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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 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. Our guest today is Karen Bowling with West Virginia University Health System, or WVU Medicine for short. Karen recently became the chair of the 340B Health Board of Directors. In taking on that role, she's applying her decades of hospital and health system leadership experience towards shaping the strategy for representing our members and advocating for 340B. Given her leadership roles, we wanted to hear from her about how 340B professionals can engage their C-suites on 340B, and how to keep those leaders engaged. We want to get right to that interview, so please check the show notes for additional information about some of the big news developments that have happened in the 340B world since our most recent episode.
(01:08):
Among those items are a major federal court decision related to HRSA enforcement of the 340B patient definition, a final federal plan for repaying 340B hospitals billions of dollars for unlawful Medicare payment cuts, and a recent notice regarding the use of 340B in new hospital child sites. And now for our feature interview with Karen Bowling at WVU Medicine. I recently sat down with Karen to chat about leadership engagement on 340B. Here's that conversation. I'm here with Karen Bowling, she's president and CEO of Princeton Community Hospital. She is executive Vice president of Government Affairs for WVU Health System, and she also happens to be chair of the 340B Health Board of directors. So Karen, thank you so much for being here and welcome to 340B Insight.
Karen Bowling (02:00):
Well, thank you David. I'm looking forward to our conversation.
David Glendenning (02:04):
Please tell us a little bit about WVU Medicine and the patients you serve.
Karen Bowling (02:09):
Our system is now up to 24 hospitals. We either own or manage those hospitals, and they're located in three states. The primary location is in West Virginia. We are the largest provider of healthcare services in the state, and included in our 24 hospitals are nine critical access hospitals. We also have a large academic medical center. That academic medical center is located in Morgantown, West Virginia and associated with West Virginia University. And we offer comprehensive services, level one trauma center. We have clinics throughout the state, so even if we don't have a hospital in many parts of our state, we also have clinics either through telemedicine or through actual visits. West Virginia is a very rural state, probably the most rural state in the country. Many of the people that we serve live in a mountainous terrain. There are challenges in their ability to actually get to our clinics and our hospitals, and so it's really important that we have this large network in the state of West Virginia
David Glendenning (03:26):
That is wonderful to know about all the ways you are serving patients, especially those living in remote areas. And how does the work you do intersect with the 340B drug pricing program?
Karen Bowling (03:39):
Well, I have two jobs at WVU Medicine. One is as the CEO of a community hospital, but I also am responsible for the government relations program within our system. And if you think about those two roles, 340B is extremely important because we know that that program sustains many of our hospitals throughout our country, not just in West Virginia, and it is critical that our legislators know on a federal and state level the importance of that program. As a community CEO, I see it firsthand. I know exactly what those savings bring to a hospital that's located in the southern part of the state that serves a significant population of patients that have multiple healthcare problems, very complex. The 340B savings program is what allows us to be able to do our jobs and serve our community. So 340B is important on the clinical side and on the political side.
David Glendenning (04:47):
Really appreciate hearing that perspective from you. You recently, as I alluded to before, became chair of the 340B Health Board of directors. So please tell us how you're approaching that national leadership position.
Karen Bowling (05:02):
Well, my goal is really all about education. I believe that it's critical as the chair of 340B Health that I am an advocate for helping people in leadership positions as well as politicians in our communities as well as our federal officials to understand why 340B is so important. I want to be a resource for them. I want them to know, as chair of 340B Health and as a member of the W Medicine Leadership team that I'm here to help them understand the impact of any type of legislation and how that might negatively impact our hospitals or, in the reverse, positively impact our hospitals. So a very big part of my job is really about determining the right strategy to advocate and helping to implement advocacy strategies that will make sense to our folks that are in the federal government and those that are on the state level as well.
David Glendenning (06:13):
We are certainly grateful for your leadership at the board. And from what I'm hearing, you have kind of a unique insight into both the hospital leadership world and the 340B world. So we're here today to speak primarily about how to engage leadership on 340B. So how do you get the attention of health system or hospital leadership when it comes to 340B issues?
Karen Bowling (06:38):
Well, as I said before, it is really all about everyone understanding the importance of 340B to patient care. I'm a nurse by background. I think as a leader, understanding the clinical piece of it helps me advocate to our other members of our leadership team about why 340B is important. We look at financials and we see it and we see with a 340B line item and the savings. But then my job is to say, why is this important? What clinical applications does it have? How does it allow us to serve the people in our community?
(07:14):
We have a council that we bring our 340B pharmacy staff as well as people in our system C-suite together to talk about the work that 340B does to make sure we're compliant, to make sure we follow the rules, and also to make sure everyone understands how we use those 340B savings and why that's important to us. We have a team of pharmacists that work in our system, and that is their entire focus. So we need to put those individuals with our C-suite leadership so all parties are on the same page when it comes to understanding 340B. It's really exciting to me to be able to play a part of that to help make those connections happen.
David Glendenning (08:05):
That council sounds like a wonderful idea. I'm sure that's something many of our member hospitals could be considering to make that connection, as you say. So once a hospital has made that connection, once you have the attention of those leaders on 340B, what role can those leaders be encouraged to play on 340B issues?
Karen Bowling (08:28):
Our 340B committee really does talk about advocacy as well. We talk about compliance, we talk about our different programs in our different hospitals, and so I think it's a way to level set everyone in the C-suite, and I think that information is very helpful when we are trying to figure out what role the leader should play on 340B. I believe without any question that health system leaders can be a powerful voice for the protection of 340B. I can tell you that our system CEO, Albert Wright, is very knowledgeable about 340B and very willing to pick up the phone and advocate to our senators or our congressmen about why the program is important to our system. And so we have to really have that communication strategy, and we have to be able to advocate.
David Glendenning (09:28):
I hear you when you're talking about those themes of communications and advocacy, both very important. Let's start with the communication sides. As a comms guy myself, that's something that's near and dear to my heart. What are some of the opportunities to engage leadership in that area of communications?
Karen Bowling (09:46):
As an example, WVU Medicine, we do press events. We talk about the things that we do to benefit patients. We don't even have to say 340B. As an example, WVU Medicine has two things. One is a mobile mammography screening. We call it Bonnie's Bus. We also now, most recently in the last few years, developed a mobile lung screening program. These two programs get press throughout the state of West Virginia, and they are serving people that may not be served without those mobile units. Those are examples of things that allow our policymakers to understand how we use funds. Our system also does a lot with local community events.
(10:33):
So I think just being out there in the community and letting our policymakers know that we do these things because we are able to have 340B savings that could contribute to those. I also believe that doing op-eds, letters to the editor, or any other things that we can think of that would promote 340B, we have to be out there, we have to be visible, and we have to always be thinking about how people view what we do as healthcare institutions in our communities to focus on improving health and wellbeing and of course, treating the sick and injured as we always have.
David Glendenning (11:13):
Karen, I know you walk the talk when it comes to telling those stories, and you had mentioned op-eds. You were the author of a pro 340B opinion piece that we all read earlier this year. Can you tell us about how that came about?
Karen Bowling (11:28):
I wanted to make a difference. We talked about what kinds of things that we could do to ensure people knew a lot about what was going on with 340B, especially some of the negative things that had been occurring over the course of the last few years. And so after becoming the 340B health board chair, I thought it was really important that I step up. And so we talked a lot about in this particular op-ed, the harm that's being caused by the drug company restrictions. It's just unbelievable. West Virginia as an example, we have a lot of very small pharmacies, as I mentioned earlier, where mountainous terrain, it's very difficult for many of our patients to get out to some of the large regional pharmacies. And these restrictions are harming our patients, certainly harming our health system in our inability to get those savings and use those savings for good reason.
(12:26):
And I felt compelled to write that in my OP-ed so that we could put a face to it. Not just talk about 340B savings, but really give a perspective as a healthcare institution how these restrictions could negatively impact us. And we work closely with 340B Health and the WVU Medicine Communications Department to develop a message and then, which I think is extremely important and an advice I would give to anybody looking at how can you better advocate, really be able to pitch your op-ed to regional publications, because we have really good connections to individuals in our local media while we were able to pitch that op-ed and it went into our state journal, which is a statewide publication, and I'm really proud of that work that we did in conjunction with 340B Health so that we could get that message out there.
David Glendenning (13:26):
We will certainly put that op-ed in the show notes so our listeners can read it and hopefully be inspired. And how about the advocacy side of 340B? I know that's near and dear to your heart. What can hospital leaders do in that advocacy area?
Karen Bowling (13:41):
First and foremost, you must develop relationships. And without those relationships, you're not going to have the impact that you need to. You have to get to know your lawmakers. You need to know them, invite them to your hospitals, invite them to events that occur that are community related and that you're participating in. Develop that relationship so they feel comfortable picking up the phone and making a call. If there's a question on 340B, or quite honestly any kind of health advocacy, you want them to know you are the person to call. You're the expert. Because quite frankly, they will hear a lot of things from a lot of people, including the big pharmaceutical companies. They need to hear it from you. And so for us, as an example, we hold legislative briefings. We talk to staffers that work on the hill on either the Senate or on the House side.
(14:39):
This is not just a federal level. We do legislative briefings across our state in district offices, in state legislatures. I also suggest that if there's a lobby day to DC with members of Congress, go be part of that. Let them know who you are. Let them know why you're going to be present and what you're going to talk about ahead of time. But you don't want it to be 25 minutes long. You need to make it short, to the point, and concise and ensure that you're doing what you need to do to educate them about something like 340B and why it's important to your state and why is it important to your local institution or your facility.
David Glendenning (15:26):
Can you give some examples of some recent advocacy efforts that West Virginia University Health has been involved in?
Karen Bowling (15:35):
These contract pharmacy restrictions are so onerous on us and continuing to be challenging for us from a financial perspective. So we begin to look at what options as a state might we be able to do. And we saw where Arkansas had passed legislation that would help in our ability to ensure that we could have better access to contract pharmacy. So we decided to do it as a coalition, and I'm a big advocate for coalitions. We looked at that Arkansas legislation. We said, "Okay, let's see what we can do as a coalition to figure out how we could pass that same piece of legislation or something similar." Because remember, everything has to be adapted to your statutes within your state. But we are looking at how we could create a bill that would ban the PBM discriminatory pay policies and the drug company contract pharmacy limits.
(16:41):
Our state legislature is a part-time legislature. So we begin our session in January of 2024. So our goal really is to be prepared for how we might, one, create the legislation that will make sense in West Virginia, and two, work together as partners to find sponsors for that legislation and then hopefully get introduced. So that's just one example of ways that we try to partner and work together on advocacy, and that in particular is on the state level.
David Glendenning (17:14):
Very exciting to hear that bill, that West Virginia bill might be in the works. We'll be keeping a close eye on it for sure. Karen, what additional advice might you have for 340B program level professionals? That's a lot of our listeners are in that area. What advice do you have for them on keeping hospital leadership engaged on 340B?
Karen Bowling (17:37):
The first piece of advice is data, data data. If you're educating individuals in the C-suite, they're going to want to understand the data. So have your data, know your data, and be able to present your data in a way that the C-suite will appreciate exactly what impact the 340B savings has to your particular institution or to your health system. You want to be concise, you want to be compelling, but you do not want a multi-page document or you don't want to document that the writing is so small no one can even read it, or they have to grab their glasses. I get a lot of financial reports as a CEO and I tell my team, well, can you bullet down to a few bullet points so that I can understand exactly what you're telling me about our financial picture today? So I think it is important we still have to have those financial spreadsheets, but I think that you need to make your points in a way that everyone in the C-suite can understand why 340B savings is so important.
(18:46):
And I also think that you really need to think about when do you bring out the big guns? I mean, when do you bring out the system CEO or the system CFO, or when do you bring out the CEO of a local hospital, rather than the government relations person or one of our great members of our pharmacy team? Sometimes when you're dealing in advocacy, it is important to get the attention of your members in Congress that they understand at the very top of your organization, whoever that might be, they know enough about 340B to be able to have a good conversation, and to be able to explain why it's so important to their health system. Now that isn't every day or every time you go to lobby, and it isn't every phone call, but you have to assess the situation, figure out, is this something we might have to die on the hill for? Because I think sometimes you have to have the top leadership to get the attention that 340B savings deserves.
David Glendenning (19:52):
Karen, I really enjoyed this conversation. We appreciate everything you do for your patients and for 340B, so thank you for being here.
Karen Bowling (20:02):
Oh, you're welcome. I enjoy doing it and I'm very proud to be part of the 340B Health Board. It's a great board with great people, and of course, proud to represent WVU Medicine. So it's an honor to be on here to have this conversation.
David Glendenning (20:18):
Thanks again to Karen Bowling for all she does for WVU Medicine and the 340B Health Board. We hope her passion for protecting the future of 340B is inspiring to many of you who are contemplating ways to work with your leaders on doing the same. For a healthy dose of that inspiration, be sure to visit the show notes for a link to Karen's pro 340B opinion piece that appeared recently in the West Virginia State Journal. Does your hospital or health system have a leader who you think would be a great guest for our podcast? Please send their information our way. You can email us at podcast@340Bhealth.org. We will be back in a few weeks. As always, thanks for listening and to be well.
Speaker 1 (21:05):
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 340B Health and submit a question or idea to the show by emailing us at podcast@340Bhealth.org