Delivering Ambulatory Care in a Complex Academic Health System: Timothy W. Cutler, PharmD

Ambulatory care, bolstered by pharmacy services, can keep patients healthy and out of the hospital, according to Timothy W. Cutler, PharmD, associate chief of ambulatory care at UC Davis Health. In this interview with The American Journal of Managed Care^® (AJMC^®), Cutler describes the unique aspects of working in a medical center with a large geographic footprint, as well as how pharmacy technicians can play a role in providing optimal care.

This interview has been lightly edited for clarity.

AJMC: Could you tell us about where you work?

Cutler: UC Davis is interesting. We think of it as sort of a diamond in the rough and maybe a little lesser known than some of the other UC [University of California] medical centers like UCLA or UCSF. What is interesting about UC Davis is that we cover a large part of California, so we are actually servicing patients across 65,000 square miles, 33 counties, and that makes up 40% of the state, so we have a large geographic footprint.

We’re a tertiary medical center, so we have a level 1 trauma center as well as a burn unit, and we have a lot of specialty care we provide to patients from the rural areas to the more urban areas, given the size of California. That also means the scope of services we provide is quite broad considering the number of people that we have to service.

AJMC: What are the unique considerations of working in a large system?

Cutler: I’d say there are multiple things that make us unique. One is, as I mentioned, we have a large geographic footprint and that makes it hard for patients to come to us. So, we’ve done a really good job being strategic and making sure we can provide pharmacy services to patients in their home, whether that’s a home infusion solution, home delivery, telemedicine, or remotely monitoring our patients, and then of course also having them come in when it’s appropriate to get management on site as well.

One of the most impressive parts of our health system is the fact that we have a pharmacist solution or pharmacy solution, whether that’s a technician support, and financial assistance for every patient that comes here, meaning we have robust pharmacy enterprise, which allows us to be able to care for any patient, any need, in almost any clinical setting, so that's something I'm really proud of. We didn't always have that when we first started on this journey. We had pockets of pharmacy support, and we really marched toward that strategic goal of making sure every patient would have a pharmacist or pharmacy solution in the end.

AJMC: How do you ensure the financial and operational sustainability of pharmacy and ambulatory care?

Cutler: I would say fiscally we’re a high performer, especially the pharmacy enterprise. We make up about one-third of the revenue for the health system, and we’ve grown that 5-fold in the last 5 to 7 years, so we’ve really ratcheted up our financial support for the organization. Then I think the other place that we really excel is we are experts in pharmacy-related needs. We have pharmacists who can really make sure patients are getting the most out of their medications.

We also have a really high Net Promoter Score for our services, meaning if somebody were to recommend our services to other people, that’s over 88% for the patients and 97% for the providers. So, we provide excellent care, and I think that’s something we excel at: We provide comprehensive care and we provide specialized care, and as I mentioned, we have a solution for every patient, which I think is really unique and helps us stand out.

We’re good at managing the patients where they need it in their homes and not always the most expensive place, which is the hospital. We have a really large ambulatory footprint that allows us to make sure patients are staying healthy and out of the hospital. We do think patients need to go to the hospital when they need to, but we want to keep them out as much as we possibly can. So, we really excel, I think, in the pharmacy areas that we support our patients in ambulatory and in acute care. We have experts in those fields, board certified and always practicing at the top of their license.

The second thing I think I’m most proud of around the pharmacy support is our pharmacy technician program. We have a lot of technicians that are taking care of our patients alongside the pharmacist and sometimes even taking the primary role in helping them with financial assistance, affording medicines, which is another area that we really do well, so we provide the best care and we do it in a fiscally responsible way. We always try and keep those patients in the place that they’re most comfortable and going to be healthiest, which is outside the walls of the hospital.