Combining Technology and Personal Touch in Specialty Pharmacy

Aislinn Antrim: Before we get started today, one of our top stories is about a study on disinfecting N95 masks, which found that heating them may be the best option. So, there is more of that on Pharmacy Times. Today I'm speaking with Jonathan Ogurchek, founder of STACK, a compliance management software, and an expert in the specialty pharmacy field. So, first, can you just give us a bird's eye view of how digital health solutions are more important than ever and what role they're playing right now?

Jonathan Ogurchak, PharmD, CSP: Yeah, absolutely, and thanks so much for the opportunity to talk. Today, your digital health—especially in the wake of the current environment that we're dealing with—it has kind of become first and foremost with everything that's going on. You know, we went from a period of time where things like telehealth [and] telemedicine were really struggling to take hold and move forward, and now if you want to see a prescriber for even an acute, you know, type of need, that's the way that you're scheduling and then visiting with people. So, it's kind of a novel sort of way [that] it forced our hand to move into more of a digital way of consuming not only content like this, like you and I today, but looking at things like just traditional medical care, traditional specialty pharmacy care, traditional just overall care for patients. And so, you're looking at avenues like FaceTime and Zoom to actually provide that one-to-one patient interaction or some of the more EMR-based types of technologies where there is such a struggle to make that happen right now. It kind of happened out of a force of nature, as of right now and, you know, you do see some challenges with that because, particularly in your older populations, they may not be as technologically savvy. Or even your younger populations that may not be technologically savvy, I don't want to make it an age-related thing. You know, there are some of these capacity requirements. Do you have the ability to perform a tele-visit? Do you have the ability to even get onto a web portal to schedule those things, to know what you need to do? So, you know, from that perspective it's kind of somewhat eye opening to see, like, what the barriers to entry have been and how quickly so many providers have been able to overcome them and some of those challenges to move forward.

Aislinn Antrim: Definitely it's definitely kind of a forced learning experience. We've certainly seen many people begin working from home in the last couple of months. What are the challenges for that from kind of a healthcare standpoint, for healthcare companies that are moving to a home environment, and how is technology helping with that?

Jonathan Ogurchak, PharmD, CSP: Sure, so when you're looking at considerations like cybersecurity, you know, every organization may or may not have had certain elements to afford their employees the ability to work from home—some of us were like why are they doing that in the first place? And so, as more more and more employees were being shifted to work at home, there's these considerations that you need to look at. Are they using their home device? Are they using a work-owned device? You know, bring your own device types of scenarios and engagements, particularly as it relates to patient information, is critical to know. Do you have something in place to make sure that you're protecting the health information for your patients? So, even though HIPAA rules have been slightly relaxed at this time, it's not to say that there should be a free-for-all, either. There should be some consideration of patients’ security and safety in place. What are some considerations as it relates to your own company’s firewalls or VPN capabilities? How are you accessing that data—is it going just over an unsecured internet connection or is it something that you're actually putting behind a protected environment to make sure there isn't possibility of intercepting that information in translation? What about things like document storage and usability? I say that selfishly on the STACK side, because we saw this coming and we started to build a solution, but it can't tell me how many people have been faced with this same sort of problem. I sent my whole workforce to work from home, but all of my stuff is sitting in a filing cabinet back in the office. How do we access our contracts? How do we access these things that we needed to actually do our jobs from a day to day basis? So, a lot of time, you know, a lot of work forces have been really struggling with it. How do we look to digitize our offering so that people have the tools that they need to be able to work from home? And then, you know, in addition to that, you have all of these other things. You know, we mentioned HIPAA but what about things like confidentiality? What about, you know, engaging patients? What about, you know, all of the different waivers that might need to be in place from a securities or a regulatory perspective just to afford opportunities. You know, it's great that we can sit and work from home right now but there's also, you know, coming out of this situation it's going to be maybe an eye-opening experience as well to make sure that we can continue to have some regulations around what we need to do to be able to best protect patient safety in this more digital type of workforce.

Aislinn Antrim: Certainly. You mentioned security, what are some considerations around

compliance and appropriate use in a digital workplace?

Jonathan Ogurchak, PharmD, CSP: Absolutely. The compliance, as far as that's concerned, you should always have some type of check and balance in place for your workers. Are you accessing the right patient information for the right purpose? Are you going into a patient's account just because you have a one-to-one communication or need for documentation of communication with that patient? I used to work from home as a pharmacist, upwards of a decade ago. At the time, there were solutions in place for my employer where you didn't have the ability to later send in papers. As you're doing these sorts of things, you needed to use a whiteboard just that way as you're taking notes that are specific to a patient, so there was no physical record that you had to worry about shredding at home. So, those types of considerations you can implement in your work force just to make sure that you're not keeping things, even if you're accessing most of your patient information via some type of device, they're not inadvertently writing down patient information that's just staying at home. There are some other considerations. Security-wise, working with your workforce to see if there is a dedicated space where they can work that's away from the rest of the family that's now probably working at home with them, as well, you know. Keep it away from, you know, spouses, kids, partners, things like that so that way when we're having conversations with patients it's more of a private, intimate sort of situation instead of being in an open area where that information could be disclosed elsewhere. So, there are certain things that you could do with just building security within your work environment at home that are considerations that can really help to improve that care. In addition, we've talked about some of those tech considerations, but how much of that data is already in the cloud versus you need to find a way to access it? Are there things related to employee productivity? Are there markers that were in place just to make sure that while you're keeping this information secure you’re making sure that the patients are truly only accessing things that are pursuant to an engagement, and how are you documenting that? Are you finding ways to actually document that there was a need to go into Jonathan's chart to see what's going on, or were you just kind of poking around to see what meds are Jonathan on. You know, a lot of health systems and hospital systems have those things in place for inpatient, but not so much for traditional outpatient or, you know, whatever we're calling this existing tele infrastructure right now. So, you know, there are some considerations to take in place and helping to make sure you outline those with your workforce, but also make sure that they're being enforced, especially as more people feel comfortable working at home now, it’s paramount to make sure that that's still a secure environment for your patient.

Aislinn Antrim: Absolutely. Security you mentioned already, but do you have any tips on how people can begin looking at this if it's something that is new to the working at home environment? How should they get started?

Jonathan Ogurchak, PharmD, CSP: Sure, there's always solutions out there. You've seen a number, I mean, clicking through Facebook, Twitter, LinkedIn, anywhere, you're seeing solutions for work at home types of solutions. There are some that are HIPAA validated and verified, they've gone through appropriate regulatory compliance things just to make sure that the data interchange that’s occuring that does contain patient information, whether it's just written information in the patient chart or if it's something that, you know, patient information that's being construed via a telemedicine visit. There are platforms that are out there that are safe and secure, and so for organizations that are looking for solutions, make sure you're asking those sorts of questions of a potential vendor. You know, organizations like zoom where we're doing this call right now, they weren't necessarily set up to do these types of visits and you saw a number of security issues that came out as we first started to make this move into more of a digital workforce, and they've since done a complete 180 and made a lot of appropriate changes to impact that, but they may not necessarily be aligned with what your organization's looking for from a patient health information security perspective. So, you know, most organizations already have HIPAA privacy policies in place, make sure that that is covering telemed visits or, you know, distance education types of learning like we're doing right now, and make sure that if you're going to make those changes that's something that you can then relay to your patients so they know what their rights are, they know what sort of privacy use is in effect for them as they're transitioning the modality of care.

Aislinn Antrim: Okay. Where do you think technology is going? Obviously, this has pushed us forward very quickly, but even after the pandemic do you think these changes will kind of stay in place to some extent or where do you think it's going?

Jonathan Ogurchak, PharmD, CSP: Yeah, once you let the horse out of the barn it's hard to rein it back in, and I think this is a huge opportunity for pharmacy. If you look at pharmacy as a sector, they tend to be a little bit behind the time as it comes to adapting new novel sorts of technologies. You know, the patient of today is used to the consumerism of going online, ordering something, and it shows up on your front porch—well, it used to show up on your front porch a day later, you know. Those sorts of things you couldn't see as it related to the delivery of care, particularly that came about in the pharmacy segment, and so I'm seeing this is a huge opportunity. What are some ways to actually deliver that care or continue to deliver that care the way that patients truly expected? Are you able to provide? Most pharmacies jumped on board with providing home delivery and they did it in a matter of weeks as opposed to deliberating over time to make that a reality, so are there ways to make that the standard of care? Does home delivery become more of an option, not in the traditional mail-order sense but from a community pharmacy that's able to provide that type of relationship that they're used to seeing in the community, but now they don't have to actually walk into a facility to do that. Technology can drive a number of things related to outcomes, as well. Everybody has a phone that they can use, [so] how can you engage patients via text message or push message? So many people have things like Apple watches, [so] how are you going to find ways? And this is a huge opportunity for the pharmacy sector to get ahead of things, use the tools that people already have to better impact their care and improve their care. Because if you're able to touch those patients at the time that they're having a side effect from their medication or the time that they're actually experiencing that question, you as the pharmacist and us as an industry are going to be able to tackle some of those things as opposed to people figuring it out on their own.

Aislinn Antrim: Definitely, there are great opportunities out there. How can pharmacists kind of bridge the gap between utilizing this technology and also maintaining that personalized, hands-on approach that you mentioned is so common that pharmacists are really invested in?

Jonathan Ogurchak, PharmD, CSP: You know, I speak from a specialty perspective but a lot

of the specialty types of opportunities are easily translatable into other areas of pharmacy. You know, the hands-on approach of managing patient care is something that the patients are striving for and you tend to see that more in the specialty sector just because it does require a little bit more of a hands-on approach to managing the needs of that disease that needs that drugs and even that diagnosis, but patients are still seeing those things. That's why there's such a great relationship in the community with patients, and so if you're able to leverage that relationship that you have with me, the community pharmacist, but you're just applying that that care in another way, be it some type of technology route. It's still maintaining that relationship, and you're also now growing that relationship because you're not just seeing the pharmacist behind the bench, you're seeing them in your home, you're having the ability to communicate with them a little bit more frequently in the home. And technology is probably the way that that's going to happen. There are a number of apps that I've seen, a number of services, even just pharmacists that aren't doing, you know, out of the box that is a solution. But they've found ways to engage through drive-up pickups and different ways to utilize technologies that people have to continue that care that they're used to experiencing in a more traditional sense. And so, you know, pharmacists always say they're the most accessible type of provider, [and] if you have the ability to layer that accessibility with just a different delivery mechanism then it becomes a win-win for everybody. Pharmacists still stay at the top of, you know, that level of care but you're also just reaching the patients where they need to be reached.

Aislinn Antrim: Wonderful. Switching gears a little to specialty pharmacy, what has been the role of specialty pharmacists during this pandemic?

Jonathan Ogurchak, PharmD, CSP: I haven't seen much change. A lot of the specialty pharmacies that I speak to, aside from the management of their staff within their home facilities, that high touch level of care related to managing specialty patient has always been there, there's always been that higher level of touch, that higher level of engagement just to ensure, you know, the right drug, right patient, let's counsel them on side effects, intervene if there's problems that

are occurring. The actual delivery to patients, you know, that fulfillment model has always been something that's in effect. Let's make sure that the drug is there because we're using a third-party carrier to get it to the house. What happens with it, you know, if it misses the plane? What happens if the delivery driver is not able to get it there for some reason? There are a number of things from a logistics perspective that have always been in place in pharmacies and specialty pharmacies, in particular, to make sure that you can ensure that final mile of delivery for drugs for patients. And so, it's kind of an interesting dynamic. A lot of the specialty pharmacy model, it

was almost designed, it's time to shine, because that type of higher-touch engagement model was built from a continuity of care and a management of care perspective that fits perfectly into this type of remote delivery model. And so, you're not seeing too much of a change for those patients requiring specialty drugs because they're used to that already, in a lot of cases, from the specialty drug management perspective.

Aislinn Antrim: Interesting. How are these specialty pharmacists, even outside of the pandemic situation, how are they helping patients access these high costs medications and what's their role in that?

Jonathan Ogurchak, PharmD, CSP: Sure. Specialty pharmacists have always—and pharmacies in general, maybe not just the pharmacists—but, you know, there are teams that the workflow associated with a specialty pharmacy is prime for managing the high cost. Actually, I think I see it on my board, I was talking with a rotation student about cost and how that kind of comes into play in that workflow for managing drugs for specialty patients. But, you know, the workflow of specialty pharmacy matches the complexity that's necessary to get the drugs approved through a third-party payer or to find some financial assistance for those patients to be able to access these drugs. Just because, if you take a step back and think for a minute, most people don't know what a specialty pharmacy is in the general public unless they've been diagnosed themselves with a specialty disease condition, they know of somebody that is diagnosed with a specialty condition, or they know of somebody that works for special pharmacy. And so, you know, this whole concept of higher touch management, you know, you're not being handed a prescription to walk through your pharmacy or job to your pharmacy and hand that over to a pharmacist. There’s a level of disengagement to a certain degree for patients because they're not used to getting these drugs through another pharmacy, but that workflow is built specifically to help them manage costs. You're doing things like benefits investigation and verification—does the patient benefit structure match what they need to be managed with this therapy? And on top of that do we have the pharmacy able to fulfill this drug and so, if not, there's a handoff process that takes place to get the drug to the right pharmacy. You know, from there are they meeting prior authorization criteria? You see teams within pharmacies that help the prescriber to meet prior authorization requirements and walk them through that process. Here, that hand-holding that's associated with the specialty pharmacy and managing a prior authorization that helps them to access the medication. You know, once it's approved and what do you do? Just because the patient has a specialty diagnosis and that's potentially a higher cost medication doesn't mean that they should, you know, choose between a medication or some of the other things they need to do, and so what are the things like copay cards, foundational assistance? Specialty pharmacies’ workflows help those patients to access those medications and help to put those resources in place to make these drugs a little bit more affordable. And so, you know, that's always been the case, and specialty pharmacies have been designed so their workflow actually matches the complexity of what comes about, you know, from the requirements of affordability, from the accessibility, etc.

Aislinn Antrim: Definitely, and cost and managing that is such an important piece of the puzzle. Finally, just in general, can you discuss the value of pharmacists and just why they're so vital during the pandemic and outside of it?

Jonathan Ogurchak, PharmD, CSP: You're seeing it right now. Pharmacists are, like we said before, they're the most accessible health care provider. You know, not many other places you just walk in and ask healthcare questions. You need to schedule an appointment. You know, the beauty of having pharmacists in a community setting is that you have the accessibility to, when you have those questions, to bring them to light. You know, you as a patient don't need to kind of struggle on your own now, even though we were talking about technology before, but even in this day and age where you can go online and search for just about anything, you know, are you searching for the right thing? So you're able to have a true health care professional and the pharmacist that can provide those answers to the question, not only the answers to the questions but you're seeing more of an expansion of practice, not only today as a result of our current situation, but even prior to that. You're finding ways that pharmacists are able to provide a difference in delivery at the point of care. You know, they're able to provide testing, they're able to provide different services, screenings, education within the pharmacy that you're not necessarily able to get otherwise. And it's just based on the nature of, you know, pharmacists being trained to be healthcare practitioners. It's one of the things I would always tell my students when I run healthcare lectures, you know, becoming a pharmacist is one of the most flexible types of degrees that you can gain because you learn such a wealth of information and you can apply it in so many different scenarios. So, you could be a practicing pharmacist in the community, you could go and work for pharma, you can go and work for any number of different areas, but it's because you're trained to think on your toes and apply the knowledge that you have to each new patient scenario as it presents itself that's critical. And, you know, there are others in the health care community that do that but the accessibility of pharmacists is what makes that unique, kind of partnering those two together.

Aislinn Antrim: Wonderful, well thank you so much for joining us, thank you for taking the time, and now we're going to hear from some of our other MJH Life Sciences brands on their latest headlines.