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340B Insight provides members and supporters of 340B Health with timely updates and discussions about the 340B drug pricing program. The podcast helps listeners stay current with and learn more about 340B to help them serve their patients and communities and remain compliant. We publish new episodes twice a month, with news reports and in-depth interviews with leading health care practitioners, policy and legal experts, public policymakers, and our expert staff.
Announcer (00:04):
Welcome to 340B Insight from 340B Health.
David Glendenning (00:13):
Hello from Washington DC and welcome back to 340B Insight, the podcast about the 340B drug pricing program. I'm your host, David Glendenning with 340B Health.
(00:25):
On today's episode, we have Cindy Williams with Riverside Health System in Virginia. We often have pharmacy and health system experts like Cindy on the show to discuss 340B operations, compliance, and clinical topics, but we do not often get the chance to speak with these guests about their career journeys in the 340B world.
(00:46):
We were excited to speak with Cindy about her decades-long career in pharmacy, especially the roughly 15 years. She has been closely involved with Riverside's 340B program. We wanted to hear what advice she has for listeners who might be seeking or starting out on a similar professional path. But first, let's do a quick recap of some of the latest news about 340B.
(01:18):
The Centers for Medicare and Medicaid Services recently released a proposed rule outlining its plan to remedy Medicare Part B pay cuts to 340B hospitals that were in place from 2018 through most of 2022.
(01:32):
As you will recall, the US Supreme Court unanimously ruled last summer that these reductions were unlawful. CMS is proposing lump sum repayments of about $9 billion to affected hospitals for the additional amounts they should have been paid since 2018. But the agency also says it will decrease the rates. Medicare will pay all hospitals in future years for non-drug items and services to meet federal budget neutrality requirements.
(02:01):
Those reductions will total 7.8 billion over the next 16 years, CMS estimates. In a statement 340B Health President and CEO Maureen Testoni described the proposal as a significant step forward and hailed the plan to provide lump sum repayments to affected hospitals. But she also called on CMS to reconsider the proposed rate decreases for non-drug items and reiterated the call for repaying 340B hospitals with interest. You can read the full statement and a CMS fact sheet on its remedy plan by visiting the show notes.
(02:46):
And now for our feature interview with Cindy Williams. Over the course of her distinguished pharmacy career, Cindy has gained significant 340B experience and she has used that to become a strong advocate for the program and a valued resource for others seeking to learn more about 340B.
(03:05):
Myles Goldman sat down with her to reflect on this career and find out more about what guidance she has for future leaders in the 340B world. Here's that conversation.
Myles Goldman (03:15):
I'm here with Cindy Williams, Vice President and Chief Pharmacy Officer at Riverside Health System in Virginia. Cindy, welcome to V Insight.
Cindy Williams (03:28):
Thank you Miles. Glad to be here.
Myles Goldman (03:30):
I'm really looking forward today to hearing about your 340B career journey, your journey even more broadly in pharmacy. Let's start from the beginning. What attracted you to pharmacy in the first place?
Cindy Williams (03:46):
Well, when I was back in high school, I realized that I may want to consider some type of career in healthcare but wasn't really sure what that might look like. So we had a friend of the family that was a community pharmacist at the time and he allowed me to come in and shadow him for a few days and felt like that would be a good career path. And from that point forward, that became really my goal through college was to go to pharmacy school eventually.
Myles Goldman (04:12):
And tell us more about your educational experience once you decided to really go down this pharmacy path.
Cindy Williams (04:21):
Yeah, so one of the things that I did, and I think many folks do that are going to pharmacy school is that once I was at pharmacy school, I went ahead and got a weekend and a summer job working as a pharmacy technician, and that was at the University of Virginia. So I got my start early in pharmacy school at the University of Virginia working in that role.
(04:41):
And then when I finished up in pharmacy school, I accepted a staff position at University of Virginia. And I think, at least for me, that role being a fairly broad-based role, it gave me experience in a lot of different areas of pharmacy. I did a lot of work in their infusion area and even got a little bit of exposure to research.
(05:03):
And then after I left the University of Virginia, I spent some time in retail and that's where I got into leadership. I then had a little stint in home infusion and then I came back to health system pharmacy around 25 years ago or so and have spent the rest of my career in that setting.
Myles Goldman (05:21):
How did you first become involved with the 340B program?
Cindy Williams (05:25):
About 15 years ago, our organization became eligible for the 340B program and at that time my role within Riverside was system director of pharmacy, and so it was natural for me to be asked to provide oversight for the program.
Myles Goldman (05:41):
And as you've gained more experience with 340B, what advice might you have for people who are just starting out in 340B? What do you wish you had known that now?
Cindy Williams (05:54):
First and foremost, you really need to understand the program, right?
(05:57):
So I think you really need to invest in some formalized training. When I first became involved in 340B, it was prior to 340B University being launched, and so I turned to 340B Health. And so I can still remember my first summer meeting. It was right when our organization had become eligible. We had just filed our application, not quite active yet, and I attended the 340B sort of primer sessions through 340B Health in Washington.
(06:27):
So I think regardless of where you get that information, it needs to be from a reputable organization obviously, but I think you need to invest first and foremost just in education to gain your competency around the program itself.
(06:43):
After you've got that baseline knowledge, you've now got your connections. You need to make sure that you've got all the key connections internal to your organization because the 340B program is not just about pharmacy, you need to make sure that individuals in your finance department, especially those that are responsible for your cost report, the Medicare cost report, they're key individuals to know. You certainly need to have strong relationship with your information systems team.
(07:09):
So it really is a team that makes 340B successful. Probably a lesson learned for me is that when I got involved in the program, I probably didn't know what I didn't know and maybe didn't understand all of the key individuals in the organization that needed to be involved in the program.
Myles Goldman (07:31):
What do you see as the greatest challenge in managing a 340B program? What advice might you have for those facing a similar challenge?
Cindy Williams (07:40):
I think understanding how your organization can continue to maximize the value of the program to the organization in order to be able to stretch those scarce resources, but doing that while maintaining a compliant program and at the same time continuing to stay abreast of the program changes to understand how those changes may impact how you're leveraging the program.
(08:06):
We already talked a lot about the internal partners, obviously within the organization, but they're external partners, whether those partners be any of your 340B vendors or split billing vendors or third party administrators for contract pharmacy, subject matter experts in the field if we need to bounce something off of them.
(08:24):
And then with our external audit partner who can be a wealth of insight because oftentimes those vendors are servicing a number of different organizations across the country. And so if you're coming up against a challenge in your organization, they may very well have seen an organization that has figured out how they're going to move past that challenge and either can provide that information or connect you to another colleague in the profession.
Myles Goldman (08:52):
Coming back into the health system world, how did you end up at Riverside Health System and what has your professional journey been like there?
Cindy Williams (09:03):
I joined Riverside in 2001. I was actually in pharmacy leadership for a national hospital pharmacy management organization at the time, and they had a relationship with Riverside, and Riverside was in need of a change, if you will, in system leadership to enhance and progress pharmacy services. And so I joined Riverside at that time as the system director of pharmacy, and I had oversight of all hospital or operations, which at that point included for acute care facilities.
(09:36):
As my role expanded to include oversight of our medical group, our ambulatory practices, we opened a retail pharmacy. We've got very extensive cancer and non-cancer infusion. We have long-term care services.
(09:53):
As my role continued to grow and expand, I subsequently left the pharmacy management organization and became the vice president and chief pharmacy officer for Riverside.
Myles Goldman (10:04):
That's a lot of great and important growth in services and initiatives. How did you approach launching and expanding some of these programs that you were just talking about?
Cindy Williams (10:15):
I think it really starts with understanding where the organization is going and then understanding what role will pharmacy play in that. Every organization's going to be different, and as healthcare finances and other things change, organizations are going to continue to have to learn to respond. So I think really having that seat at the table, understanding the strategic plan, understanding the role that pharmacy can play, and then determining what are those service offerings that make sense for the organization that pharmacy can develop and implement.
Myles Goldman (10:53):
With your chief pharmacy officer hat on, is there anything you now know about specifically being a chief pharmacy officer that you wish you had known when you first started?
Cindy Williams (11:04):
I think one of the most important things, and I mentioned it in one of my earlier responses, is you have to be at the table. And I think there are oftentimes that others in the organization may not fully understand the breadth of what pharmacy can bring to an initiative. And so when you hear about meetings or committees or whatnot where pharmacy may play a role. Just asking the question, is there any reason I can't sit in on that committee?
Myles Goldman (11:35):
I know you've been involved with professional organizations. How have these different professional organizations benefited your career?
Cindy Williams (11:44):
I think it is critical to have not only the connectivity, but when your work life balance allows, to have more active engagement with professional organizations.
(11:56):
And I think there's a number of reasons for that. I think first and foremost, it's around staying connected with what is going on in the profession, but it also connects you with peers and that professional networking is so valuable over the course of your career, whether it's you seeking a professional colleague to act as a mentor in a certain area or whether you step up and become a mentor for someone who is maybe just entering the profession or just starting a different career journey.
(12:31):
Oftentimes you reach out to these professional colleagues, I call it the phone a friend. If you don't have those connections through professional organizations, it's really difficult to be able to leverage what others have learned to maybe fast start something within your own organization.
(12:50):
I think when you know, get that involvement, it does tend to snowball and it does open additional doors and allows you pretty much as much involvement if you want to up to and including elected office.
Myles Goldman (13:04):
You also have been very active advocating for 340B and other pharmacy issues, and we're really appreciative here at 340B Health about that. How do you make the time for advocacy with all the other responsibilities you are managing?
Cindy Williams (13:18):
We're all really busy. You wonder how can I squeeze another thing into the day? But I do believe that advocacy is really important because if we don't advocate for ourselves and our profession, nobody else is going to do that for us, right?
(13:31):
And I think for me it wasn't as much an issue finding the time because I'm not sure that advocacy always takes a lot of time, but I do think if you've never done it before, it can be really intimidating. I remember the first time that I did an advocacy day up on Capitol Hill with 340B Health, I was quite nervous, right?
(13:52):
You're going in and you're talking often to legislative aids, but you may also be meeting with the member and what am I going to say? And I think one of the things we often forget is we are the experts in most cases in this topic that we're talking about. We know our organizations, we know the good work we're doing, and it's just getting the courage to do it.
(14:13):
So what I would recommend is you find a mentor that's done this kind of work before and before long. What you'll find out, or at least what ended up for me is now I've become a mentor for those behind me to go to Capitol Hill and have those kinds of conversations.
Myles Goldman (14:28):
I also understand that you have been teaching pharmacy students. Can you tell us more about your work in teaching?
Cindy Williams (14:35):
I am a big advocate for student learners and developing our team members to be preceptors.
(14:44):
I truly believe that having student learners in the department, whether that's technician students, pharmacy students or pharmacy residents, really raises the bar for the entire team. And having opportunities for quality pharmacy rotations is also critical to our student learners so that they do get a robust experience during their training program that will serve them well when they go into practice on their own. I mean, the didactic experience that schools of pharmacy and other programs teach is wonderful, but you really need to learn how to apply that learning into clinical practice and that's what rotations do.
(15:28):
But I also believe that you need good professional role models. That's one of the reasons that I've always not only signed myself up to be preceptors, but also encourage the organizations that I've worked for over the years to participate in these programs so that we can continue to develop the workforce of the future.
Myles Goldman (15:49):
And you yourself have had an impressive career. What do you think have been the keys to your success?
Cindy Williams (15:55):
I think it's really important that whatever role you're in pharmacy or in life generally, to understand that what you've learned in school is really just the starting point. It gives you the baseline skills to start in the profession, but you really have to commit yourself to lifelong learning. And a lot of times that means you're learning outside of your typical work week. You're going to conferences, you're reading professional journals, you're staying up to date with breaking news and healthcare, whatever your field may be.
(16:30):
And then I think the second thing is the value of participation in professional organizations and connecting with professional peers. I think it really has helped me be a much better healthcare professional, a much better representative of the profession to Riverside and really has helped us continue to move things forward in the area pharmacy because of the tremendous learning and encouragement that I get from other colleagues.
Myles Goldman (17:03):
Many of our listeners, as we've noted before, are pharmacists or pharmacy technicians who are just getting started in their careers. What would be your advice to these listeners who want to become a leader like you someday?
Cindy Williams (17:16):
Well, I mean, I think first and foremost is obviously master your craft, right? And if you're wanting to get into leadership, expand that learning horizon to leadership learning as well, you'll want to start learning some of those leadership skills. Just because you're not in a manager role doesn't mean that leadership skills aren't important and every aspect of what we do. Look for opportunities at your own organization to step up and volunteer.
(17:43):
There's always projects going on. There's always performance improvement initiatives going on. You don't have to be a leader to be involved in those. I'd say the best ideas come from the frontline staff who are actually practicing in day-to-day patient care.
(17:59):
You then start developing those professional relationships within your own organization. But take that a step further. Get involved, as I've said, in professional organizations outside of your working organization. So 340B Health, ASHB, APHA, your state affiliates, whatever that may be. We've already talked about advocating for the profession. I do think that is part of really that career journey.
(18:24):
And then one of the things I often tell my team is share your story because if you don't do it, nobody's going to do it for you.
Myles Goldman (18:32):
Cindy, we really appreciate you sharing your story with us and all the great experiences you've had. You really have had an impressive career and we appreciate as well the contributions you've made to pharmacy to 340B and to 340B Health, so thank you so much for joining us.
Cindy Williams (18:51):
Thank you.
David Glendenning (18:53):
Our thanks again to Cindy Williams for her decades of pharmacy service, her influential advocacy for the future of 340B and her sage council for all those contemplating a similar career path.
(19:05):
On future episodes, we plan to speak with more longtime 340B leaders like Cindy to discuss the keys for how they have navigated a constantly evolving health system landscape. Is there a 340B veteran you think we should interview on this show? Please email us at podcast@240Bhealth.org with your ideas for guests and episode topics.
(19:29):
And thanks to all who attended the 340B coalition summer conference and came by to visit our exhibit hall recording booth. A special thank you to the conference presenters we interviewed while we were there. You will start hearing those episodes soon. We will be back in a few weeks. In the meantime. As always, thanks for listening and be well.
Announcer (19:55):
Thanks for listening to 340B Insight. Subscribe and rate us on Apple Podcasts, Google Play, Spotify, or wherever you listen to podcasts. For more information, visit our website at 340Bpodcast.org. You can also follow us on Twitter at 340BHealth and submit a question or idea to the show by emailing us at podcast@340Bhealth.org.