Providence Health

Building and coordinating a Medication Utilization Management (MUM) program across a large integrated healthcare delivery system requires engagement and accountability by leaders at all levels of the organization. Stakeholder groups are diverse and span multiple departments including providers, nurses, pharmacists, informaticists, care coordinators, financial analysts, and certainly not least, patients. The first building block of a successful program is having a dedicated team to focus on strategy development, decision making, and governance that is front facing with these stakeholders to drive engagement and acceptance. These initiatives can have significant financial impacts, the magnitude of which is often driven by what we call the “6Cs” of enterprise-wide pharmacy program success. Using our “6Cs” framework, here are some key elements to consider.

Collaboration – Ensure stakeholders are represented in system governance. Structure pharmacy representation within medical staff committees and informatics governance groups. In addition to acute care and hospital settings, cultivate close partnerships with infusion services, home care, and self-insured health plans where applicable. Without such collaboration, we are left with MUM initiatives that are merely decisions with minimal implementation and less-than-optimal corresponding desired outcomes.

Champions – Identify at least one credible physician champion for each initiative especially if it involves changes in current prescriber workflows or care team behavior. In addition, socialize the “why,” and answer any questions or concerns that stakeholders might have leveraging initiative champions and subject matter experts within the system to alleviate push backs.

Communication – Establish robust communication channels targeting all relevant stakeholder groups. To facilitate this communication and ensure message consistency, develop, and make supporting education and resource materials such as initiative implementation toolkits readily available. Hardwire changes into physical and electronic workflows where possible. 

Calculations – Establish sources and processes to identify potential MUM initiatives. In addition, establish criteria and mechanisms for selecting MUM initiatives that are viable and actionable. 

Set annual financial savings targets that are cascaded down to the facility level. Develop methods to estimate financial and clinical impacts. Create a system to regularly calculate, track, and present actual cost savings and initiative performance on a timely cadence to stakeholder leaders. Establish an approach to calculating savings and net fiscal impact on all initiatives targeting outpatient services and other fee for service sites of care. Provide tools to visualize progress on an initiative and drill performance down to the facility and individual prescriber levels where applicable. Lastly, to allow for refocusing of efforts and resource reallocation, establish initiative retirement thresholds and develop a process for sunsetting MUM initiatives that have been exhausted or are no longer providing value.

Contracting – Coordinate MUM initiatives with pharmacy contracting efforts. Building a unified contracting and MUM team will connect the dots, ensure alignment, and optimize outcomes. Establish coordination pathways between the system team and individual facilities. This coordination is essential to ensure MUM initiatives and contracts are acted on, while also enabling real-time feedback on any issues experienced by frontline caregivers such as shortages and incorrect contract price loads with distributors.

“Building and coordinating a Medication Utilization Management (MUM) program across a large integrated healthcare delivery system requires engagement and accountability by leaders at all levels of the organization.”

Care – Design initiatives that increase care quality, access for patients, and improve caregiver experience. Minimize adverse impacts to both and avoid prioritization of one at the expense of the other. Facilitate implementation and ease the way for your staff. Support change through policy. Consider clinical outcomes, healthcare resource utilization, and throughput. Consider payer coverage, reimbursement, and patient out-of-pocket expenses.

The “6Cs” highlight the multifaceted and multidisciplinary nature of a successful MUM program. With larger health systems, the complexity of the program grows, but so does opportunity. Thus, success is not driven by pharmacy alone, but rather by a coordinated effort and an ability to work as a team.