Working In Oncology
Working In Oncology

Episode 1 · 2 years ago

The Biggest Problem for Patients Is… Access w/ Allie Anders


Your access to patients is through 2 little sliding pharmacy windows, and your “office” is just 5 feet wide. 


Welcome to the workplace where our very first podcast guest gets face-to-face with patients: her dispensary. 


In this episode, I interview Allie Anders, Dispensary Manager at Carolina Oncology Specialists, and we dive into the details about the biggest problems facing her patients and how Covid-19 has affected the community oncology setting. 


Listen, as we cover: 

-The #1 problem for her patients: The falsehood that they can’t get access 

-Why she meets with so many mid-levels 

-Covid-19 changes in the dispensary ... & which of these changes will stick around for the long-haul 

And, of course, this wouldn’t be a healthcare podcast without touching on insurance! 


Stay connected with Working in Oncology on Apple Podcasts, Spotify, or our podcast website.

You're listening to working in oncology, a podcast and video show that spotlights oncology practice staff and industry influencers who work behind the scenes to shape the future of oncology. The more knowledge the oncology community shares with each other, the more we all grow. Let's get into the show. Welcome back to working in oncology. I'm Scott Costroin with bioplus Specialty Pharmacy, and today my guest is Aleanders, who's dispensary manager with Caroline, oncology specialist in Hickory, North Carolina. How are you doing? Good? I'm good, very good. So today we're going to be talking about working in oncology. Obviously are catchy title, but more specifically about your role and what you do on a daily basis, and it's maybe some changes and some things that might be impacting your job or your industry or how you interact with patients. But before we dig into the technical stuff, so for our listeners, tell us a little bit about yourself, and I know the answer to this, so I'm cheating, but you can tell me something that has recently happened to you that's very exciting. So about me. I have worked in pharmacy for sixteen years. Start out in Rachel Works in Hospital Ivy Mixing primarily, then switched over to recent again, because everybody knows, you can always get a job in retail. Doesn't mean you enjoy it, but you can always get one. And then I came back to community oncology. I actually for the first time, just by chance, because a personal work at the hospital was working in it. And Yeah, so here I am loving it three years later in the community on cology setting and most recently I had a baby, number this is number three. So I'm not busy at all. Busy. So No, no, new mom life is easy and calm. Right. I'm worried, very peaceful, very peaceful. Yeah, so work is probably a great escape and then you get to have all the fun when you get home at night, right or in the morning. That's exactly where my boots hit the girl and they don't stop till I don't know, whatever thing's done. That's a seven job. That's that's awesome and congratulations on that. So so you mentioned your path to pharmacy. Tell me a little bit, and our listen is a little bit about your specific role, your daily specific role at Caroline oncology specialist. First of all, just blessed to get to work here. I myself and now have a CO worker, Melissa. Our jobs are to just ensure from start to finish that our patients have access to their oral medications, something also sometimes that includes shots, but primarily oral medications, from start to finish. So we do everything from when the doctor prescribes it so when it's actually in the patient's hands. We don't clear out anything from our queue until we know it's in the patient's hands. Sometimes we feel meditations in office, I'm in house, in our dispensary, or we will shift them out to or send them out to special depharmacies, just depending on insurance and so many factors, as anybody that works in pharmacy knows right well. You mentioned you mentioned access, and that that leads to a separate topic that I think is is relevant every day and certainly with what you do with patients. So, as far as access goes, what are your biggest challenges that you see on a daily basis around access, whether it's cost or insurance or, you know, just speak to your personal experience. I think the biggest in my opinion and experience, the biggest problem for our patients. Number one is the falsehood that they can't get access. I did not realize until recently in other areas and other...

...practices I've spoken with, just depending on where they're at, because we are in a mountainous community. We're you know, we don't have one of the big city and most of the places around us are not either. So I have had patience tell me all. I just didn't think I'd be able to take it. So I'm just not going to. And it's just a sad issue because we know that there's help out there and most of the time, especially because we're under the poverty will here, most patients can have access to these medications for free or very reduced price, but they have no ideas. It's it's like a growed up the best of us. I heard my grandfather and my father teaching me. Don't ever assume someone knows how to get access to this if they don't even have access to get the access. So that's our jobs to show them that there there is help and they can they can get it and we can lead them and guide them to do it. But I think that we're gonna and I think I think you're right. I think that's that's great, especially considering your unique I think geographically you mentioned, you know, being below the poperlary level, very mountainous area, and there's some challenges financially. What what obstacles tend to get in your way as far as access, you know, dealing maybe with manufacturers or insurance plans or you know, what's what's a what do you find as most challenging to get that? Financial Assistant? Insurance definitely is the first step. So when we go to feel a medication or try to feel the medication for patient, we know that every drug, almost every drug we are prebscribers prescribe, it's usually going to require prior authorization. Now, when I didn't work on this side of pharmacy, I always thought, man, why aren't those doctors offices hurrying up on these prior authorizations, and even more so now. I know that some people may feel the office it, but if you have someone dedicated to doing that, there's no reason patients should be waiting weeks to start their medications. On my one of my physicians office is fourteen days automatically. That's ridiculous. I can get prior authorizations I've returned in twenty four hours or sometimes two hours. So that's a big access issue, because if you don't have someone willing to fire advocate for you and you don't know how to do it, then you're going to go without meds. And these are people who have extreme diagnosis run off the bat, so they need it as soon as possible. So I think that's a big issue. But the insurance is the biggest obstacle in that case. But we've learned to overcome them because we know they're how to get around things. But secondly, I think I don't know. We've become good with our drug reps and our manufacturers. Most are good about giving us samples or vouchers for thirty days free start, so that helps our patients. But the biggest issue really that throws a kink in our plans always is the insurance. Truthfully, sure that's true and we certainly hear that a good bit and I think that's just part of the overall landscape. You know, it's something that's in this scapable. What what type of you know, tips or what type of I guess, tricks maybe, have you come up with in working with these patients on a daily basis, you know, to maybe improve your workflow or maybe improve, like you mentioned, speeding things up. You know what, what do you do that maybe some of our listeners might be interested in? That would be a helpful hint around PA's or speeding up the process. Well, in our practice, when I came here there have been one other person here before me and she was a pharmacy tech also, but it was very new and she was kind of overwhelmed and she did was not she did her best. I mean she did a great job, but her passion was elsewhere and when I came in I learned what they could from that and then look at on I saw that our nurses who work in our infusion center... were literally doing the prior authorizations for oral meds, they were sending and re feels. They were doing everything to do with I was like, well, why I am are here? Because, you know, they they were doing everything that I could be doing. I think having a dedicated team to if you work in a specialty practice in oncology, you need someone in your practice dedicated to solely get in these medications in patience hands. You can add other duties to those. And before our practice started picking up and becoming busier and busier in the dispensary. I did have other duties and other forms in our practice, but we knew that someone need to be dedicated to getting these drugs into the patient's hands, because there's no sense in the follow up if they haven't even started the medicine. So I think that's the biggest thing, is making sure there's a team or one person starting out dedicated to ensuring the patient has, you know, their medicines. But within saying that, they also drug Reps. I know some people like to get off and say they don't help and Oh they're annoying me. My drug reps are fantastic. They are the reason I can have access to what I do. They keep me sampled up, they keep me voucher to look, I mean without having those samples and vouchers. But I first started, my doctors would come to me and say, for instance, Permacta for ITP hematology drug. They would come up and say this patient's platelets are in the tank, I need it right now, and I would say, I'm sorry, I'm going to have to get the insurance to prove that. I'm going to have to do this PROMACTA has a voucher for a free thirty day supply. I can order the MED have it in the next day. We do not personally keep these drugs in stock because, as everyone knows, they're twenty thousand, fourteen thousand just depends. So what we can have is next day. That's usually good enough for my doctors, my physicians. Now everyone's different. Some people's physicians may want to have things in stock. We keep certain things in stock, but a fourteenzero on our drug we're not just going to keep sitting on a shelf. So we use the vouchers to our advantage to have the meds of the next day. We also keep the samples first if the next day is not good enough. So I think knowing your drugs, knowing what Sam have, samples and Bouchers, that's really a big benefit to being able to help your patients asap. Then you have time to you have a couple days to work on the insurance portion. I appreciate you sharing that and you know you bring up another interesting point. What's the communication like between yourself and the positions you mentioned just now? The situation where they've got, you know, patients platelets that are at risk and you need something. Now, what's your kind of describe your your direct communication with physicians in your practice. I'm very blessed, first of all, like I have three positions here and we have fourteen midlevels. We do things a little bit differently. Every time we go to meetings, everyone raises their eyebrows as if to say wow, what you meet so many midlevels? Well, our physicians know the cases, but they go in the rooms with the MIDLEVELS, but they've hard reviewed the case. The midlevel also use their case and so therefore when they go in they they've already taught, both discussed and so they get filled in on the little things that may have happened in between the visits. The doctor knows the whole gets the whole picture, plus the things the patient might forget to tell the position when they walk in the room. You know, midlevel goes at first, comes get doc dot, goes back in as soon as they need if they're going to prescribe medication, they usually message me directly from the room. Now usually the midlevel does that because we try to get our positions in and out but to the next ring. So they'll message me from their room say hey, I'm want to do a new start on revelement and I'll say, okay, I'm going to need to see that patient and they'll say, okay, anything that you need for me right now, and I'm no, just send them by our window whenever you're done. And so, of course there's things I need the... Sung of phone to with certain drugs. So there's very open communication you have. If you want to have a dispensary in your practice, excuse me, or even proscribities type of medications, there has to be open communication between the physicians and the practitioner you work with, or it's not going to work. I have a very good relationship with every single one of them and they're fantastic. Well, I could certainly attest to that, knowing how hard you work and how connected you are to everybody there, and I know you're so vital to the overall function of that practice. Talk to me a little bit about your patient interactions and I know how passionate you are about patients. Tell me Your your general interaction with them and what that looks like, and you know some of your different aspects around the patient care, maybe be a counseling or logistics. You know anything that falls in line with that. So we have weird blessed that our window to our dispenseries a little two door windows, probably like a five foot wide Officelista, and I definitely couldn't be six of part fee apart. In the pandemic, however, we're right face to face with patients. So when they're in the lobby waiting, they have access to come ask US questions, they have access to come say hey. I just had a man five minutes ago say hey, the pharmacy hasn't called me about my palm list. Can you help me? And I was able to do that just for were jumping on this meeting. I mean, you know, I'm able to have they have access to us and I think that's important. And then because if a patient feels like, you know, of all been the doctor's offices where we feel like I've have an issue right now actually, where we feel like, okay, why is no one calling me back? Why is no one being attentive to this small issue in the grand scheme of things, but it's still an issue. So that's our big thing for our patients is we want them to know we have our own phone line in the dispensary. We have our personal, eat or work emails for them to have access to and just making sure they know call us. If this is what I mean to do. Patient, I say anything with oral medications, call me. Just just call me off the back now. Side effects or if you're having a reaction, of course call on one or call our nurses, but they know to call us if they need things. And then we also when patients are getting we have an infusion center, so in patients are getting treatment in that, we will bring their medications to them in their bay they're in. And then if a patient is a patient who's switching medications, maybe they've had progression or or maybe they're just having access issues. Sometimes the practitioner will messages and tell us, can you come talk to them? We're the doctors a little bit behind, so can you go ahead and come talk to them? You know. So it's just once again, it's really about communication between us all that makes it work. Yeah, yeah, I agree with that and that's I think that's great advice and that's a great way to do what you're doing. You mentioned be in social distance from Melissa, so tell me about how you've been intacted by Covid and you know, what did you change or what did you discover in during the pandemic that maybe you're like, Hey, this is great or Hey, well, let's hope this never happens again. So yeah, we would happen. We're fortunate again, like I can't say enough about the preface I work for. We were fortunate to have we were already kind of watching covid from a distance and I think all the places deep down were we'd already took some precautions before they made it. You know, I had the baby in April, so in March, Tho the weekend, the Black Friday in March, we like to call it, the when they kind of came down all of us, we already were prepared in the scenes. No one could fully prepare, I don't think, but we were already prepared for some changes to roll in. No, once again, we're privately affiliated. So we're very fortunate that we don't work for you know, we definitely follow standards, but we were able to make some calls on our own, you know. So we were able to go ahead and order...

...things and I'd already start up on breathing treatments and, you know, just different things that we knew we may need. So that was an impact. Just trying to brace for the unknown, which and our patients getting chemo and already have a no immune system. We did we had to do some radical things, like we have a treatment curve area. Now we have a but covid has a pecause in good ways to we now have a fashtrack for labs. We didn't have that before. Everybody was mucked all together. Now, if you're just needing lab work, and that did and you're not needing to stay for results, we just we have a fast track area now where patients come in and they can check in and they go get their labs in the leave and it takes to come just fifteen minutes, ten minutes. So covid, we try to find the good and Covid we didn't want a lot of people in our lobby. We have a rather large lobby, but we didn't want them all out there. So that makes perfect sense. So what what will you continue to do that you discovered still post covid? Like you mentioned the Fasttrack Lads, but I'm assuming you'll continue that or will that change? Or is there's anything else that will keep taking them we're going to even have a new area for it. We're going to we're going to have a new fashtrack area. WE'RE gonna we've actually had been able to hire some New People. We're going to have a new front. We're going to rearrange the front gust staff so there's always going to be like a concierge kind of person at the front to help patients, direct them. We're ready to go and check them in so that our front gust staff is not as overbogged when they're scheduling in our eyes CT's and all these kinds of things. It's definitely open our eyes. Is some things that you can even do better. So we try to look at covid and why do in a positive way, but look how this benefited US instead of look at all this junk having to do that. Maybe we don't even know if it's helping, you know, because there are some still with Covid, but we try to focus on that fact. And then, as far as in the dispensary, there are certain drugs and certain endbioudics that it's scary to think about not being able to get. So for our patients especially, who just sometimes seem to take it because they have no black count. So we are definitely keeping things in stock that before we kind of like, oh, we can disordered if we need it. Now we're a little bit more cautious to keep those and stuck, especially if it's a drug we know is going to affit their flat account. Right right, that's interesting. Well, you've got fantastic optimism coming out of covid it's always it's always interesting this. Sometimes trials and struggles end up open up new avenues and new things that you know, hopefully make you in the patients life easier. What type of resources or tools do you use in your daily activities? Do you have like a you know, a source that you tap industry wide, or like a dispensary publication or community group or anything that maybe makes your joblow easier or that you glean helpful hints from? Well, you guys help me a lot, you know that. But I also use the drug reps, like I said before, to I there were three new drugs that came out in the past week to a week from today backwards. So two we're for really red fusion drugs, and then I can't even think of what the other one was. Right now. But to lung drugs and another one I think was I'm from my long aml anyway, I immediately called the drug retch for those companies that have good I said, Hey, I know it just got to prove today, but I need, I need to go. I got patience. That occortory told me like I need. I told them I need, need to know more about this. So they go ahead and they let me know. So that's a really big helpful thing for me. And then smart ID works as who we use to help manage our dispensary. Have you ever heard of them? Not Familiar with them? Now you can feel free... expand on that. So we use QS one for our operating system, for our dispensary, which is where we feel the prescriptions through and everything like that process claims. So smart idea works is the side of QS one that like. If I have a claim I didn't get paid on, I called smartdi works. If I need to get a doctor's license put into my system, I cost my IDI works. If I anything, I just call it. They're fantastic. Can't speak enough about them. Small Company, but great rewards. They I mean I personally like they know my kids names there and they're that. It's that. It's awesome. They also, I talk too much, so that's how kids things. But they really care about doing US thrives. So they make sure we are up to date on everything we need to be. And you know, run an accord and till estate law and can't speak enough about them. And then, like clinically, we use up to date a lot. I use a pocrates a lot, those two for interaction checks and things like that, and in general, I mean my physicians were very lucky to work for. We work and then we have good contacts with, you know, baptists and things like that. So we're fortunate to have. You know, if we have questions, we have good resources. I guess the point. But I can't stress enough having a good APP like a pocrates or up to date too good bye, because just the knowledge that's on those apps are important. Well, that's great information. I hope some of our audience and listeners that's something maybe they've heard for the first time, so appreciate your sharing that. So what do you how are you working on any current projects or what's the future look like for your role? Just status quo or anything coming down the pipeline? Regarding the practice, or doesn't everyone want to say it depends on what happens with these insurance companies, obviously with the new gear coming. I don't choose to let it stress me out. The diur fees and they we could have a whole segment on that, but I chose not let it bothering. Instead I try to keep searching for ways to fight them. I don't I they are doing borderline. It really should be illegal. There's just loopholes. So instead, how about legislation closes those loopholes for them. But that's a another topic for another day. But we keep to ensure that we keep a really tight eye on our billing and everything like that. So we really try not to take two higher risks, because sometimes high risk is not higher turn in pharmacy. So we really and that's, like I said, that's where my specially pharmacies, helped me. But I we're going to expand our dispensory, hopefully some a little bit, make a bigger area and better access for patients, because some of our patients, you know, they can't stand and they can't necessarily stand outside my window. So we're going to have a different area for them. To be able to sit and discuss with us when we're going over new patient starts on new meths and then, I mean, as far as I'm called you as a whole, what's coming for the future. I hope good things. I mean, you know I hope. I always hope for good things. I said this week if we could create a cure for the allergy, cough and neuropathy, we'd never have to work again. You know, so right. But I mean I really like like the three drugs that have came out in the past week. I'm really hoping are going to help these people that are like family. Does you know? They're there's too many recurrences and there's two. You know, when you work in it, you're like, okay, I swear there's more answer this week. I where. But it's going to always be that way because that's why we're here. So I'm really excited to see these new drugs coming out and I won't access to a broader span of pharmacies because some people that get access really, in my opinion, shouldn't have it. So I would love to see better pharmacies get access to these drugs. I...

...advocate for that all the time. I'm like, why are you giving your business to this Parma see to push you? Let me be one that has great customer service, please. That's right. Well, that's been so informative today and I really appreciate your time. And if some of our listeners want to follow up with you, what would be a good way for them to contact you, you know, if they want to follow back, and some of you said today and gets more info from you. Oh, email, you know, the little bit. Email anytime. I don't want I think that the biggest things oncology is making sure that you we have to work as a team to get to the main goal, which is given the patient the best quality of life and care possible. So if anybody wants to reach out to me, they can email me at my work email, which is a anders so it's a a inders at Oncology coscom and anybody's welcome to reach out and if you have any questions and vice versa. They need to teach me something, I'm always open to learn of new things because it's definitely an ever evolving situation in oncology. Well, appreciate your sharing that information and I think you're right. Oncology so dynamic and it's changing every day and I think you know, like with this podcast and some of the communities, with everybody being able to connect and network. I think everybody, we all benefit from that, especially keeping the patient as our focus. So we will leave it at that and I want to thank again Ali Anders for joining us today at Krol, oncology specialist in Hickory, North Carolina, who is a dispensing manager. And again this is Scott Constro with bioplus specialty pharmacy, and thank you for listening to working in oncology podcast. Thank you, Ali so much. Have a great rest of the day. Thanks you to are you satisfied with your patients current speed to therapy or are you just settling? You can improve patient outcomes with bioplus specialty pharmacies and power of to the first ever two hour, two day to gather a promise. It's faster and easier for you and your patients to learn more. Visit bioplus Ur xcom. You've been listening to working in oncology. To ensure that you never miss an episode, subscribe to the show in your favorite podcast player. If you're listening in Apple Podcast, we've love for you to leave with rating of the show. Just have the number of stars you think the podcast deserves. Thank you so much for listening. Until next time.

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