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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.
Narration [00:00:04]:
Welcome to 340B Insight from 340B Health.
David Glendinning [00:00:12]:
Hello from Washington, D.C. and welcome back to 340B Insight, the premier podcast about the 340B Drug Pricing Program. I'm your host David Glendinning with 340B Health. Our guest for this episode is Adam Porath, the Vice President of Pharmacy Services at Renown health in Reno, Nevada. Adam spoke at this year's 340B Coalition winter conference about an innovative Meds to Beds program that Renown set up for its patients with the help of 340B. We sat down with him during the conference to discuss that program and the lessons it might impart to other health systems considering a meds to Beds initiative. But before we get to that interview, let's do a quick recap of some of the Latest news about 340B. A federal judge in Washington, D.C.
David Glendinning [00:01:08]:
has ruled that the Health Resources and Services Administration can require its pre approval before drug companies can replace upfront 340B discounts with backend rebates. The decision means Bristol Myers Squibb, Eli Lilly, Novartis Sanofi and the consultant Calderos cannot unilaterally move forward with rebates at this time because the government has not given them the green light. But it also leaves the door open for the government to approve potential rebate models and directs HRSA to reconsider its rejection of one such scheme and maintaining the status quo on rebates for now. The judge relied heavily on briefings we provided as intervener defendants for why the unilateral imposition of rebates would cause substantial harm to 340B hospitals. The drug companies have 60 days to appeal the judge's decision if they decide to do so. The decision came the same day that another judge overseeing Johnson and Johnson's rebate lawsuit before the same court granted a motion from 340B Health, Genesis Healthcare System and UMass Memorial Medical center to intervene as defendants. That will enable us to participate as a party in that case as well. 340B Health members can read more analysis of these key developments by visiting the show Notes and now for our feature interview with Adam Porath with Renown Health.
David Glendinning [00:02:41]:
A key part of the clinical pharmacist's job at a hospital is making sure patients obtain the drugs they need to stay healthy and stay out of the hospital. Renown is one of the health systems that is doing that by putting those drugs directly in the patient's hands before they even walk out the door. I chatted with Adam about Precisely how a health system can go about setting up such a Meds to Beds program. Here's that conversation.
David Glendinning [00:03:07]:
I'm here with Adam Porath, who's the Vice President of Pharmacy Services at Renown Health. Adam is joining me just as the evening reception is getting started here at the 340B Winter Conference. So, Adam, you get extra credit for joining us at the end of a long and productive conference day. Welcome to 340B Insight.
Adam Porath [00:03:30]:
Happy to be here.
David Glendinning [00:03:32]:
Tell us a little bit about Renown Health to start with and the patients you serve there.
Adam Porath [00:03:37]:
Sure. So Renown Health is a three hospital health system. We are a locally owned, not for profit system. Renown Regional Medical center is the flagship hospital. That hospital was founded in 1864. It's the oldest hospital in the state of Nevada. Originally a smallpox clinic, was a county hospital for a while, and has been a private, not for profit since the mid-1980s. We are a disproportionate share hospital for 340B purposes.
Adam Porath [00:04:10]:
And we are the safety net hospital for the greater Reno area. So renowned Regional Medical center is a level two trauma center. We are the only trauma center between Sacramento, California and Salt Lake City, Utah. So it gigantic geographical area. We cover over 100,000 square miles where we receive patients from rural facilities. We are academically affiliated with the University of Nevada School of Medicine, and we have a children's hospital within the hospital. Great.
David Glendinning [00:04:41]:
And we are here to do a comprehensive look at your Meds to Beds program. We talked about meds to beds before on the program, but this is going to be a bit of a. Of a more comprehensive look. So let's start with the inspiration here. Why did Renown decide to launch a Meds to Beds program?
Adam Porath [00:05:00]:
Yeah, so we know from national data that over a third of discharge prescriptions never get filled for patients. And so, you know, there's downstream ramifications of that. Without medication adherence, you can have unnecessary readmissions to the hospital. And so this is something that we really wanted to address to make sure that patients were leaving with the medications that were prescribed for them. So our Meds to Beds program was initially started as a pilot for Medicaid patients in 2016. We actually studied that pilot and found that patients that participated in the program were 25% less likely to be readmitted than historical controls. So that that really showed us that there was a clinical benefit and something that we wanted to expand to a larger patient population.
David Glendinning [00:05:45]:
And what are the benefits there that you've found to the patients of having meds to beds.
Adam Porath [00:05:52]:
Yeah. Other than increased adherence, the biggest thing is patient convenience. You know, a lot of patients, the last thing they want to do on the way home from the hospital is have another stop. And so we found specifically with our, not surprisingly, labor and delivery moms on their way home or families that may have had a child admitted to the hospital that, you know, they were early adopters to. Our meds to beds program, because all of the prescriptions are 340 B eligible, provides another revenue stream for the organization. So, you know, all of these things, the clinical benefit, the convenience for the patient and the increased revenue were reasons why we started our program.
David Glendinning [00:06:28]:
Yeah, I'm hearing that trifecta there. Convenience, improved health, additional resources, that all seems to go together very well. So clearly a very impressive operation you have there. How does it appear for those actually using it? What does the process look like for a patient who is utilizing meds to beds?
Adam Porath [00:06:49]:
So initially our process was to opt patients in to the program. And so that is something that evolved over the course of our evolution of the program. So currently we have an opt out program. So patients are going to participate unless they tell us that they don't want to. And so this was really a culture shift within our organization to get nurses to promote the process and to really buy into that this is the best care that they can be providing for their patients. And so they present it to patients as here at Renown, we provide you with discharge medications on your way home. If for some reason you don't want to participate in that program, let us know. So upon discharge, when the pharmacy receives the prescription that's prepared like a normal retail prescription and then that's delivered to the floor.
Adam Porath [00:07:40]:
And that could happen a variety of ways. So it could be with a pharmacist or a pharmacy technician or nursing staff that may actually do the physical delivery of the medications. We do triage our pharmacist resources to the most complex patients. So those patients that maybe are a newly diagnosed heart failure patient, you diagnosed diabetic patient, whether that be a pediatric or an adult patient, those are really where we're focusing our in person pharmacist counseling sessions. Otherwise, patients are counseled either virtually through a tablet or telephonically over the phone with the pharmacist in the brick and mortar pharmacy. So after the medication is delivered, we will collect any out of pocket for the patient. And that can be accomplished by a number of different ways. We do have point of care devices that our team brings up to the floor or we can Collect payment information over the phone.
Adam Porath [00:08:35]:
Lastly, we do offer to bill the patient, so if they so choose, we can put that copay on a patient account.
David Glendinning [00:08:42]:
The end goal of this of course is to get the meds in the patient's hands. So what happens if you get to a patient like say, you know, I know I need this medication, but I just, I can't afford to pay for it. What do you do in a situation like that?
Adam Porath [00:08:56]:
That's the beauty of having the 340B savings is one of the benefits is it allows us to provide this meds to bed service to patients regardless of their ability to pay. So if a patient indicates to us that they simply can't afford it, we refer them to our social services team. That team will basically sign off that we can use utilize our charity care account to pay for those medications. We only bill the actual 340B acquisition costs so that we can stretch those resources to cover as many patients as possible simultaneously. That team is looking for resources. So does the patient qualify for Medicaid and just isn't signed up or is there another insurance offering that maybe we should provide to that patient so that hopefully the next time they come in they aren't uninsured. But on average we do cover the cost of medications so that about 30 patients per month are provided meds to bed services free of charge.
David Glendinning [00:09:53]:
That's great that you're able to have that level of commitment and level of support for the patients. So how have things been going? What have the results been of establishing meds to beds there?
Adam Porath [00:10:05]:
It's been very positive. As I mentioned before, we saw a 25% reduction in readmissions for Medicaid patients. That really allowed us to expand services to all patients. Initially that was five days a week when we opened an on campus pharmacy location. And then later in 2022 we expanded that to seven day a week services. Most recently there was a closure of the last operating 24,7 pharmacy within the kitchen community. And so in very short order we were able to demonstrate that with our, with 340B there would be an ROI to do overnight staffing and provide a 24 hour pharmacy service. So we, we started that in April of last year and we've seen a lot of benefits from that.
David Glendinning [00:10:54]:
And that, you know, all strikes me as a, as a fairly significant uptake of that service that you're offering 24 hours a day. What do you suppose is behind that?
Adam Porath [00:11:05]:
We were actually really surprised to see, you know, I thought the majority of the prescriptions that we would see would be emergency department prescriptions. However, what we see is that 50% of prescriptions are actually chronic medications that are either from hospital staff that work overnights or, you know, reno is a 24 hour town, so we have a lot of patients that work the night shift that it's just most convenient for them to come into the pharmacy overnight. So that's been largely more successful than I thought it was going to be and at this point is certainly covering the cost of the staff.
David Glendinning [00:11:39]:
Yeah, that's fascinating. I'm picturing a blackjack dealer coming in for her maintenance meds after her shift ends on the floor and you being available for her to be able to do that.
David Glendinning [00:11:50]:
That's great.
Adam Porath [00:11:51]:
Absolutely.
David Glendinning [00:11:52]:
Other than expanding the program, which you clearly have, have you made other adjustments to it along the way?
Adam Porath [00:11:59]:
Yeah, we've made several adjustments, specifically within our electronic medical record that have really enhanced the program. There was a build that we did to create a patient flag within the system and that was triggered off whether the patient was opted in or out of the program. That flag, FLAG would flip the patient's preferred pharmacy to the renowned pharmacy while they were in the hospital, but it wouldn't impact their settings when they were discharged, so it would default back to their preferred pharmacy after discharge, which really increased the uptake when patients weren't worried about that. You're going to change my pharmacy if I participate in this service. That flag also served another function that it allowed us to create patient lists to follow up to see all the patients on this unit who's opted in, who's opted out. So that was utilized by nursing leadership as well as the pharmacy team to verify insurance information, et cetera. So that that one build piece was essential for the success of our program. Creating regular reporting to stakeholders was super key in the evolution of our program.
Adam Porath [00:13:10]:
So getting the nursing leadership to buy into. When we talk about an eligible patient, what are we really talking about here? Getting to a common definition of that really created that collaboration and buy in into. Okay, now we can all march arm in arm that this is something that is the best care we can provide to our patients.
David Glendinning [00:13:32]:
Any, any hiccups that you ran into along the way, Any, any barriers to success that you needed to overcome?
Adam Porath [00:13:37]:
Yeah, the largest barrier that we found is that not surprising, a lot of patients discharge all at once. And so it's just not physically possible to be on the floor for every patient that's discharging. You know, we already talked about how we triage our physical pharmacist resources but really tackling that problem was the biggest thing. And so most recently, we have implemented a pneumatic tube station within the pharmacy that allows us to deliver prescriptions throughout the facility, everywhere except for our discharge lounge. And I would say that, to me, is probably the other key to success. We have a very robust, highly utilized discharge lounge. And so what this is, it's a unit. When patients are ready for discharge, they will actually move them out of their inpatient bed.
Adam Porath [00:14:29]:
The entire discharge process happens within this lounge. Nursing education, setting up transportation and waiting for their meds to beds prescription. We staff a pharmacist in that discharge lounge Monday through Friday to facilitate patient counseling. So since we today are seeing roughly 40% of our meds to beds participants flow through this discharge lounge, we just felt like we really had to resource that there. I feel like that discharge lounge is also something a little bit unique, but. But definitely has added to the success of our program.
David Glendinning [00:15:03]:
Yeah, well, unique discharge lounge and the pneumatic tube. I love it. I read a great piece recently where we're talking about pneumatic tubes being this, you know, essentially 1850s technology that has gone away almost, except for hospitals where it really still makes sense. And this is such a. Such a great application of that. That's amazing. You talked about the importance of collecting metrics and having goals to set earlier. Can you give us a sense as to where you are now with some of those metrics, some of those numbers that might be tagged to the success of the program?
Adam Porath [00:15:37]:
Yeah, really proud, ultimately, of the success of where we're at today. So in December, December of 2024, we're over 80% of eligible patients participating in the program. That translates to over 2,000 patients a month and creates downstream revenue of in excess of $1.8 million per year.
David Glendinning [00:15:58]:
I am glad to hear you've achieved so much that is really excellent. What. What do you think has made your meds to beds program so successful?
Adam Porath [00:16:06]:
Yeah, there's a few things I think you can point to that I would call the secret sauce. You know, we talked. We touched on the discharge lounge earlier. I think that that's hugely important in our success as well as the pneumatic tube. You know, that's, as you mentioned, a great innovation into the program. Some of those EMR changes that we made really, I think, helped us along the way to increase implementation and then simply, you know, reporting data to the team, getting them to buy into that data, and celebrating the successes when those come along. And so little things like the pharmacy staff providing candy as a thank you to the nursing units that hit 100% participation go a long way for collaboration.
David Glendinning [00:16:53]:
Well, Adam, we look forward to checking back with you in the future to see what new targets you're hitting and what additional successes you're able to have with the this program. So until then, best of luck and thank you again for being here.
Adam Porath [00:17:06]:
All right, thanks so much.
David Glendinning [00:17:08]:
Our thanks again to Adam Porath for joining us at the end of a long day of conference sessions to give us his perspective on Renown's Meds to Beds program and the lessons learned along the way. Do you have a good 340B operations or compliance story to tell? And are you attending the 340B Coalition Summer Conference in the nation's capital this July? Please email podcast@340bhealth.org and we can speak about getting you on the show while we are recording episodes during the conference. We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and be well.
Narration [00:17:50]:
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
Narration [00:18:09]:
to the show by emailing us at at podcast@340bhealth.org.