Season 2, Episode 4

New Expectations of Pharmacy with Dr. Kyle Skiermont

In this episode, you’ll hear from Dr. Kyle Skiermont who will share how he has helped lead Fairview Pharmacy Services towards the Triple Aim. Kyle serves as COO at Fairview Pharmacy Services which is the largest health system owned ambulatory pharmacy organization. 

Shownotes

HB: Alright, so today we have a special guest on the Talk to Your Pharmacist podcast, Kyle Skiermont. Kyle serves as COO at Fairview Pharmacy Services, which is the largest health system-owned ambulatory pharmacy organization. He has worked his way up through this organization and has worn many hats along the way to gain experience in specialty pharmacy, infusion and MTM services. As COO at Fairview Pharmacy, he helps oversee a $1 billion+ pharmacy enterprise that includes over 35 retail settings, multiple hospitals, including the University of Minnesota, a specialty pharmacy and infusion pharmacy, licensed pharmaceutical manufacturing, a PBM and more. So Kyle, welcome to the Talk to Your Pharmacist podcast!

KS: Thank you. I’m excited to participate, and I am glad you invited me.

HB: Well, now that our listeners have heard a little bit about your background, maybe you can fill in any gaps from that intro and maybe share a little bit about your personal life. I think I saw you were even a track and field athlete while you in college, so that’s an interesting fun fact too.

KS: It is. Wow, that’s going way back. Believe it or not, I actually had gone to college, was hoping to play soccer and was injured playing soccer my freshman year, ended up running track and became an all-conference sprinter, actually, in college. But the reason I bring that up is one of my passions still today is — even as a guy in my mid-40’s, I’m still playing soccer a couple of nights a week. And between that and my wife’s activities, I’ve got three grade school-aged children that keep me busy. We’re definitely very interested in travel, we do a lot around sports, food, cooking, kind of going out to restaurants. But definitely spending time with my spouse and my three kids keeps me busy and has kept us in the Twin Cities, actually, for a number of years. I’ve lived here for about 20 years, about twice as long as I’ve lived anyplace else. Kind of bounced around the Midwest, lived on the East Coast for awhile, and I think similarly in my career. I’ve been able to do that all in the different areas that you mentioned. I’m one of those weird people in the world today who I’ve actually spent my entire career at Fairview, so have had the opportunity to do a lot of different things, as you mentioned some of them, but have been able to do that with inside of one organization, which has been really fun. And kind of every 2-3 years, as I’ve kind of gotten that itch or as I’ve started to look to see well, gosh, maybe I want to do something different, I’ve been fortunate to have that opportunity inside of Fairview and inside of an organization that has been great to me for nearly 20 years, and as I’m sure we’ll talk about here, has given me many opportunities in the pharmacy space.

HB: Yeah. Interesting. Well that’s fun because my husband and I are also into doing triathlons and things. And he was actually a track and field athlete. And one of the perks that comes with that is we get to go down to some of the Ole Miss football games, down on the sidelines before the game starts. So we’ve enjoyed that. So Kyle, first set the scene for us about what is Fairview Pharmacy Services. And how is it considered the largest health system-owned ambulatory pharmacy organization?

KS: Sure. So Fairview Pharmacy Services is really, it’s the pharmacy arm, it’s a wholly owned, separate LLC of the Fairview Health System here in Minneapolis-St. Paul area. And as you described, we’re a fully integrated delivery network. We’ve got 11 hospitals, including, as you mentioned, the University of Minnesota Medical Center. We’ve got 60+ primary care clinics, similar number of specialty clinics. Really try to be that true IDN of taking care of patients from beginning of life all the way through to end-of-life care. And so for Fairview Pharmacy Services, really, we approach it kind of the same way from a pharmacy perspective. We want to be a comprehensive pharmacy organization and really offer essentially anything that a patient could need in their healthcare journey, so everywhere from the basic retail pharmacy, which as you mentioned, we have a number scattered around kind of the Twin Cities metro area in Minnesota. But doing things like infusion and the specialty pharmacy as well. And really branching into the clinic operations as well, so kind of trying to be into the clinics and really probably the easiest way to describe it, as I said, is trying to do everything that a patient could need. And I think you bring up the largest health system-owned ambulatory pharmacy organization. I don’t know that I can definitively say that, but pretty sure based on kind of what we hear from others attending a lot of national conferences and being involved in a lot of other groups. We don’t hear a lot of other people who are close to that $1+ billion market at this point.

HB: Yeah, it’s really impressive. And as you mentioned, it’s neat to see that you’ve been able to serve in many different positions throughout this organization. Do you have maybe a favorite area of practice? Or has it just kind of kept evolving with all of the different areas of pharmacy that you’ve been able to experience?

KS: Yeah, I mean, I think it’s definitely evolved over the years. And I think my interests and the things that I am passionate about inside of pharmacy have evolved a little bit. But I think one of the core things that’s really been one of my favorite things that I’ve had the opportunity to work on really in pretty much every job that I’ve had at Fairview is developing the team that I get to work with. So it was something that I think, you know, kind of coming out of school, I wasn’t sure that that was something that I wanted to do. In fact, oftentimes, we’ll joke with students and residents that I thought management and leadership was for suckers when I was first getting out of school. But as my career has gone on, that’s been for me, some of the best things I’ve done is seeing people who are on my team develop into new roles. I really enjoy seeing their successes. I very much enjoy working with residents and students, specifically, but not just in the kind of traditional learner role. It’s also, it’s the managers and directors and vice presidents who I’ve had the opportunity to work with over the years is — like I said, seeing their success and kind of build them up and develop their career has been something that has really brought me a lot of joy. And then I think also just really expanding what pharmacy can be. So we’ve had a lot of success here at Fairview. That success has bred the ability to do other things in pharmacy or expand services or really try some things that maybe if we hadn’t had those success in given areas that we would have been given the opportunity or afforded the opportunity to do. And in fact, over the years, through some consulting relationships that Fairview pharmacy used to do but then also through a kind of spinout company from Fairview, a network of health systems specialty pharmacies called Excelera, getting to work with a lot of other health systems around the country as well. So for me, it’s been really rewarding to not only see kind of that growth and development that’s been able to happen inside of Fairview but to also be involved, you know, even if it’s been in a very small way, at a lot of other health systems around the country as well in expanding their pharmacy services.

HB: So Kyle, somebody listening might think, how do you start at the very bottom as a staff pharmacist or a clinical pharmacist and work your way up through? Do you have any tips for somebody who is starting out in their career and how to advance? And then I’d love to hear a little bit more about some of your leadership skills that obviously you’ve developed and that you try to instill in your team.

KS: Sure, yeah. So I think one of the things that I would tell new people coming into the market or coming into pharmacy is, yeah, I think at the most simple or base level, it’s to not be afraid to try new things, to not be afraid to take risks with your career. One of the great things about pharmacy is there are so many different opportunities. I’ve had I think nine or 10 different job titles and kind of job responsibilities at Fairview, and that’s just in one organization, not to mention that I could have worked for one of the large chain operations, could have worked with a payer health plan, could have gone into the pharma on the manufacturer side of things. So the reality is is once you have that pharmacy degree or that PharmD, it opens so many doors. And so not to be afraid to take a chance or try something that maybe you’re not 100% sure that it’s ultimately going to work out to be able to take that risk. But when you do take that risk, to throw yourself into it 100%. Don’t do anything halfway that if you decide to make that leap or if you decide to try something new, do it with all your heart, do it with all your mind and really get after it and show up every day with the best attitude that you possibly can, with the best intent and quite honestly, with the best ideas that you can not be afraid to implement those and pull those out.

HB: Yeah. That’s helpful. And then any specific leadership skills that you would recommend to people who are wanting to grow in that area?

KS: Yeah, so I think for me, one of the important things to learn in particular in the healthcare is you’re not always going to be the expert. You’re not always necessarily going to be the smartest person in the room. You’re not always going to have all of the answers, and that’s OK. That’s — for me, one of the things that I’ve definitely learned working with a lot of teams is my role is to really break down barriers for them, to kind of provide input and ideas but that ultimately, it’s the teams that I am leading, so it’s my frontline managers, it’s my directors, it’s my VPs that are ultimately the ones who are going to execute a lot of that strategy or the ones who are going to execute those good ideas and quite honestly, are the ones — because they’re at the frontline, they’re the ones who are taking care of patients, that they’re going to have those ideas. And so to not always feel like it’s always got to be your way or it’s always got to be your idea in order for it to move forward but to really surround yourself with good people and oftentimes, people who think differently than the way that you think. And kind of similar to not being afraid to try those new things for yourself, to also not be afraid to really get behind one of your staff or one of your leaders and support them and support their ideas to ensure they’re successful.

HB: Well, I think that’s obviously serving you well as COO. So Kyle, what are some of the biggest areas of pharmacy practice change that you’re seeing, especially in the ambulatory setting?

KS: Yeah, so there’s so many. I think some of the big areas is really just overall, the growth in what I’ll call clinical services. And by that, what I mean is pharmacy is changing so quickly and moving so dramatically away from — it’s no longer just dispensing medication. It’s not just pills in the bottle but really owning all things related to medication therapy up into including the outcomes those patients have. And so whether it’s working specifically with a patient or whether it’s working with a provider group, really seeing pharmacists take a different approach and step up and, as I said, kind of owning that medication therapy or those medication-related problems. And so I see pharmacists and pharmacy integrating themselves into the care team much, much better than they did even at the beginning of my career. I think about giving recommendations or advice to providers when I was first starting, and the difference 15-20 years ago to doing that today where I think even the providers and various other healthcare professionals that we work with now, that’s expected. And then I think one of the other big areas in the ambulatory setting is probably even more so than in the acute care setting, or at least differently I think, is the importance of kind of cost or the price and that financial burden for patients where as the costs of medications — and quite honestly, the success and specificity of the medications increase, that that’s becoming a whole new area that I see maybe not even necessarily specifically to pharmacists, but I think the pharmacy organization overall of really needing to be a resource, again, for providers to help ensure that their patients can start the therapies that they’re prescribing. But then also for the patient, to really initially help them to get on those medications but then also from a long-term perspective, helping to reduce not only the kind of adverse events or kind of the toxicity from medications but that financial toxicity as well. And how can we ensure that patients actually have access to the medications that are being prescribed for them?

HB: Exactly, yes. They do need to get access to those medicines. So Kyle, I saw somewhere, maybe on your LinkedIn, about new expectations of pharmacy. What do you mean by that?

KS: Yeah, so I think it’s a little bit what I was just talking about is kind of the move or the growth in clinical services and kind of moving past the, “Well, we’re a cost containment, cost center” or “We’re just about order takers and order fillers,” to, “No, we’re a key element of the healthcare team.” And whether that be working directly with patients, whether that be working with providers not only in the kind of point-of-care for the patient but also in development of protocols, development of utilization management, overall strategies within the broader healthcare system, working with manufacturers, kind of in all of those areas, really moving away from the pharmacist who, like I said, is kind of the order-taker, the order-filler, oftentimes in the basement of the hospital to really moving out to the point-of-care and quite honestly, the point of impact and the point of influence with various stakeholders, including providers and patients.

HB: Exactly. Well, how do you stay current with all that’s going on in healthcare and specifically, within the pharmacy field?

KS: Yeah, it’s a challenge. Our CEO of our health system was doing a presentation not long ago, and he was showing the rate at which medical knowledge doubled, and if you looked at a couple hundred years ago, it was measured in 50-100 years. Even 50 years ago, it was measure in decades. And we’re at a point now where it’s being measured in days where kind of the knowledge that humans have in health care is doubling. So it’s a challenge to do it. I think for me, it’s doing things like reading kind of daily updates from a variety of different organizations. It’s attending conferences — and not just pharmacy conferences, but if you go to conferences that are broader in healthcare. But I think for me, one of the big areas that I’ve seen and has definitely grown over the last few years is really, it’s just getting out and talking to people — and people not only just in the pharmacy space. Clearly, that’s a way to be helpful and kind of staying connected to my network that way but also ensuring that I’m seeking the opinions and trying to seek out colleagues from other area, so working with people who might work at a health plan or a payer, making those connect points to people who may work at a pharmaceutical or a device manufacturer — and not just clinicians, but people who are on the business side or the contracting side of things as well, to try to ensure that the information that I’m getting or kind of trying to stay current is not — pharmacy is always very, very important to me because that’s the specifics of my job but really looking at it from a broader healthcare perspective as well and also making sure that I’m trying to stay updated with doing that reading or conferences or connecting with people around aspects outside of just the clinical care as well so the business side of pharmacy and healthcare, the regulatory and compliance perspective as well.

HB: Absolutely. So what are some of the things that excite you about the future of pharmacy?

KS: Gosh, that’s another one where there’s so many things that really excite me. You know, a few that kind of keep me coming to work every day or keep me really excited to be in the field is one, just getting much, much better about demonstrating outcomes and demonstrating that the interventions that pharmacists are performing or the interventions that they’re involved with are really changing outcomes — outcomes from a patient satisfaction perspective, obviously from a clinical perspective, but also from a total cost-of-care perspective. And so as the data and the ability to — more importantly, probably — to synthesize and analyze the data is getting better, I think more and more, we’re starting to see just what an important impact the pharmacy and pharmacists can have. I mentioned a little earlier kind of the expansion of clinical services. That’s something that excites me is really the expansion of Medication Therapy Management and those clinical services. We’re seeing a lot more pharmacists at the point-of-care in clinics, and that’s something that I think will show dramatic impact. Pharmacogenomics and personalized medicine, I think as more and more — I look at how oncology pharmacy has changed, for example. And not that it’s perfected yet, but we essentially gave people poisons 10-15 years ago. And some of them were very, very effective but had ungodly side effects along with them. Well, now we’re moving into with various tumor markers and things and immunotherapies, really being able to give people medications that are much, much more successful and targeted if you’ve got a given type of cancer but also have much, much lower side effects. And then I think maybe one last thing is just the idea of how do we start to use kind of remote access or different ways to give information to our patients but also to get information from our patients. So just all of the various electronic tools and web-based tools and apps are available now for us to not only as a provider be able to push information and hopefully be able to push useful things out to patients, but then also to engage patients differently and to achieve or to gather patient-reported outcomes and other various things that you can’t get or you can’t physically have a patient coming to you physically on a day-to-day or hour-by-hour basis.

HB: I completely agree. And I think the technology is just continuing to disrupt the healthcare system. Not only is it making that knowledge change cycle, if you will, that you mentioned earlier about changing it from decades to days, and that’s a lot from technology. But just how technologies enabling us to do things like telepharmacy or even just better patient engagement and things like that. So Kyle, as our final question, what is some advice that you would tell your younger self or for other pharmacists out there who are just getting started in their career?

KS: Yeah, so I think one of the big pieces of advice we kind of touched on it on an earlier question on kind of the leadership style of really not being afraid to try new things or to kind of take those risks. But I think one of the other things that I guess I wish someone maybe would have told me or one of the things that I tell a lot of new pharmacists and new leaders is to really own your space on the healthcare team, that pharmacists are becoming more and more — and already are in so many cases — such a vital role of the team. So don’t feel like you’ve got to kind of sit back, don’t feel like you’ve got to wait to be asked something or wait for your opinion to be sought out. If you’ve got an idea for something, you know, broadly, you know, it could be specific for a given patient — speak up, say your piece. Or even if it’s something more broadly around what’s happening in your given pharmacy or what’s happening just even more broadly in the healthcare system, I think that is something that I would definitely share with my younger self. And I think one other big thing would be to get involved outside of just your day-to-day world. And that may be in a charity that you’re excited about, it may be in a given disease states, national organization for patient advocacy. It might be legislative. Or it might be with an organization like ASHP or the National Association of Specialty Pharmacy or — I don’t mean to just call those two out, but the myriad of different pharmacy organizations that are out there. To get involved because A, it’s going to help build your network and give you a whole lot of really, really smart people that you can tap into. But B, it hopefully gives you the opportunity to change things on a level that you would not be able to do just on your own.

HB: Wow. So many awesome things that we’ve been able to learn during this episode, Kyle. It’s been such a pleasure to have you as a guest on the Talk to Your Pharmacist podcast.

KS: Hillary, thank you again for inviting me.

Connect with Kyle on Linkedin: https://www.linkedin.com/in/kyle-skiermont-75809a10/

Host

Hillary Blackburn

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