Heroes of Healthcare
Heroes of Healthcare

Episode · 5 months ago

Pharmacology, COVID & the Future of Medical Treatment

ABOUT THIS EPISODE

Medication regimens can at times be extremely complex and scary for patients. It can be helpful to have a guide — someone who can explain what they are taking, why they are taking it, and what side effects might occur. That’s where the pharmacologist comes in to save the day.

In this episode, Dr. Becky Bean, Senior Vice President and Chief Pharmacy Officer at Novant Health, explains the important role pharmacologists play in a patient’s treatment.

Topics covered:

  • The deeper dives of a doctorate pharmacology program
  • The pharmacist’s role in COVID treatment
  • Precision medicine, digital care technology, and the future of medical treatment
  • Health equity

To hear this interview and more like it, subscribe to Heroes of Healthcare on Apple Podcasts, Spotify, or wherever you listen to podcasts.

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Just very rewarding to help people feela little bit more comfortable about taking medications and being successful and actually improving theirhealth versus the risk that sometimes can come along with medications. You're listening toheroes of healthcare, the podcast that highlights bold, selfless professionals in the healthcareindustry focused on transforming lives in their communities. Let's get into the show. Welcometo the heroes of healthcare podcast. I'm your host, Ted Wayne.I'm excited to be back and want to give a big shout out to mycohost, Olivia d' Angelo, and the outstanding interview she had last episode withDr Priest of Navan. No surprise, we had record breaking down loads andwe love having Olivia as part of the show. Today I'm excited to discussa topic that we haven't hit since our first episode with my father, andthat's the role that the pharmacist plays in the healthcare system. Joining me todayis another of the outstanding team of clinicians from Navan Health System, Dr BeckyBean. Dr Being currently serves as a senior vice president and chief pharmacy executiveat Navan health. In this role, she's responsible for the development and implementationof Nevan Health's strategy for the system wide pharmacy services, consistent with the missionto improve health of the community one person at a time. Becky received herBS and pharmacy and pharmacy doctorate from the University of North Carolina Chapel Hill ofbeing joined navant health in two thousand and seven as a clinical pharmacist and transitioninto leadership in two thousand and thirteen. She moved into the role as asenior director of medication management in two thousand and seventeen, and then this role, Dr Bean has led the Implementation and collaborative practices for pharmacists across the NavatHealth Medical Group. She has created a structure to support managing the complex medicationneeds of the patients across the continuum of care. So it's without further adoI'd like to welcome to the show Dr Bean. Welcome to the heroes ofHealthcare Podcast, Dr Bean, thanks for joining us. Yeah, glad tobeat her. Thank you so much, Ted. Yeah, we're as always, always excited every time we have a new guests. So I think Ihear myself saying all the time I'm so excited, but I always am soit's legit, but really excited to have you here. Want to talk alittle bit more about pharmacology, your area of expertise. Again, a littledifferent. The opening episode was with my dad and he was an oldtime pharmacist, so we haven't talked about this side of the healthcare world in a while. So it's great to have you here and to talk all things and howpharmacology plays its role in the healthcare system, and especially during the whole years ofcovid. So before we jump into some of that, hope you couldjust spend some time and tell our listeners a little bit about yourself and howyou got into this crazy world of healthcare, and we'll just jump right in.Yeah, absolutely. Well, first of all, thank you. It'sreally exciting to have an opportunity to share sort of the pharmacist story, thePharmacy Journey, the things that we did a contribute to patient care. Soreally privileged to have the opportunity. For me making a decision around what Iwanted to do with my life and I spent some time thinking about what amI good at, you know, what are my natural skills, but also, you know, what means something to me, what ties back to mypurpose, you know, where can I use my heart in the work thatI'm doing? And so I landed on I felt like math and science wasmy wheelhouse, and so I knew I wanted to do something related to mathand science, and I actually had a friend growing up in high school whowas a few years older than me, who went to pharmacy school, andso that's what sort of triggered pharmacy in my mind is potentially being an option, and so just started doing some investigation around what that means, what theopportunities are, and felt like it was something that I could be good atand something that I could actually make a living doing. So that was thereason for going into it, but I'll tell you, you know, itwas it was a tough journey. There were times in my college career Ican remember taking organic chemistry and thinking maybe this is it for me, butI'm really glad that I stuck with it because it's been such a rewarding career. It's very rewarding to help people feel a little bit more comfortable about takingmedications and being successful and actually improving their health versus the risk that sometimes cancome along with medications. All of those connection points and having an opportunity tobe a participant in helping somebody a chief better health is such a privilege.So I'm glad that I stuck with it. Yeah, it's you know, it'syou know, you said, you said the word purpose, and Ijust more and more, as I guess I get older, I realize thatit's really key, it's really critical. It's just finding that thing that youfeel gives you the purpose. You know, without purpose, we we tend tofeel a little bit lost. What made you decide to go? Youobviously the two pass within pharmacology. Probably typically is clinical. I guess youhave research, clinical, institutional and then retail. What made you decide toget more into I guess what I is at my saying that right you morein the institutional and too, in the healthcare, since my health system somewherein the health system industry. You know,...

...when I was coming out of PharmacySchool, Pascius was one thousand nine hundred and ninety six, so it'sbeen a minute built the time, but at the time you just didn't haveas many options. So you had retail pharmacy, you had a hospital andyou had industry, and you know, it took me a little bit tofigure out where my niche was in the pharmacy world and I've actually been ina lot of those different areas. So I actually started in retail pharmacy,like many pharmacists do, and had that opportunity to work in a community pharmacyand just really help patients gain access to medications and do patient counseling in thosesorts of things, and it was a it was a tough job at thetime. I mean it was long hours, you know, twelve hour days,weekends, evenings, and so it was just it was a tough joband I really enjoyed it. I developed a lot of great relationships with mypatients. Even sent Christmas cards out to all the patients and loved it.But at some point just felt like I wanted a little bit more work lifebalance and I wanted to have more of a, you know, Monday throughFriday type of role. And say ended up moving out of retail pharmacy andspent some time working in a hospital. I moved to Raleigh where I grewup, worked in hospital for a while and really loved that and then,like many folks do, relationships can sometimes draw you away from a location.So and move back to Charlotte to get married and spent some time working inlong term care where I really had an opportunity to flex some of those clinicalskills that I that I learned in pharmacy school and broadened my view around whatoptions exist. So there's not just retail, hospital and industry, there's long termcare, there's managed care, there's working in clinics with physicians and HelpingTailor Medication regiments to a particular patients needs. Its lots more opportunities. But Iended up working in long term care where I would literally, you know, had twelve different facilities that I would go every month and I would dochart reviews and make sure that whatever medication we were using for a patient connectedback to a reason like an indication, and make sure that we were trackingside effects and reducing risker falls and things that can sometimes be more risky forolder patients and Rove that work. Love that work, I mean I couldsee the difference that I was making every day in involved working with nurses andinvolve working with physicians, a lot more patient contact sort of in the laterstages of life, and it actually inspired me so much I went back toschool to pursue my doctrines. That's when I went back and got my doctoratebecause I felt like there was more I could do if I had just alittle bit more clinical knowledge in the application with that clinical knowledge and spend alot of time there. But again, yea, it took me a littlebit to find my niche and where I wanted to go as intervening a littlebit earlier. So it was great to intervene and folks that were in longterm care and we're in the later season of life, but wanted to startmoving that a little bit earlier in the life stage, and so an opportunityopened up where I am today, which is now about health, to focuson transitions of care and help patients navigate from being in the hospital to beingback home to be more successful, because what we were findings that people wouldcome back into the emergency room or back into the hospital because of some kindof medication related events. So our pharmacists would call patients after discharge and literallyjust walk through you hear all the medications that you're taking. This is whatI want you to stop, this is what you're going to start taking.Make sure they actually got the medication and then walk through with them the why. Why are they taking it? What do I need to watch out for? What would mean I need to call my physician right away? What arethings that might just get a little bit better over time? And it wasvery rewarding to spend and we were spending forty five minutes, you know,sometimes an hour with patients, just helping them walk through the complexity. Ifyou've ever known or been in the hospital, it can be complex. You canhave a lot of changes that occur in the medication regiment. is sothat that time we took interacting with patients and helping them understand the why andmake sure they were on the right path to be successful with whatever changes weremade resulted and pretty significant reductions and readmissions. So we have thirty day readmissions andSixty Day readmissions dropped pretty significantly and I say to the tune of aboutseventy percent. So just that one intervention that wasn't rocket science, it wasjust somebody who had knowledge and expertise around, you know, how to take medications, really translated into some great success. And so that's when I knew Ihad kind of found my Adnitch, you know where I wanted to bethe work that I wanted to do. So that was a very long answer, but I guess my my key messages. It took me some time to figureout what my purpose was and what I really wanted to contribute and howI wanted to help patients navigate what can be pretty complex and pretty scary andhelp them be set up to be successful. Right. Yes, it did.You ever was at an aspirate? I mean you most careers and alot of times they evolved in the path that we think we're going to endon. Is Not and we never think we are. I know for myselfwhere I am today and where I thought I would be as nowhere near thesame plan. But that's okay, and need to think if you ever isthat. Was it an aspirate? You...

...know, but I'm also talked topeople and they said, aspirationally, this is where I wanted to be.Was this? Do you ever envisioned? You said, I want to beable to be part of a big healthcare system and be running the whole thing. No idea. I mean I always say if my the title to mybiography would be Farendipity, like things just happen like I think I'm luck intothings. Sometimes it's timing, it's right seeing opportunity, it's being in theright place at the right time. I never anticipated leadership would be my path. I know it was really more about providing patient care and doing what Ineeded to do to provide the best care that I could. So, whetherthat's clinical knowledge, whether that's learning how to talk to people and communicate moreeffectively, I focus a lot of my energy there. But when I washere, probably five years into my journey here at about health, somebody sawin me some leadership potential that I didn't see in myself, and so theyencouraged me to go into a manager role, apply for a manager role and startleading the team rather than being a part of the team. And sohad the opportunity to step into leadership and it's a it's a difficult transition sometimesto move away from what you love, which is the patient care, andbeing more in a leader position. But what I found every time is Ihad the opportunity to really paint broader brushstrokes in a leader position where I couldset many more people up to provide the same level of care, to bethere for patients, where and when they need it. So being in aleader position just allowed me to really design more vision and strategy for how wecould do this on a broader scale. So that's what that's what drives menow. So it's not necessarily the patient care. The one one that Imight do it's sending my team up to be there for our consumers when andwhere they need it. Yeah, well, you're having a broader impact. You'restill having an impact on patient care. You're just now actually able to doit and in a more broader sense acting. The questions I had isit's you. So when you come out of pharmacy school and you'd pass yourboards, you're a license pharmacist. What different things? And it's funny Isaw ask my dad this, but he because he's his master's in pharmacology.But what different things did they work on in you to get to your doctorate? Is it a broad case of everything from more depth in the chemistry partof it and all the way through the application? Just a little let's spenda few minutes of various great question. So the difference, so when Igraduated, and there's been a lot of evolution and how we train pharmacists andhow we educate pharmacists. But when I came out it was a bachelor BS Program of Bachelor's in science, and in North Carolina and many states theyactually change the requirements to get licensed to where now all pharmacists come out witha farm dy or a doctorate in pharmacy. But at the time that I wascoming through there was different. There were two tiers. There was bachelor'sand then people could go on to pursue the Pharm D and I would saythe difference between the curriculum and the Bachelor's program and the Pharm d program wasprobably more of a deep dive in to some areas of pharmacy that you don'tget in the Bachelor's program and so one of those deep dives would have beeninto more pharmaco kinetics and so how do how to medications function in the bodyand how are they eliminated? What does that look like and how can thatchange depending on patient characteristics, whether it's, you know, the kidney function ortheir liver functions? A lot more deep dives into that, a lotmore deep dives into how we prescribe and use medications for certain disease state.Since it was a lot more clinical in nature. And then the second piecethat's different as a part of a doctorate program as we spent a whole yearin rotations, so in the field functioning as a pharmacist, you know,in the field with physicians and nurses and training around how to function as acare team to deliver better care for patients, and so it was a much moreintensive program compared to the Bachelor's program from an experiential perspective, I foundso much value. People Laugh will ask me sometimes do you wish you hadjust gone through you got your bachelor's and doctorate at the same time, becauseI had about ten years between getting bachelor's and getting the doctorate. I meanit would have been easier to do it all at once and as I wentback to school while I was working full time, but I felt like asI was learning and getting these deep dives into some of those areas, Iwas applying it real time. Well, I'm learned that I was very easilyseeing the application of the things that I was learning and how that helps mebe a better pharmacist, and so that was rewarding. While it was toughto work full time and be in school, pursuing a doctor at that like Igot a lot more out of it than maybe I would have had Idone it immediately after completing the Bachelor Program Yeah, I think it, sinceshe said, so key. You know, they talked about, you know,generational the the younger generation in terms of how they learn, and theytalked about since, since Google, the younger generation does not need the oldergeneration for information. So when I was growing up, either it was myparents or are an encyclopedia. That was where I got most of my information. But now we google everything and we google it is we're walking down thestreet. But what's been interesting, and and I love what you talked about, that what they say with the younger...

...generation is what they're what they're strugglingwith this application. So they can go to Google and they can see howthings are done, but they don't always understand what is the application of thisin life and how do I use it and all that, and I thinkthat's so, so key that in the doctor program they're saying, okay,here's the theory stuff we're giving you. Okay, now let's go apply itand see how it actually works and where does the theory fall short and doesn'treally hold and where is it? Like wow, this is the area reallyneed to do because, as we know, anytime we go and do it andexperience it, it's it's often different than what we perceived in our ownmind or we're told that it was. Absolutely it's not like memorizing content becauseI need to take an exam and there they answer to the questions like I'mapplying it every time I'm interacting with the patients. It's just a different experiencewhen you have that application at the same time that you're actually learning and learningthe curriculum. Yeah, that's great. So let's jump in a little bit. Well, let's back up in time. I tend to do this, butI don't you know, and I love back and at the time.Yeah, a couple of in time and then let's look forward, because Ilike both of those things. So, you know, I said to youbefore we got jumped on the call, I keep wanting to to get awayfrom covid a little bit with the show, but we're rising in cases again withthe Delta variant, so I guess it's still hot topic. But let'sback up and talk about navant and you know, I guess now almost eighteenmonths ago, but warry and March two thousand and twenty. I guess I'msaying that right. If and things breaking out, and one of the thingsI read about an article for Navant was you guys did a great job ofanticipating the refrigeration needs and some of those sorts of things in expectation for thevaccine. But tell me the role that the pharmacy and your team played asCovid was breaking out and how does farm, how does the pharmacy team fit intothis whole healthcare delivery? Yeah, absolutely. You know, it's funny. I'm going to back up even further than ultralow temperature freezers. Leek.I can remember the day that my leader, Eric Sciagalu, called me and saidHey, covid nineteen, there's there's a there's a virus at spreading andChina wive on it. Is the pharmacy supply chain stable and what do weneed to watch out for with with getting drugs in the door and so that? I don't think at time I could have known what this was going tobecome, but it ended up being very much a focus for us from apharmacy perspective. It wasn't just about, you know, how we treat patientsin the clinical algorithm and what does the evidence say and what are the researchtrials that we can engage and it was like, basics, we need toget drugs in the door and make sure we have enough drugs to care forour patients. And so we have a lot of conversation around, you know, what things are. We worried about what's produced in China. What wouldwe see those out and what we are and what are we even going toneed right? What are we going to need? Yes, I mean eventhose early conversations were so challenging because it was hard for me to even imagine, you know, a day where we wouldn't be able to bring medications in. And so we did a lot of just thoughtful planning around that, makingsure that we had if there were certain medications that only one, one optionand we can't you know, there's no alternative, we would try to orderup on some of those things in a feasible way, but we really hada good plan for how we make sure we have enough drugs on hand tocare for our patients. And then, as we learned more and more aboutwhat that meant, from the pandemic perspective, what medications we were using for thesepatients. We were able to create some analytics and like a real timeway to predict how many medications we would need on hand based on our bedcount, based on how many in patients we had with covid and so wecould get really precise around inventory management. That, I think, helped setus up to be really successful. We did not have any challenges with gettingdrugs in the door that we needed. So that was a real, realsuccess story and one of the benefits of working in a large system. Wewere able to move drugs around based on where it was needed. To thinkabout the time when we stopped elective surgeries. Well, we didn't need to storedrugs in those units anymore, so let's move those drugs around to whereit where it's needed. So if it's something to for somebody who's on aventilator, then let's move it to where we need those medications around. Sobeing able to be flexible and nimble like that really really helped us. That'sone getting drugs in the door. The second piece that I think was reallyjust a trend, like a powerful message just around teams and how we functionas teams and we leverage the expertise from the physician to the nurse to thepharmacist to provide better care. We had a really good model of scanning theliterature, I mean sometimes hourly. What's working for these patients? What arepeople using? What does the research tell us? And so we leveraged ourclinical pharmacists with with expertise and infectious disease to really help us scan that literatureso as we were needing to make changes to our treatment algorithm, we couldvery quickly make those changes. And so that was a beautiful partnership between Pharmacist, critical care physicians, Emergency Care Physicians and Turnist, where we were servedthis multi disciplinary group that was constantly evaluating how we're treating patients, what theoutcomes were telling us, what the data...

...was telling us and, more importantly, how we may need to tweet that based on the information that comes andso that was a wonderful partnership. Yeah, I have I'm started army that throw, but yeah, I want to just point that. Not Thinking aboutthat, but yeah, what you know, where's the team? Right? So, if I end and if I understood so, as the clinicians thedoctors are in treating and doing your team is monitoring, which, again,we've heard throughout the if there's one of the many consistent themes that we've heardthrough all of our guests is that in those early days we didn't know itdidn't it was. You know how to treat it, we didn't know rightcreat it with. We didn't know what was working. As you said,we're looking at what's the literature saying what are our colleagues and different cities,different locations and saying so it's so. The pharmacy team was the one kindof monitoring, looking at the weather channel right to say this is what seemsto be happening and here's what's going. So that allowed the clinicians to remainfocused a just as you guys could provide data, but they didn't have togo spend their time trying to find that information. You guys are feeding itto them. That practly, yeah, helping to support because you can imagine, there was so much information coming out. Yeah, I like so rapidly.I mean that I don't think we've ever seen that pace of studies anddata and trials and things being published like we did in the covid days andyou know, we needed somebody, we needed people to be scanning that literatureand what's what's information that's going to influence how we care for these patients.And I don't remember a time in my career where, you know, inSeattle they were experiencing some of the first cases and New York and there wasjust collaboration across the country with folks that were providing care to learn, youknow, what was working well and how can we be more successful. Sothat was wonderful partnership and collaboration that I think helped us along the way forsure. Yeah, well, and I'm sure you know you guys have muchaccess to much more scientific and clinical data. But even just I'm was there influence, because I remember when there was a quick for a hot minute thereeverybody, I think, and I kind of cynically say I think. Ithink it was proctor and gamble. I think they might. I said theyput it out, but til it all sold out because everybody said he can'ttake Gad bill with this. It makes it worse, and so everybody.So the shelves cleared out of time and all and that sort of stuff.Will you guys being at all influenced by what some of the you know,disinformation or misinformation that was going on maybe over social media or stuff. Howdo your pharmacists do that? They block that out and just only go toclinical resources, or does that influence sometimes some of the conversation? So Iwould say that the pharmacists know where to go to get reliable information. Sothey have specific sources that are vetted, that you know, you know asa trust. It soverse and that's where you go to get information on trials. Because you're right, there's so much more information out there then when wewere growing up and it was a cycle is that you were going to.So it's just a totally different world. So knowing where this trusted site,you know, the trusted groups that if they endorse this and that's the rightthing. So knowing that information is one thing. I do think it's achallenge from a consumer perspective. You know, and I'll bring up the example ofHighdroxy chlor Q, when I remember when that we were using that initiallyand people just started going out and hoard let even like stories of physicians writingthemselves prescriptions and going out and getting highdraxic chloric when to protect themselves when there'sreally no evidence to support that it would work in that setting. Is Sothe Board of Pharmacy in North Carolina actually had to put out some language andsome regulation around high draxy chloric Quinta a voide, supplies just completely getting exhaustedand then patients who take it for other conditions were worried they weren't going tobe able to get their hydroxychloric win and so things like that really created somesupply issues. Because of information that may go out, people apply that informationin a way that's maybe not not ideal, and then the next thing you knowyou're creating shortage shortages and creating issues that that didn't need to be there. So the title and I was a great example. Hydroxychloric whe's a greatexample of one of those drugs we had to really closely monitor. The otherexample a Zithromysin, was an antibotic that there was some initially we were tryingthat for some of these patients and so there were runs on that that werehappening in the patient setting, and so we just had to be really cautiousaround what supply look like broader than just within our system. But in themarket place, so that we could make sure that we had the drugs weneeded to care for the patients. Yeah, but you will, but you haveto have the discipline right not to not to be influenced by the thingsthat we tend to be influenced, because I'm sure any but into your teammight have been sitting on their drive into work or just listening to having theirmorning coffee and hearing the things about tyle rol, about things, about theother things and saying, well, maybe, maybe we should be looking at that. So right, but also have an open like your mind open enough. Okay, well, let's let's investigate when these are let's discussed that.Yeah, let's at least. Well, all be Craz let's talk about it. Right, exactly, exactly. The...

...other thing. I think I mentionedresearch, but that I mean early on. You know, we were hearing somesome conversation around Rendessevie and the fact that maybe all to be effective andhelp and at the time, you know, it wasn't available, and so weour research program was really an overdrive trying to find trials that we wantedto participate in that would give us maybe some access to some of these drugswe may not otherwise get. So that was also critical to our success,just making sure that we had a infrastructure in place to be able to goafter the right studies that made sense for our population, that we had peoplethat could help do the work. But it was a nice strategy and reallyhelped us grow and build our research program which continues and continues to grow tothis day. So that was a nice partnership between a lot of different stakeholdersin the organization. So the question that kind of possimated so and and Iwant to go but I want to continue to go back, but let's goforward again for a minute with my question. Will spend the time. But uh, if you think about it today, if it's so, if a patientcomes in today they're positive for covid what is the standard care? Havethey established a standard care which is okay, now you need to give them this, I call it the cocktail, meaning a couple of different things thatwe treat them with pretty regularly. has there become a standard out in theacross not just in navant but in across the country, where this is thethis is the standard of care for a covid positive patient? Yeah, yeah, I would say there's some there's some standards, just based on what wenow know today, around how to care for patients with covid nineteen, andit typically depends on the severity, the severity of the disease where than theyrequire oxygen, what that looks like for that patient and that dictates what treatmentregimen somebody may receive in the hospital right proxisting conditions. I'm sure too that. So there's a whole algorithm that the the physician and the care team canwalk through based on how somebody's presenting, and that will point them in theright direction with what medication to use for that particular patient. So we dohave some options. I would say, you know, I wish we hada silver bullet that somebody comes in with covid nineteen and this is the drugthat we give them and that cures them. But we just we haven't gotten thereyet. I mean really everything that we have in our arsenal is morearound reducing progression into more severe disease or trying to keep people to the lesssevere side of things and keep people from having to be in the hospital.But nothing seems to be that silver bullet that's curing covid nineteen. For myperspective, the best way to treat covid nineteen is to prevent it through vaccine. Our vaccines have been very effective at preventing covid nineteen, much, muchmore effective than any drug that we could try once somebody has covid nineteen.So so far that's our best strategy and really some of the messaging is roundwhere it's now preventable disease. If we are getting folks vaccinated, we canprevent books from getting covid nineteen and then the ones that do test positive,that the severity of the case is so diminished that it's not leading to hospitalizationand death like it once was. So great, great news to have avaccine. Yeah, okay. So, yeah, because when my as Imentioned again in the show, when my father did get it and get sick, you know, fortunately within two days he was back out. You know, I've got, you've had it for about ten days. He was getting, you know, not getting better. We put them in and in tendays he was out and be you know, they treated him with a series ofdifferent things, you know, both to prevent and to strengthen, steroids, some of those sorts of things. So, yeah, so you're notseeing any one specific. We you know, we go to Remdempsivie, we goto a steroid, we go to this. It's really it's there's ahandful of things all applied based on a case by case basis. Yeah,yeah, and it depends on severity and oxy to requirements, that sort ofthing, for sure. Okay, so let's go back again. We'll gobackwards again. Let's go so you so you remember? You're talking about howDr Eskiaglu, who we love and have had on the show, so we'refans too, but he's telling you about this is coming out and you guysare starting to do the research and feeding the team is there as they're dealingwith the front lines. Yep, even like made a little map on alittle piece of paper. Okay, this is where Uhana is, this iswhere the trains. You know, all the trains go in and out ofChina. I mean it was just like eye opening how much was coming outof China and the supply chain issues that we were likely to experience as aresult of the pandemic. So that that was really fascinating. But I alsoyou mentioned ultramow temperature freezers and this is also a great example of something comesout in a press release from fiser around potential storage requirements for their product,their vaccine candidate, and it sets off a chain of events that make thesupply of the this freezers very short, and so we had to act really, really quickly. So that came out. I want to say it was Ican't remember what month it was. It was in two thousand and twenty, maybe April of two thousand and twenty, when that information can a must.I can't remember what month it was, toad, but when the information cameout, probablable or it's all about it later we're like, okay,let's secure at least, you know,...

...some ultralo temperature freezer stories so thatwe can be prepared when the vaccine comes. And it was interesting because, youknow, it felt like we were investing in something, but we didn'tknow exactly what was going to be coming out. We didn't know. Wethought it was going to require ultra low temperature freezer storage, which it did. So we were glad we had the capacity to store the vaccine when thetime came, but we didn't know how many, you know, doses perbile, what that was going to look like, what kind of capacity wewould need it in our freezer to be able to store the vaccine. Butwe were very proactive and making sure. Okay, it's worth whatever the investmentwas to make sure that we have these freezers on site and it was goingto take four months to get those freezers in, so we had to actpretty quickly to make sure that we would be able to manage when the timecame when we had vaccines coming in our door and it became such a topicof conversation. The media was interested in the ultralow temperature freezers for everybody wasinterested in that. But we did have to invest a little bit just tomake sure that we would be able to have the number of vaccines that weneeded. And the other thing we couldn't predict, as when, you know, when we were going to actually have vaccine coming in our door, howmuch of it would we have? So we had to take some well calculatedbets around what we would need to be successful come December when the vaccines actuallyarrived. Sure, because you could have made the purchases of these things.I'm sure they're not cheap and you know, they could have been sitting in awarehouse somewhere and they said, oh no, you won't need those.You they're find it room temperature right, and you said they are okay.What do we do with these things? And, like a lot of thingswith the pandemic, we had to make decisions with just a little bit ofinformation. Yeah, and hope, but those decisions were the right ones andit's fortunately set us up to be very successful. I mean very glad thatwe've got what we've got. And you know, it's just ironic to methat as time has gone on, we get more and more information around storageand how long things are good in the refrigerator. So it's less of anissue now as it was then, but at the time that was number onepriority. We want to be a leader and getting our community immunized and thisis what we're willing to do to make sure that that happens. Yeah,so when you look back now, hindsight was was the your predictions on capacityabout right? Did you guys have? Did you have enough storage to takein what you needed? Yeah, only what was available. I'm sure atsome points you might have wanted more, and it wasn't even available for severalmonths. I mean the demand was so high to for people that wanted toget vaccine in. The supply was very limited. I mean was trickling inat a snail's pace, so we were administering everything that was coming in thedoor. So we didn't really need a whole lot of storage initially, butwe're starting to see that obviously flip where we've got more supply and less demand, and so we're prepared to store it and I would say our predictions werepretty spot on. Yeah, I think the Multitas stiles and the extra dosesin the vials and all of that met that. We have more storage thanwe initially thought, which is fine because I do think this technology is technologyof the future. So they're going to be more medications and things that comeout that require ultralow temperature freezer storage, and so now we're set up tobe able to accommodate that. So it certainly was a good investment, notjust for vaccine but for what we're expecting from a drug pipeline perspective. Great, so let's talk a little bit about that, about the technology. Yes, explain a little bit more about you, what you mean by that and whythis is different. Why do you think this will be more. Thisis the beginning, not not a one time sort of a thing. Butlet's talk at the technology differences in the especially the fiser and Maderna models.Yeah, so the work on the Mrna virus work and sort of that sciencebehind that vaccine is not new. I think there's been a lot of researchon it for a very long time, not just for vaccines but also fortreatments for cancer and things like that. So the MRNA technology and science ispart of the future and so we continue to look at drug targets, vaccinetargets that may help us treat conditions that we've not been able to treat effectivelyin the past, and so that's why I say I think you think they'regoing to be continue to be products that come out that probably need that typeof storage, that ultralow temperature freezer storage, especially for longer periods of time.So the sets us up to be able to do it and it's partof what's so exciting about the MRNA technology is that it's not just this vaccine. I think their future vaccines that are in the pipeline that that we maybenefit from. There's cancer treatments in the pipeline that we may benefit from.So it's exciting to see US finally to a spot where we're at least we'vegot a covid nineteen vaccine that's been super effective and who knows what's next,so excited to see what that might look like. So let's Bret and let'sjust spend a couple more minutes because I just think it's so important as weare continuing to encourage vaccination. I don't think. I don't think it's anysurprise for those of us who are pro vaccine who say the variant, theDelta variant that's now spiking in the US again, is affecting the last numberI heard was ninety seven percent of the patients are unvaccinated. So message tothe people who are not who might be afraid of it, that it's clearlythose of those who are vaccinated seemed to...

...be getting helped from it and thosewho are not vaccinated are susceptible. I heard a great I don't know whowas it was person on the radio, but I loved when they ask theperson, well, we're hearing about people with the vaccine getting covid and andthe person said yes, and I know people who have gotten the flu vaccine, who get the flu. Right words, it's never a hundred percent fool proof. That's right. But the people who have the flu shot, whohave gotten the flu, have milder symptoms, have faster recovery and everything, andwe're also seeing that play itself out as well with with covid but Ithink if you can just spend a few moments talking about what is Mrna?I think I've heard people say it alters my DNA and I know that that'snot true, but maybe just again explain what, why is that? Howis that technology different than like a live virus that we've used in the past, and that fact that it isn't something we just cooked up in the lasteighteen months and we're throwing it out there. Yes, a great question. So, Mr and what essentially happens is the MRNA triggers the production of what'scalled spike protein, and that spike protein is what triggers your body to generatethe antibodies to fight off covid nineteen. And then very quickly, just assoon as that spike protein is created, it's degraded and eliminated from the body, so it doesn't actually stay in the body, enter into the cells.It literally just creates that immune response and then it gets eliminated from the body. So that's what makes it very safe and very effective. And the otherwonderful thing about it is it's not live, no live virus in there, sothere's no risk of actually getting covid nineteen from the vaccine. So that'sthe technology behind it. It's the MRN a sort of comes into the body, it triggers the creation of the spike protein, which then triggers the responsefrom the immune system. And so when I say there's other drugs coming,other drugs with very similar pathways to help the spide off things like other pathogensand even testing it in different types of cancer. Yeah, Dr Sciaguo hadmentioned that he felt it was going to be potentially was going to be thethe PAS to HIV, yours and prevention. So very, very exciting with stufflike that. So let's let's keep moving through some of these things thatwe did talk about, which I know you're ashonate about, was a termthat you talked about with you which is like precision medicine, digital care,drug to patient, drone deliveries help in some of those sorts of things.Let's talk about some of that in terms of where you see pharmacology and theand and the healthcare system and and how they are continuing to evolve and expandand play an important part. Yeah, absolutely. Yeah, I mentioned oneof the courses of steady as I was pursuing my doctor it was pharmaco kinetics, which essentially is the study of how drugs functioning your system. What's reallyexciting about precision that US know. What we know is that not everybody processesmedication the same. There are a lot of genetic components that impact whether ornot something is going to be effective, whether or not you're going to bemore at risk for adverse events, and so what precision medicine does is ithelps us have a very tailored approach based on my DNA and my genetic makeup, so that I can have the best result from a medication that I'm taking. As if we think about, you know, the way we manage patientstoday, as we have evidence and we know that this is the drug thatcan treat this condition, but we don't take in the consideration, we don'thave that information necessarily about the genetic makeup of the person taking the medication,as so acision meds and allows us to do is to very specifically tailor drugsto individuals, and so it's really exciting. I think the the science has beenout there for a while and there's some ways that we can we cantest this things and incorporated into treatment pathways, but I think we're really on acusp of having more information or what it really means and whether or notthat drives better outcomes for patients. And so there there's some medications that youknow you can just be more at risk for side effects if it's over overactive in your body, and if we need that information on the front end, we could cut the things down and then you could be more successful onthat medications. I see that as being a big part of how we managepatients in the future, which I think is really exciting. You think aboutcancer and some we use MED's all the time and cancer and hope that they'regoing to be effective, but oftentimes they're not. And so if we couldbe very specific around which cancer therapy is going to be beneficial for this patient, it's going to help patients be more successful, it's going to reduce costof care, and they're going to be so many benefits to that. Yeah, I love that. I love that example. That's great one, becauseI was going to try to give an example to make sure I was understandingand your example is better than mine. But yeah, I mean I've gotsome friends who, unfortunately are dealing with cancer, as we all do,and you know that process of trying to find the right formula for them canbe really hard right, really hard on them physically. And got a goodfriend and she's been dealing with just really...

...bad side effects, you know,two or three days after treatment, just white in her out for the thingand all that. And now fast forward several months they feel like, Oh, we've found the right thing and so she's taking it, it's having aneffect and she's feeling good. But it sounds like what you're talking about withthe precision medicine is we can eliminate those six months of pain and suffering,so to speak, and go right to the thing based upon the the thegenetics and what we know the science is telling us, will work better foryour your individual needs. Absolutely it's exciting. I mean it's exciting as a consumerof health care to think that some day you should I be diagnosed withcancer, that my regiment could be very tailored to what I most likely torespond to. So everybody should celebrate that that. I think that's something that'scoming and we're learning a lot more about that and learning how we leave itinto workflows. If we know this information up front, how do we makesure that it's in front of the prescribers at the point of care when they'remaking decisions around treatment? Right? Yeah, no, that's very exciting. That'svery cool and in so let's talk about digital care. Is that so, if we've learned anything, because pandemic as a that we can provide alot of care virtually. There are a lot of things that we can doto care for patients and different settings. We no longer need people to comeinto our four walls all the time, and so digital care is, Ithink, transforming the way we think about providing care to individuals inside. Isee that just continuing. So we do a lot of virtual visits now.That's going to continue to happen. I think there's some digital technologies that helpus more interact with people on an ongoing basis. To think about, youknow, some of the things that I give an example. You've got diabetesand you know you're checking your blood share at home. Finding ways for thatinformation to flow back to the physician and then guidance to come back to thepatient is huge. We can have more real time ongoing management and empower patientsto be better at a equipped to be able to manage diabetes at homes.I think digital methods of communication and interaction and care are just going to continueto grow as a part of the strategy. But also I think consumers are goingto start expecting and I know I would rather if I don't need togo into the doctor's office. I'd rather be able to connect virtually and havemy needs met. So I'm really excited about that. I think it alsogives us opportunities to scale out services that I think are really beneficial to alot of individuals, and so being able to connect with whether it's a nurse, you know, pharmacist, a physician, having an easy way, kind oflike what we're doing today, to have a conversation is just a gamechange or in a difference in how we provided care in the past. DrBean, is your team getting involved in the telemonitoring? So you're about telea monitoring with cardio, like you know, I might wear the vest or artmonitor and my cardiologist is monitoring it or conceive the feedback. But whatare you seeing in the areas of Tel a? Monitoring with medications? Sotwo point diabetic, I've got the I've got the Monitor on and my pharmacistis sitting there saying, okay, you you know you're out, you're outof insulin and I see your spiking. You know, sort of a typeof thing. Are you seeing more of that? Yeah, I think that'sgoing to be a part of the future. There's a lot of technology that nowexists to help with that flow of data, patient data, to provider, who can then provide guidance around how to Adjustos as. insulince a greatexample. So say you're a patient in your checking your bloodsher or your bloodshore. You're on a continuous glucose monitor, so constantly checking your blood sugar.You can have a pharmacist on the other end that seeing this spikes,are seeing those trends, those patterns and making in just in time changes andinsulin doses to make sure that patients stay in the range that they would liketo be. So I think that's certainly a part of the future. It'sremote patient monitoring and having somebody on the other end to sort of identify thingsbefore they become severe to help patients be more successful. So diabetes is agreat example of that. Certainly something we're doing today with some of our pharmaciststo help with Matt managing the patterns and adjusting the insulin dose to reduce therisk for the the highs and the lows that can occur with with fips areon insulin. That's great. You know, one of the things I've seen recently, and I don't know if you or your team's have seen any ofthis, in prototype or things like this, and I think it's kind of veryrelevant understanding the recent the recents Oxycotton trotten. You know settlements that arenow coming out and billions of dollars being covered by the pharmacy companies who werebehind it. But one of them was I saw it's an actual device thatyou could give to an individual that would potentially have the like. Oxycotton isa good example in it that could would limit your ability to dispense it athome. So, in other words, if it knew, if you,as the pharmacist would put in a month supply or thirty, let's say,thirty tablets of boxy cotton and you could set it to say this is onlyto distribute one per day, personal, let's say, and then this isthe person could take the system through a...

...thumb print or something verified that theywere who they were and it would drop out the one tablet. They couldtake it, but if it got tampered with or broken open, the pharmacyor somebody would be notified that, you know, something has been breached.Have you seen anything like that and do you think that's going to take holdhere? Yeah, I mean, I haven't personally seen that, but itwouldn't surprise me and it sounds very familiar to some of the things in eveniousthat we do in the hospital. So we have patient controlled and Analgesia whereyou may have, and I'd be going a pain medication and then set,you know, to provide a certain amount over a certain period of time andthen if you need a bull of sto so you can, you can geta bullists, but their limits and we're able to set the guard rails aroundthat to make sure that we keep our patient safe. So I love theexample that you're sharing, because certainly it's a way to keep patient safe inthe in the out patient setting. If we had a mechanism to make sureonly what they need to be getting and should be getting is what they're actuallygetting, not only is it going to make sure they're not overdocing or gettingtoo much, but make sure that they're not vulnerable to other people are tryingto access and gain access as medications. So I do think, you know, lots of technology out there to help keep patients safe and also provide bettercare for patients, and I think our job now is to think about whatare the problems that we're trying to solve and what technology exists to help ussolve those problems, because there's no shortage of technology and innovation happening out there. But finding the tools that are going to be the most meaningful and themost impactful it's part of the work as well, and making sure that we'rethoughtful and how we met those things out to make sure that it's going tomeet the needs of our consumers. Yeah, the place I heard that mechanisms havinga lot of success and it makes sense and where they're testing it isin clinical trials. Yeah, because what they're loving is it's also giving thedata back to the clinical trial that shows that the patient who is taking themedication followed the routine, because the said, because that little container that's dispensing thetablet is feeding the data to say they didn't take it too much,they didn't take it too little, they took it exactly right, you know, all that sort of stuff. And and I think and it's a greatplace for to be trying that mechanism to see how it works well. Andwhat I love about the example you shared, an Alberadin at beyond just, youknow, oxycotton and the OPIOU set thedemic and trying to minimize risk assisitionwith that. We haven't it that we have an adherence problem. So,yeah, it's not uncommon for people not even to fill the prescription, muchless, you know, take the medication on an ongoing basis the way itwas intended. And so tools like that will help help people be more successfulwith maintaining therapy so that they can achieve the desired outcome. And said,I love, you know, the technology and innovation that's happening around better identifying, you know, what are the barriers to adherence. Is it a knowledgebarrier? Is it an affordability issue? Is a side effects that just neverget reported back to the physician who can make an intervention? So I lovethe idea of getting smarter about identifying the adherence barriers, WHO's at risk foradherence issues and more proactively tailoring interventions to help people be successful in medications.And let's say nobody wants to take medication, but there are life saving medications outthere, life changing quality of life changing medications out there that if we'reable to help people feel a little more comfortable, help people be a littlebit safer and make scary medications a little bit more exciting around what the whatthe actual outcome can be if you're able to be consistent with taking it.Think about the difference we would make in a lot of lives if we could, we could overcome some of those challenges to actually taking medication that's prescribed fora condition. Absolutely, absolutely well. So, as we're as we're comingup on some time here, I just wanted to I know one of thething I wanted to mention to you, which I know you're passionate about,and really it's really important to you is health equity. We talked about thatand I'd love for you to share with our listeners a little bit more aboutyou're feeling. You know, what's going on with there and and why isthat? Why is that a passion for you and for Navan? Yeah,I mean I think for me, just a recognition that not everybody has thesame access to healthcare. There are there are healthcare deserts in the communities thatwe live in where there's literally not a pharmacy and they're not healthcare facilities forindividuals. And so how do we make sure that we have equable access tocare? And so what can happen sometimes when you look at I'll give theadherence and as an example, if you look at an adherence metric and youlook at a percentage of individuals that are taking a medication as prescribed, ifyou don't look at it with the Lens of, you know, age andrace and ethnicity and things like that, sometimes you can mess out on someof those challenges that can be unique to certain groups. And so what wetry to do is start thinking about looking at things like adherents with sort ofsort of those dimensions of diversity to understand where there may be some unique meansthat we might need to tailor our approach to helping people be successful in medicationdifferently, and so that's why it's a...

...passion of mine, because I thinkwhat we're recognizing is we don't have equitable care today. We have people thatdon't have access and it's our responsibility as healthcare providers to be able to bringbring access and care to the individuals who need it the most. And soif we don't look specifically at those different dimensions and diversity and understand where thethe gaps are, we're not going to be successful with improving health and deliveringon our missions. It's super important for us to be able to understand whatthat looks like. So I I had told my team, you, let'sreally think differently and challenge biases around and how we're doing today and where weneed to be position to be able to provide unique solutions for folks so thateverybody can be successful on the medications that they're taking. Sure well, I'msure like any state, I mean you know North Carolina and in the southeastarea that you guys service. You know. I'm sure you know you getting accessin Charlotte and Raley, you know, is that's not necessary an issue.But when you get into the more rural communities, they're struggling to getphysicians in those in those markets. I'm sure access to medication and what's needed, and that is no different. is No different. It's not mutually exclusive. Exactly when, and you mentioned during delivery, and we're looking at innovationand how we actually get medication to consumer, and so there's a lot of workhappening and what we call last mile delivery, and so it's just superexciting to think about a day where maybe your medication comes directly to your doorstepand it's coming to you by drone, you know, on your phone.Okay, my medications coming, here's what time it's going to come. Imean how convenient is that if you have a virtual visit with a physician andthey prescribe a medication and one hour later it's delivered to your door? Imean, that's exciting to think about and there's a lot of innovation happening therearound how we actually get medication to consumer, because I think that our consumers aregoing to demand it and the technology is going to be there to supportit. Yeah, very exciting, you know, and if you know,not just in and in pharmacy, but obviously in the all lines of medication, and I mean numage issues, me health care. It's just amazing.I mean more and more with the with the with the show. I wantto start, you know, focusing on some of these really leading edge technologythings that are coming. I know again we talked about this Dr Ascaglu andhe's such a champion of all that and being a former aerospace he's a littlebit of the Geek in behind him that he loves. But it's fun,it's fun to talk about and to think about where we can go. DrBean, has been a pleasure having you on. We always kind of closethe episodes with my favorite question, which is who's your hero? So,as we start to wrap things up and you think about it, who wasyour hero now or growing up, or any at any time in your life? You know, I will say my hero now probably is different than whatI've have said as I was growing up, but, and I'm not going topick this one, I'm going to say my parents, my mother ormy father, or my heroes. I mean my dad literally save my life. It's a story I must felt out of waterfall and you Semite National Parkand he caught me before actually fell. So he literally saved my life.But I say my parents because they just invested in me so that I couldbe successful. I mean, I think about my attitude towards life, youknow, being grateful for what you have, giving back, having an emotional intelligence, and how I interact with people and how I approach problems and howI work through adversity, all of that I learned from my parents and Ithat's what makes me successful is being a well to deal with adversity and puta positive spin on it and be grateful for what I have and be gratefulfor the the opportunities that I have given. So they're might here. Is becauseI wouldn't be who I am if not for my team parents. Well, I think for a lot of us that's the case and I think youknow, obviously you appreciate and I feel lucky to have that same situation withmy father and my mother was as well, but not I think for a lotof us that that's where it resides and I think as we get aswe get older, we become more appreciative of them and who they are andwhat they did for us. So I love that and I love your heart. I Love Your Passion for what you do. We appreciate all the workthat you do, you and your team had Nivan. So thank you verymuch. Thanks for being part of the show and I'm sure we would loveto all as I always I always want to keep a little open door.We'd love to come back and, as things continue to evolve and grow,have you back on the show in the future and give it give everybody anupdate as to what's new in the world of pharmacy and healthcare. I wouldlove that. Said, thank you for the opportunity. I have just reallyenjoyed the opportunity for a chat this morning and would be glad to come backin the future. Great, well, thanks again. We're being part ofthe PODCAST. Absolutely you've been listening to heroes of healthcare. For more,subscribe to the show in your favorite podcast player or visit us at heroes ofhealthcare podcastcom.

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