High-Performing MID Programs Integrate Pharmacists Into Oncology Care Teams: Q&A with Osama Abdelghany, PharmD

Medically integrated dispensing (MID) has the potential to enhance and standardize patient care and outcomes when implemented correctly under proper leadership.

Osama Abdelghany, PharmD, an executive director of Oncology Pharmacy at Smilow Cancer Hospital at Yale-New Haven Health and a panelist at the Boston Regional Institute for Value-Based Medicine®, explained the structural requirements for successfully implementing MIDs within a hospital system.

In this Q&A with The American Journal of Managed Care^®, Abdelghany discusses the benefits and requirements of an MID in an oncology clinical setting.

This transcript was lightly edited for clarity.

AJMC: What separates a truly high-performing medically integrated dispensing program from one that is simply embedded within a health system?

Abdelghany: The main difference between the 2 settings is that the medically integrated pharmacy in a highly functioning health system is truly integrated in a clinical and operational workflow. We're talking about a pharmacy that goes beyond just dispensing, a pharmacy that has access to electronic medical records (EMR), real-time information that helps them engage, on a day-to-day basis, in the clinical needs of the patient, toxicity assessment, and adherence. Also, a highly functioning pharmacy is involved in prior authorizations and making sure that patients have access to the medication they need in a timely manner.

The most important aspect of a highly engaged and functioning MID is shared accountability for the outcome of the patient. They're not just dispensing medication. They are co-owners of the outcome of their patients. They proactively look for outcomes, collect data, share data, and value the shared accountability in mind. They're not outsiders; they integrate it within the team at a much higher level.

AJMC: In a large academic cancer center, what operational or clinical workflows are most important to get right in order for MID to consistently improve oncology care delivery?

Abdelghany: There are several of those. The first, and probably the most important, is having a workflow that is driven by the EMR. The EMR is the sole source of truth where we have information about treatment plans, dose-reduction labs, clinical notes, and any adjustments or modifications, all in one place. Having access to that EMR in real time separates highly functioning pharmacies within the health system from anyone else.

The other important aspect and a workflow that we all need to integrate is a close collaboration with the prior authorization and financial clearance team. It's very critical for the patient to start on time, and decreasing the delay is essential, so that close collaboration is another important workflow that needs to be embedded.

The third one is really that closed-loop communication. It's what separates us from outside pharmacies: we have all the information that we need, and we put that in one place that now physicians, collaborators, and everybody else in the team can see. That’s another important workflow, which is closed-loop communication.

And finally, you need to build in all your assessments, toxicity assessments, adherence monitoring, treatment plans, escalation processes—all that needs to be built in in a clear fashion that everybody can see and follow. Those are probably the 3 or 4 main workflows that need to be embedded in a successful pharmacy.

AJMC: How do you evaluate the role of emerging technologies like AI-supported adherence tools, remote monitoring, or automated dispensing in strengthening MID’s clinical impact in oncology?

Abdelghany: Obviously, technology is very important. It was the only way we're going to accelerate what we're really doing and take us to the next level. Generally speaking, when I look at technology inside or outside the pharmacy, I first ask myself—and I learned that from one of my mentors—what is the problem we're trying to solve, or the process that we want to improve, and does this technology actually help us to accomplish what it is we want to accomplish?

The 3rd question that comes to my mind is, is this technology tool better than the alternative? When I go through these questions, in my mind, we’re basically trying to do a couple of things as a specialty pharmacy or medically integrated pharmacy. We want to improve our ability to deliver great care; we want to do that as proactively as possible and not retroactively or delayed. We also want to make the care more efficient.

One thing I look for in technology is integration with our existing processes and software; you cannot introduce something that does not align with everything else. The adoption will be slow and probably will not have the intended effect. We've done a few things to do just that, to make the care efficient, to improve on what we do today. We incorporated software to help us with prior authorizations and automation to make prior authorizations, and the ability to start a treatment faster.

We also introduced artificial intelligence in the medication assistant program to match patients with any eligible program available. We're still looking at software to help us with adherence, not only to deal with adherence, but to actually predict who is going to need support. Again, that shift from just reactive to proactive. This is all going to grow, but we need a systematic approach to identifying new technology.

AJMC: When you’re communicating MID’s value to executive leadership, what outcomes matter most—clinical measures, financial performance, patient satisfaction, or reduced treatment delays?

Abdelghany: It's hard to point to one single thing, and we actually, I actually try not to do that. There is a set of core values that we bring as a medically integrated pharmacy, and we would like to highlight all of those at the same time, obviously, with priority here pointing to impact on patient care and outcome, putting the patient in the center. We always talk about supporting access to medication, making sure that the patient gets the drug at the right time, without delay. Helping with prior authorizations and helping with financial support to avoid financial toxicities is essentially the first core value that we bring.

The second is supporting patients throughout the treatment journey, monitoring adherence, assessing toxicity, and addressing that toxicity by dose reduction and optimizing supportive care. It's also something equally important that we bring to the table. We talk a lot about patient satisfaction, and again, that is driven directly by the first 2 items. If you provide the medication in a timely fashion in an environment that supports patients, we always see a high satisfaction score.

The last piece is the financial value. Not only talking about revenue or margin for the organization, but also assessing if it is optimizing payer strategy and reducing waste, along with margin. We create a picture of all the things that we bring that are not competing priorities. I would say it's patient access, patient support, patient satisfaction, and financial value as the story we try to tell when we talk to our senior leadership.

AJMC: Looking ahead, how do you see the oncology pharmacist’s role evolving within MID programs at institutions like Yale, particularly as therapies become more complex and personalized?

Abdelghany: Right now, we are supporting care. I see the future of pharmacy and pharmacists to be partners in that care and shape it. As you know, cancer care now is very complex; personalized therapy is the standard in most of the disease states that we care for. One thing we hear all the time is that we have all these new therapies, all biomarker-driven, but there is a gap between the availability of therapy and making sure that the patient actually gets the therapy they receive.

I see a pharmacist in the future who is intimately involved in personalized therapy and making sure that every patient gets tested for the biomarker that is relevant for the disease, and then matching that patient with the therapy to benefit from. Also, see the pharmacists much more involved in managing the toxicity, being more proactive than reactive, and being a partner in adherence, toxicity, and optimizing care.

Pharmacists will also have a bigger role in the value-based environment. If there is a value-based program where we are actually looking at the total cost of care, I see a pharmacist taking a lead role in that area. Holistically, I see pharmacists have always been medication experts, and we want to be a medication and therapy partner to escalate what we do today. They’d have that higher level of proactive engagement in an efficient care journey.