case, much of this change was paid for over time by software solutions like one from McKesson that Carta relies on to manage the hospital’s 340B program, a federal program that requires brand-name drugmakers that participate in Medicaid to provide reduced-price outpatient drugs for specialized facilities, or “covered entities,” that provide drugs to indigent populations.