Pooja Babbrah’s Legacy of Supporting Pharmacy Interoperability

Melanie Marcus: Today we're talking about the role of the pharmacy and the expanding care team. And we're digging into the important ability for all healthcare providers to connect and exchange data to support great patient care. So we're really talking about interoperability and, to be specific, pharmacy interoperability. What does the future hold for pharmacy? How will pharmacy look once we've brought interoperability to life through technology and standards-based innovation?

Our guest today, my friend and colleague Pooja Babbrah, is well versed on this subject. She was, of course, supposed to be a doctor when she grew up. That's what her parents wanted her to be. That's also what Pooja and her childhood friend planned to do. As it turned out, Pooja's friend did become a doctor. But Pooja took a different path. And those of us in the technology world, like me, are very glad that she did.

Pooja, I am so happy to have you on the show today.

Pooja Babbrah: Thank you so much for having me on this podcast, Melanie. I'm really looking forward to this conversation.

Marcus: You've worked at the intersection of healthcare, technology, policy and standards for many years now, including McKesson, where I was, too. And now, you've got two important portfolios and projects that you're focusing on with pharmacy interoperability and technology and standards needed to make all of that a reality. Before we go to that, I'd love to just get a little background on you.

Babbrah: I grew up in the state of Washington’s capital, Olympia. I went to the University of Washington to do my undergrad and then ended up doing my MBA at Arizona State, which is how I ended up in Phoenix.

Marcus: So, at what point did you become interested in healthcare?

Babbrah: Like any good Indian kid, my plan was to be a doctor. When I graduated from the University of Washington, I decided I needed to get out of Seattle, so I moved to Washington, D.C. I worked for the National Academy of Sciences as a database manager. And after about two years, I realized that it's great work, but sitting in front of a computer all day and not interacting with people was kind of killing my soul to be honest with you. I took the opportunity to go back and do grad school at ASU. I wasn't planning on coming down to Arizona, growing up in Washington. And literally the day after I landed, I ended up meeting my now husband and so have been in Arizona for, gosh, going on 30 years now.

I ended up going to a couple of startups, more on the general healthcare technology side. A lot of the startups I went to were actually associated with larger companies. A lot of these companies would have a chief medical officer that would have a great idea. So the company would be give them some seed money to do a startup. I kind of did a couple stints there. I think I went to three different startups that were associated with larger companies. You know, story behind that is unfortunately, when there's a downturn, the first thing to go were these kinds of pet projects. So after going through about three layoffs at these startups, I ended up honing in on more of the pharmacy side. So I ended up at DrFirst, which is an e-prescribing company. I was hired as a product manager there and ended up launching the EPCS, electronic prescribing for controlled substances. We used to literally have to get on the phone and call pharmacies to say, “Yes, you are OK. You can actually dispense this controlled substance prescription.”

But it was when I launched that product that I really recognized that pharmacy plays such a big role in patient outcomes. And the story behind that is someone I used to work with at another company had a child who was on a controlled substance medication. And after launching EPCS into the market, I met with him for lunch and I was describing what we had just done. You know, we launched EPCS. And he looked at me and he said, “Pooja, you don't understand what a difference that makes for my family.” And the story that he shared was, you know, they were very careful about making sure that their child's medications were filled for the weekend or for a vacation. And once in a while they would run into a problem that, come Friday night, they didn't have enough of the medication to get their child through the weekend. And he said, “Now, as opposed to running into issues where we don't have the meds and have to start over again—I can call my doctor and they can actually send this prescription electronically to the pharmacy.” And he's like, “This is going to make such a huge difference in our lives.” It was at that point that I really recognized that pharmacies and pharmacists and everything we're doing around technology makes such a difference in patient outcomes. And that's really what started me on this path. So, I worked at DrFirst for the next couple of years and then got into the consulting side, which is where I've been doing a lot of the industry work and things that I'm doing now.

Marcus: I understand your family has a foundation that's focused on supporting first generation college students, and I think you're the CEO now of that foundation, right?

Babbrah: So, I do healthcare technology. My husband does education technology. And we both realize we've been really blessed for where we are in our career and what we've been able to do in the industry. We both come from families from India. My dad actually came over to the US in the ‘50s. He was one of the very first international students at University of Washington. So, if you go to the University of Washington, in a museum is his story of how he came to the US. And then my husband's father left India, went to Kuwait, and then sent his kids to the US to study. So, we both have this kind of unique background of our dads back in the ‘50s forging this path forward to help us get where we're at.

So, we sat down one day and we said, you know, we've made a difference in our industries, but what are we going to do to leave a family legacy? And, we have two daughters who we want to make sure are also well positioned. But it was really that recognition that without our dads making that leap and coming over here we would never be in the positions we are today. And so we decided to start a family foundation. We are focused on giving scholarships to first generation students, primarily here in Arizona. And, the idea is not to just give the scholarship money, but to really mentor those students as well and to build that relationship, which is why we're really focused on students in Arizona. We feel like with our network and our ability to hopefully mentor these kids, it will make a difference in their lives as well. So, it's really in the name of both of our fathers and hopefully be able to make a difference.

Marcus: What an amazing story.

I want to talk about what I think is the trifecta of your current career, where you are the Practice Lead for Pharmacy and PBM Services at Point-of-Care Partners. That's the consulting that you are talking about. You are a member of the HITAC [Health Information Technology Advisory Committee] Pharmacy Interoperability and Emerging Therapeutics Task Force at the Office of the National Coordinator for Health IT, or ONC—that's the second part of the trifecta. And then third, you're a board member and were the recent former chair of the National Council for Prescription Drug Programs, or NCPDP. So what is the connection there of those three career milestones?

Babbrah: We do a lot of work with new standards coming to the market and determining how newly available data can be utilized in the workflow. And so, to inform the work that we're doing in Point-of-Care Partners, we get involved with the standards development organizations as well as stay on top of policy work that's happening. I became a member of NCPDP, the National Council of Prescription Drug Programs, which is the standards organization for the pharmacy industry. So I got involved about ten years ago, really, more involved than I used to be. I used to attend the annual conferences and things like that. But when I joined Point-of-Care Partners about ten years ago, that’s really when I started to get involved in the task groups and the work groups that were actually creating the standards. And so, you know, there was a lot of work going on with biosimilars and with specialty medications.

Through my work at NCPDP, I was involved with a stakeholder action group around specialty meds. We were trying to figure out what was the pain point around specialty. And as I started to continue at NCPDP and Point-of-Care Partners, I ended up joining the strategic planning committee at NCPDP, which is where we do a lot of the strategy work of what standards development organizations can do to inform what's happening in industry. And that's where a lot of my work between NCPDP and Point-of-Care Partners started to really come together. So things like moving value-based care forward, pharmacogenomics and pharmacy interoperability, all that's being talked about both at the standards development organization and the work that I do at Point-of-Care Partners.

Marcus: Talk about why standards are important. Like what role they play in the ecosystem and why they're important.

Babbrah: There are two things: prior authorization and real-time benefit check. Those are two things that a lot of people can relate to. Prior authorization, a lot of times the doctor will prescribe a patient a medication and they need to get prior authorization to get it approved from the insurance company. So that is a standard that has been developed by NCPDP that says we can, as opposed to having information being faxed back and forth between the doctor's office and the pharmacy. So, you know, “Let's kill the fax,” right? Let's be able to send information electronically. We have it today with a standard that, you go to the doctor, they prescribe you a medication. You used to be handed a paper prescription to take to the pharmacy. That now goes electronically. That is done because we have a standard in place that says, we need to send certain information in a certain format to the pharmacy so they can receive that electronically. Prior authorization is the same thing. So there is data being sent back and forth between the provider office, the pharmacy, and the insurance company trying to get this approval electronically. And it's being done, right? So with standards, I would say that they lay the track and move the data electronically back and forth between stakeholders. So we're not having to make phone calls, do faxes and delay people getting their medications.

Marcus: I always think about the VHS to DVD, you know, that whole progression. Well, they had to decide that they were going to do a standard DVD or a standard VHS way back when, right? So that the machines all worked with the movies they were putting out.

Babbrah: Exactly. That's a great analogy.

Marcus: What challenges do you see now in your perspective from these three roles that you're playing between Point-of-Care Partners, consulting HITAC and NCPDP?

Babbrah: Just a little background on the HITAC task force and how it started. So, ONC, the Office of the National Coordinator, is the group that is really in charge of the data standards. You know, figuring out which electronic data needs to be shared electronically. They also do certification of EHRs. So their focus has been on the standards and the information flowing from the provider—the clinical data in the EHR as well as the health plan. So when we think about interoperability, a lot of what we focus on is that data sharing between the provider, the insurance plan and the patient. And pharmacy has had these data standards in place for the 40 years now I think that NCPDP has been around. So, you know, we can send prescriptions electronically. We can have a pharmacy file a claim or submit a claim to get paid on the medication they dispense. But what we haven't been talking about is how do you bring the pharmacist into the care team? How do you make sure that they are able to support patients as well? I think there was a real recognition during the pandemic of the role that pharmacists can play in supporting public health crises and in supporting patient care.

You know, I do this when I get on panels. I always have people raise their hands when asked who all got their vaccinations at a pharmacy, right? And almost every single hand goes up. And it wasn't just that, but pharmacists were doing Test to Treat, right? You could get a COVID test and you could get a prescription for Paxlovid. But what people don't always recognize is a lot of times there are things that pharmacists can do, but they don't necessarily have the information to be able to do some of the clinical work. So HITAC is a committee that informs ONC of the work that they should be focused on. And, they essentially have task groups that are set up to make recommendations to the Office of National Coordinator on what they should be focused on in future years. The pharmacy task force got started because there was, after the pandemic, this recognition that we need to figure out how to make sure we support pharmacists in continuing what they were able to do during the pandemic but also to support them as more of a care team. So we went through—I think it was six months—we ended up with 32 recommendations to ONC of things that they need to be thinking about. But even more broadly, what HHS, the Health and Human Services, needs to be thinking about. Reimbursement, pulling in CDC’s tracking of immunizations, tracking things that maybe the pharmacists are seeing with patients that are coming in the door. You asked about what are the challenges and the barriers. I would say it is really getting people to recognize that pharmacists should be part of a care team. They need to be involved. And I think there was, like I said, this recognition that pharmacists played a big role in the public health crisis.

We're starting to get in place now this national network of organizations that will be able to share information nationwide. Why can't we bring pharmacists into this? You know, there's networks out there, like Carequality, that are already doing this today. And what I think people don't recognize is from a policy perspective, in some states pharmacists are recognized as providers so they can actually join a national network. And in some states they're not. And so, you know, we're not saying that pharmacists are going to take away provider jobs. But they can augment, right? We talk about staff shortages. We talk about provider shortages. I know you guys have a report out there that targets this and says there's a huge shortage out there. “What can pharmacists do to augment and to support rural areas” is a great example. And so I think what people that are talking about this today don't recognize is that, yes, pharmacists can join some of the national networks. But because of their status, they're not necessarily able to do that in every state. And so I think from a policy perspective, the discussion that needs to happen is: How do we make sure that pharmacies can access data? They don't need to access the entire patient record, because I know there's this concern about what information are they seeing. But give them the information they need in order to support that patient care. So I think from a policy perspective that's probably number one.

Marcus: Surescripts is a candidate QHIN as we speak. There's a technology component of this which is, as we sit here and think about bringing the question information into the pharmacy, assuming that they're allowed in their state, where does it go? Are the pharmacy technologies ready to accept it?

Babbrah: Yeah, and that was a lot of what we talked about, the ONC HITAC Task Force. ONC currently does certification today on EHRs. Pharmacy systems have not been part of that certification. So is that going to be a key component? You know, in my work through Point-of-Care Partners we work with a lot of the QHINs. And the conversations we've been having is, if the pharmacist is on a non-certified system, how do we get that certified? And again, you don't have to certify maybe the entire pharmacy management system, but the pieces where you're sharing clinical data. So I think it's a matter of getting the information to the pharmacist. But then also how do they share information back? And I think it's got to be this two-way communication. We talk a lot at Point-of-Care Partners about swiveling our seats. And what we mean by that is, you're working in your system and then all of a sudden you have to switch over and swivel your seat to a portal. And we know there's portals out there and we know that's going to happen. But how do we make it easier to get that information to the pharmacist within their workflow? And that is so important.

Marcus: To speak of primary care: You can have your technology set up, but if you're ultimately not paid to do the work, then it doesn't really make economic sense. So where do you see that coming in?

Babbrah: Yeah. To me, that's the biggest issue we have. And honestly, I am stumped on how to solve this one. Through my work at NCPDP, because I'm on the board, I attend some of their advocacy tours. They go up to Capitol Hill, right? And they educate lawmakers on standards and things like that. We did one about two months ago. And I finally just started asking the folks that help NCPDP, “How do we get this issue of pharmacist reimbursement in front of people? I know there's been kind of a lot of work.” And, one thing that they gave me some insights on, and I thought this was interesting, is they said, if we could somehow get to the White House. And have the White House or the administrative branch do some kind of executive order, is that a way? Because, you know, I think we've tried through CMS, we've tried other ways. I will say there are a lot of health plans, or payers, who are reimbursing pharmacists but there are only pockets of it. We haven't been able to do this nationwide. So, shout out to your listeners if anyone knows of anyone at the White House. To me, if you could get an executive order or tag on to some other executive order. I think that's what gets people to move to start to do that regulation. Like I said, I'm at a little bit of a loss, but that's the latest thinking in my head. So, who knows, maybe one day.

Marcus: What excites you most about this work right now?

Babbrah: As we talked about, I've been in this industry for a long time. I feel really hopeful. I feel like there’s a lot of people that are now saying we recognize what pharmacists can do. We know that there's new innovation coming in digital therapeutics, pharmacogenomics. A lot of what we talk about is the ability for pharmacists to really understand that you're on these five meds, but two out of the five are not going to work because you've got this gene that's blocking it from working. I mean, that is just such a fascinating opportunity, right? A fascinating science behind it. But just a huge opportunity for pharmacists to improve outcomes. And I'm excited about seeing all of this kind of new stuff talked about. But then also really the focus that pharmacy interoperability is getting. And I think there's a real recognition and real willingness for industry participants to start to talk about this and figure out how we can solve this.

Marcus: In terms of another innovation, where does AI fit in all of this?

Babbrah: Interestingly enough, I just this morning got off a call with a group in California and they are looking at psychotropic drugs in children. So, these are drugs that are being prescribed, in some cases for children. The problem is—we talked about the standards and having codified data—the information on these drugs is actually getting put into the patient note versus being able to be prescribed electronically. So, AI through NLM [the National Library of Medicine] is combing through these records to find out when were these drugs prescribed and what was the actual outcome for the patient in order to support whether or not these drugs should be used. What were the outcomes? And there's so many. I know they're looking to get some funding to make that project. But I think another example is when treating a patient who’s on 6 or 7 meds, we use AI to look at that and say, “Are these the right meds for this diagnosis that this patient has?” There's so much that we can be doing for simple things. Prior authorization is another one where we could really be utilizing AI in order to reduce burden on the provider, on the pharmacist. So, a lot of applications. I think there's a lot of discussion now. I think there's a lot of opportunity. It’s just kind of, where do you start and where do you start bringing that in?

Marcus: Pooja, in this season we're asking our guests how they think we can best help healthcare heal itself. And by that, I mean we at Surescripts believe that healthcare is a big industry with incredible expertise. And that industry has the knowledge and tools we need to fix some of our problems. The first thing is to identify where we have problems. So first, where is healthcare hurting? What's your diagnosis for what's wrong with it?

Babbrah: I think there's two things wrong with healthcare. One is, I don't think we've leveraged pharmacists enough. We talked about that in this podcast. You know, we really need to recognize that pharmacists can do so much more than just putting pills in a bottle. We need to utilize them at the top of their license. And we need to reimburse them for that. I think the other thing that's wrong with healthcare to me, is for so long we've had data in silos. And now because of regulation that's in place, the data is more free. But how do we make sure we leverage that data to improve patient care? To me, this includes sharing this data outside of just the provider. Bring the pharmacist in and other people who can support this patient care. So, it's making sure that now that we've got all this data available to us, how do we utilize it in a way that's going to improve patient care? So, those to me are the two things that I say are wrong in healthcare today.

Marcus: How would you heal healthcare?

Babbrah: I think I would do two things. Or I'd write two prescriptions, I guess is a good way to say it. One for expanding the role of pharmacists in the care team and actually reimbursing them for this. And second, I would say getting pharmacists the data they need to support patient care, right? That should be the two prescriptions that I would write in order to help us move forward on these two challenges.

Marcus: Well, that's great. Thank you.

Babbrah: Yeah. Thank you, Melanie. And I know you and I chat a lot about this. So it's great to see other kinds of champions for all of this work in the industry. Like I said, I'm really hopeful and really excited about this next decade in pharmacy. And what we can do and what we can help pharmacists do.

Marcus: Great, we're looking forward to it.