The mechanisms of business action: 3 critical lessons you didn’t learn in pharmacy school

As a pharmacist, my clinical expertise is rooted in mechanisms of action. Understanding how Lipitor’s inhibition of HMG-CoA reductase can help a patient insufficiently treated by an adenosine triphosphate-citrate lyase blocker such as Nexatol is critical to forming the effective medication-based plans that support physician-led patient care. 

But today’s pharmacy leaders – from clinicians inside the four walls of the hospital to CPOs overseeing nationwide networks – require additional skills they’re unlikely to have learned in pharmacy school.

My path – from completing my PharmD to my residency, from my first clinical appointment to joining C-level leadership – has taught me a lot about the business of pharmacy. And just as there are mechanisms of action for pharmacological effect, there are mechanisms of business action that power successful value-based pharmacy programs.

Here, I’ll explore three lessons I learned through experience rather than in pharmacy school.

#1: How to take an enterprise-level approach to processes

From my first days in the pharmacy, I’ve taken a very process-oriented approach to my job. Details are fundamental aspects of a pharmacist’s work, from reviewing formularies to detailing financial reports. But over the years I’ve enhanced the impact of my work by taking an enterprise-based approach to leadership and processes.

My first memory of the impact this can have goes back to my very first job. I was working my shift and realized that the care plans our team was tasked to review didn’t match. From the first shift to the third, from cardiology to orthopedic, it was obvious teams throughout the hospital were siloed.

I came to recognize that we lacked standard operating procedures for how departments throughout the hospital worked with pharmacy, much less how they coordinated with clinicians in varying departments. 

This resulted in inefficiencies – including increased instances for polypharmacy, wasted resources, and the potential for avoidable adverse medical events for our patients. But the solution was clear: see the whole field, coordinate across departments, and efficiently communicate.

Together, these approaches empower pharmacy leaders to help all clinicians work at the top of their license – and more effectively care for our patients.

Next, let’s look at the importance of financial management and executive-level conversations. 

#2: How to manage value-based financial programs

Pharmacists are steeped in the knowledge necessary to manage medication-based plans of care. But the fact is, to be effective, value-based pharmacy programs must balance costs in a way that simultaneously boosts population-level health and a network’s financial well being.

The reason is clear: drug costs in the United States are staggering. Between July 2021 and July 2022, for example, the prices for over 1200 drugs used to treat chronic conditions like cancer increased by 31.6 percent. Without a doubt, the situation is dire.

But there is a solution. A value-based focus on impactability helps clinicians to select the patients who will most benefit from medication-related interventions in order to treat the right patients at the right time. It’s a clinical practice empowered by a keen awareness of business fundamentals. That’s why it’s paramount for pharmacy leaders to know how to…

  • Understand financial planning documents like profit and loss statements. 
  • Draft financial reports such as pro forma.
  • Navigate billing and revenue cycles.

Knowing how to bill for various diagnosis-related groups (DRGs), for example, is key to how all departments and clinicians ensure they receive the correct payer reimbursements. For example, in pharmacy programs, services such as ambulatory care, long-term care, infusion, and specialty pharmacy are all billed separately.

Even CPOs familiar with billing intricacies often share a common dilemma. Without the right technology, it’s difficult to turn in-house data into impactable, financially efficient plans of care. The right technology, however, offers a world of difference in how leaders can document the data necessary to power and manage efficient value-based programs. 

Next, let’s look at the importance of executive conversations – and how technology can help power them.

#3: How to engage in executive conversations

Physician-led patient care depends on the combined expertise of all clinical team members. That’s why, even before they join leadership, clinical pharmacists are as much executive-level consultants as they are clinicians. Pharmacists are regularly asked, for example, to determine whether a patient with type 2 diabetes would best benefit from Ozempic or metformin – and then to explain why.

The problem? In value-based environments, the clinicians who ask pharmacists for their counsel (often CMOs or other leadership-level physicians; e.g., a Chief of Surgery) may do so to guide population-level health plans. And even if the question is asked on rounds, clearly communicating information to supplement a leader’s expertise takes a certain level of finesse.

Of course, no single key can open all conversational doors. But in my experience, the “meeting before the meeting” is central to clear communication. Whether accompanying physicians on clinical rounds or meeting with C-suite leaders, a preparatory discussion with colleagues can help deliver the right information, to turn a phrase, to the right physician at the right time.

What’s more: the right technology platform empowers all clinicians with the data they need to streamline communication – and keep their focus where it belongs: on their patients.

Pharmacy has great leaders – we still need more

In her Harvey A.K. Whitney Award lecture, Sara J. White (M.S., FASHP) stated it simply: “Every pharmacist must be a leader in their practice or on their shift. Each must connect with their inner drive, their passion for what they do and for making things better.”

It doesn’t matter if you’re a CPO or a clinical pharmacist. Whether you’re just entering pharmacy school, in the middle of your residency, or just about to start at your first job. Every position across the clinical spectrum throughout pharmacy needs a leader in that position.

The right technology makes it easier to act on your leadership skills – and can even help refine those you’re still working on. Interested in how RxLive’s value-based pharmacy system can help? Shoot us a message.

Lynn Eschenbacher, PharmD, MBA, FASHP, CPEL
Lynn Eschenbacher, PharmD, MBA, FASHP, CPEL, is RxLive's Executive Pharmacy Advisor. Lynn is an established leader in the healthcare industry with extensive experience leading healthcare organizations and pharmacy business models. She brings an innovative and valuable perspective to RxLive and all of the customers we serve.