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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.
Speaker 1 (00:04):
Welcome to 340B Insight from 340B Health.
David Glendinning (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 Glendinning with 340B Health. Our guest for the first episode of the 2024 season of 340B Insight is Danielle McPherson with Mercy Health. Mercy is one of the six health systems featured in 340B Health's annual health equity report. The report includes case studies on how our member hospitals are pursuing greater equity through health access and quality improvement initiatives. We wanted to speak more with Danielle about some of the Mercy initiatives featured in that report and see what equity advice she might have for other 340B hospitals. But first, let's do a quick recap of some of the latest news about 340B.
(01:11):
The drug company Takeda recently announced it would be imposing restrictions on access to 340B drugs through contract pharmacy partnerships. When the policy takes effect January 22nd, it will make Takeda the 29th drug maker to restrict 340B access. The policy applies to nine drugs that the company markets, and it includes limited exceptions for health systems that own contract pharmacies, as well as hospitals that have no in-house pharmacies. 340B Health members can visit the show notes for more details about this development.
(01:47):
In mid-December, the US House of Representatives approved bill language requiring 340B-covered entities to submit annual reports to the government on the spread they receive from Medicaid-managed care plans for 340B drugs. The language was part of a comprehensive healthcare price transparency and PBM reform package that the House passed shortly before its year-end recess. 340B Health successfully advocated for changes to an earlier version of the bill that would've blocked Medicaid-managed care plans from paying hospitals more than the 340B purchase price, even in states with laws requiring that they do so. The House passage sends the measure over to the Senate, which is working on its own version of the transparency and PBM reform package.
(02:37):
The end of 2023 capped a busy year for refunds from drug companies that overcharged hospitals for 340B drugs. Drug makers posted a total of 40 notices on the Health Resources and Services Administration's website acknowledging they had charged too much for these drugs and would be reimbursing affected hospitals. This is a new annual record for the number of refund notices, exceeding the total of 33 that drug makers posted the previous year. The refund rate went up sharply in the years following the implementation of the 340B ceiling price website, which requires regular drug maker price reports to HRSA.
(03:24):
And now for our feature interview with Danielle McPherson, the Executive Director of Managed Care Contracting and Operations for Mercy Health. 340B Health worked with Danielle on a case study of some of the ways Mercy Hospital St. Louis pursues health equity, including through 340B-funded initiatives. I recently sat down with her to discuss some of these efforts. Here's that conversation.
(03:50):
I am here with Danielle McPherson with Mercy Health. Danielle, welcome to 340B Insight. We appreciate you being here.
Danielle McPherson (03:58):
Thank you for having me. I appreciate you extending the invitation.
David Glendinning (04:02):
Tell me a little bit to begin with about Mercy Hospital St. Louis, which we'll be speaking about today, and the patients you serve there.
Danielle McPherson (04:11):
Mercy Health System was founded and established by the Sisters of Mercy actually in 1986, but our heritage actually goes back almost 200 years, 195 years, where our founder, Catherine McAuley, saw the need to help people who were living in poverty, people who were in very underserved, marginalized communities. Empowered by her bias for action, she established the first religious order that specifically focused on health equity, and it was before health equity, social determinants of health was even a buzzword.
(04:42):
Mercy Hospital St. Louis serves the St. Louis metropolitan area, and so that includes patients from both St. Louis County and St. Louis City. So our hospital is actually physically located in St. Louis County, which is racially and ethnically diverse in some of our immediate surrounding areas, but not as much as our St. Louis City communities. St. Louis City has a larger percentage of people living below the poverty level, somewhere around almost 22%, but if you include children in that amount, it's actually closer to 36% of the people who are living at or below the poverty level, which is significantly higher than the national averages. We have been very intentional about ensuring that we have clinics in specific areas in both city and county where there appears to be higher level of deprivation because our hospital is actually in the county. So to the extent, our clinics are pretty much an extension of our hospital in those areas.
David Glendinning (05:39):
Thank you for laying out that background about the area and about those patients. How do you use your 340B savings to care for those patients?
Danielle McPherson (05:48):
In fiscal year 2023, Mercy Hospital received around 5.2 million in 340B savings. So the savings were reinvested in a wide range of patient care and support. The 340B funds enable the hospitals to fund and support a lot of those that were in need, a lot of the communities that were in most need that could otherwise not have access to that level of care. Mercy also does nearly half a billion dollars in free uncompensated care across the ministries, specifically in St. Louis is around $37 million in uncompensated care. So utilizing savings to provide community benefit is at the core of who we are. It's pretty much in our DNA.
David Glendinning (06:31):
And we are here to speak largely about health equity, given the recent 340B Health report that focused on Mercy Hospital St. Louis as one of those case studies. So let's discuss how Mercy worked to advance health equity in the St. Louis region.
Danielle McPherson (06:49):
Mercy took a strategic integrated approach to identify and target health disparities and address health-related social needs and social determinants of health. We did this by creating a health equity strategic plan that is comprised of four main areas. The first is clinical disparities, identification, and management. The second is social coordination hub and screening standardization. Our third was workforce diversity, equity, inclusion, and belonging. And the fourth is strategic payer community collaborations. Those four different categories really encompass our way of making sure that we have a 360 view of addressing health equity in our communities.
(07:29):
We also encourage collaboration and meetings both among our clinical staff and our operational staff, and this is to ensure that we have a full understanding and transparency of the mission and the margin for the efforts that we are employing. We also work to break down a lot of the barriers between the health professionals making the decisions and the people who have to live with those decisions by involving all of our coworkers to provide input on the best ways to care for our patients. We kind of took a top-down and a bottom-up approach, and it seems to work the best for us.
David Glendinning (08:01):
That sounds like a very purposeful approach to that health equity strategy. So once you took that approach and established that process, what health equity needs did you identify in those St. Louis communities that you serve?
Danielle McPherson (08:15):
Well, we identified a lot. We did identify a lot. Access to preventative and primary care for patients facing barriers from social determinants of health. We've seen some health outcomes so disproportionately adverse and more underserved communities compared to others. So that was one key area.
(08:31):
High rates of substance use disorders and behavioral health problems in communities in spite of their coverage status. Sometimes we tend to assume that it's just underinsured or uninsured people who are suffering from behavioral health issues. What we found is that it's a wide variety of people, and it really doesn't care what type of insurance they have, the need is there.
(08:53):
We also see the inability to afford medications that are for chronic diseases. This issue is particularly concerning because it has the propensity to drive high ED or emergency department utilization, which drives healthcare costs way out of control.
(09:09):
So those are just a couple. I can go on and on on some of the other things, but I would say a lot of the things that really drove us to really employ a lot of the 340B funds to assist in some of these areas, those were some of the ones that were really driving a lot of the attention.
David Glendinning (09:26):
You mentioned access, so let's start with the programs that are focused on access to preventive and primary care. What are some of those initiatives?
Danielle McPherson (09:37):
We have the underserved women's services, which really focuses on maternal and childcare from social workers and community health workers. We have invested over $200,000 in 340B savings, and they're being used to fund social workers, community health workers, and behavioral health specialists who focus on people in low-income, highly-deprived areas and assisting with health and social needs.
(10:00):
We also, in partnership with Tabernacle Church and the Tabernacle Community Development Corporation, we established a clinic in the heart of North City, which was established to focus on primary care in the underserved areas of North City. And as we mentioned earlier, St. Louis City is highly deprived area, with most zip codes well below the poverty line. So this clinic is comfortably positioned in one of the most poverty-stricken areas in North City St. Louis. Over $316,000 worth allocated to ensure primary care and preventive services are accessible to people in this particular community.
(10:37):
We also had an $853,000 investment that was made for our mobile mammography van for preventive care for mammograms for patients who have transportation barriers. This allows us to go to where the need is versus expecting people to come to us, and this has made a huge impact on some of our super rural and super urban communities that are disproportionately affected by breast cancer resulting in mortality.
David Glendinning (11:03):
I'm hearing a lot of customized tailored care to the community there, which is great. You mentioned the large need in the area for behavioral health services, substance use disorder treatment. How did Mercy approach those issues?
Danielle McPherson (11:17):
Well, this is definitely a big focus for us right now, especially in the health equity space. Over $1.1 million of 340B funds used to address behavioral health and substance abuse. We have a couple of programs that I do want to highlight. The Virtual Medication Recovery program, which is an emergency department-based screening and therapy initiation that treats opioid disorder. At the point of the initial contact in the ED, patients are 66% less likely to return to the ED, which contributes to overall decreased healthcare costs. This program has also been instrumental in reducing mortality in this patient population. This is key again. I will say we've seen a influx of a lot of these behavioral health patients since the pandemic. And it was almost taboo in the past. I think people are starting to embrace it a little bit more, which gives people more hope and gives people more ability to actually go and seek help. So these type of programs have really been helpful, especially with this particular patient population.
(12:20):
We also have we call the BEACN project. BEACN stands for Building Engagement to Address Complex Needs, and this is in partnership with Behavioral Health Network of Greater St. Louis. Our 340B funds are used to provide social workers and behavioral health specialists to help patients with extreme cases of healthcare utilization. So these are our more complex patients, and it's used to help them navigate the healthcare system because it can already be overwhelming for anybody who's not dealing with behavioral health issues. So on top of that, they need that assistance to help navigate through the healthcare system.
David Glendinning (12:55):
It's wonderful to hear of all the ways you're using 340B dollars to support those services in the community. And of course, 340B is a drug pricing program. What are the ways that Mercy helps patients in need with the costs of their prescription drugs?
Danielle McPherson (13:12):
For starters, Mercy used 2.1 million in 340B funding to offset costs of expensive drugs through our outpatient infusion centers and our retail specialty pharmacy services. We also have collaborative relationships with Dispensary of Hope, which gives free medications for uninsured patients. We pay Dispensary of Hope an annual fee funded through 340B savings to access free drugs through the Dispensary of Hope medication inventory that can assist in providing certain drugs free to our patients in need. Technically, that's a lot of where a lot of people stop, is just offsetting the high-dollar-cost drugs. That's enough. I mean, honestly, that would be a benefit to a lot of people, but I think what's helpful with this 340B and the savings that we yield from it, we are able to go even above and beyond just paying or offsetting the drugs. We can actually help people with those socioeconomic factors that's also preventing them from attaining the highest level of care.
David Glendinning (14:14):
Sounds like you are having some great success in the St. Louis area for getting patients healthy and for keeping them healthy. Does Mercy have plans for how these programs might grow, evolve, change going forward?
Danielle McPherson (14:28):
Mercy St. Louis Hospital is our North Star and guiding light for analyzing ways to design the need and disperse the funds for the rest of the health system. This is not to say that we're not using 340B funds in our other communities or other states, because we absolutely are. St. Louis has certainly paved the way for a lot of programs that we are doing, and we're starting to see a lot of our other programs being mirrored like in Oklahoma City, and Springfield, Missouri, and other communities that we serve. Our future plan is to mirror the formalization of our 340B committee in St. Louis and spread ministry-wide. This is the benefit and standardization in how we approach evaluating the 340B funds. But still understand every community will have its own set of challenges and potential solutions, so we will always customize to fit the uniqueness of each community we serve. Now that time has passed, we continue to work to refine programs and repeat successful ones across all of our communities in our system.
David Glendinning (15:28):
So one of the things that we love doing when we speak to people about their successful 340B-funded programs is to ask what advice might they have for other 340B systems that are working on their own health equity initiatives.
Danielle McPherson (15:46):
Well, I have a couple of things to mention. Make sure to take an integrated approach, engage others in the hospital, ask questions, and allow questions to be asked. Work to set up a more formalized way to track 340B savings and how they are invested in care. Keep an open mind of communication and accountability on how funds are being used and what they're being used for. Transparency is key. Understand it may take a while to bring about eventual savings for patients and the system. And also, lastly, work with us and others to protect the program. As large form of companies are trying to end it, it's imperative that we have this program. Until the day there is no people affected by socioeconomic factors, social determinants of health, health inequities that are prohibiting them from attaining their most optimal health outcomes, 340B is needed and it should be protected at all costs. So unfortunately, we're not there yet, but we can collectively get there if we pass and drive our actions.
David Glendinning (16:44):
Wonderful. Well, we love to hear that advocacy piece, and of course, the more successes we see in 340B, the more we hear about the need to protect the program from all challenges. So Danielle, I really appreciated speaking with you about this. Thank you for your participation in the health equity report. Thank you for everything you and your system do for your patients, and I appreciate you being here.
Danielle McPherson (17:08):
No, thank you. Thank you for everything 340B Health is doing. I love the advocacy work that you are doing, and you're keeping it elevated and you're keeping it top of mind, so it's greatly appreciated.
David Glendinning (17:19):
Our thanks again to Danielle McPherson for sharing some of her passion for health equity with us and describing how 340B health systems, such as Mercy, are leading the way on this crucial issue. We shared the goal of a nation in which all patients have access to the care they need to attain optimal health outcomes. Please visit the show notes to read the Mercy Hospital St. Louis profile and the other case studies from our annual report.
(17:46):
Do you have a health equity improvement story to tell for one of our future reports? 340B Health is always interested in hearing those stories, so please reach out to discuss more. And please reach out to us if you have feedback or episode ideas for the podcast as we kick off the 2024 season. You can email us at podcast@340bhealth.org.
(18:08):
Happy New Year. We'll be back in a few weeks with our next episode. As always, thanks for listening, and be well.
Speaker 1 (18:21):
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, @340BHealth, and submit a question or idea to the show by emailing us at podcast@340bhealth.org.