Donald Mashni, PharmD, right, with David L. Reich, MD, center, and José Almonte, Director, Specialty Pharmacy Call Center.

A new option is now available for Mount Sinai Health System patients and employees who have rare or chronic disorders that require complex medications such as immunotherapy or chemotherapy—the Mount Sinai Specialty Pharmacy. The facility, which opened in June at The Mount Sinai Hospital, helps patients seek insurance approval and financial assistance, and relieves the administrative burden of physicians, with the ultimate goal of improving patient outcomes.

“The Mount Sinai Specialty Pharmacy will offer patient-focused, convenient, and affordable services for all our patients,” says Donald Mashni, PharmD, Director, Specialty and Outpatient Pharmacy, Mount Sinai Health System. Specialty pharmacies dispense complex medications that require special storage and handling and ongoing clinical support and monitoring by specially trained pharmacists.

When patients and doctors present specialty prescriptions to the Mount Sinai Specialty Pharmacy, the pharmacy staff can assume the important tasks of securing insurance approval, financial assistance, and clinical counseling. Pharmacy staff also coordinate delivery to the patient’s home or to the physician’s office. “Our facility will tie everything together,” Mr. Mashni says. “The goal is to keep all patient care inhouse, from diagnosis through post-treatment follow-up. This approach provides thorough and immediate communication among pharmacists and specialists. It also improves the efficiency and accuracy of the medications.”

For example, one commonly prescribed specialty drug is adalimumab, or Humira, an advanced biologic medication for severe Crohn’s disease and rheumatoid arthritis. Patients inject a pre-filled syringe every other week. The drug must be refrigerated, and each syringe must be used in full and injected in the thigh or stomach, in a different spot each time. The patient should not skip a dose or stop taking the medication without consulting a physician or pharmacist. “Adherence to the treatment schedule is critically important,” Mr. Mashni says. “It maximizes the benefit patients get from the medication and improves outcomes.”

Specialty medications once were a niche market. But advances in drug research mean they are available for many more conditions. The U.S. Food and Drug Administration approved 39 new specialty medications in 2018, according to Specialty Pharmacy Times, and because they can be so costly, specialty drugs are expected to account for almost 50 percent of drug spending by 2020, although they represent only about 2 percent of the total prescriptions filled.

The Mount Sinai Specialty Pharmacy is launching services in therapeutic categories that include HIV, hepatitis C, inflammatory bowel disease, rheumatology, dermatology, and oncology. It shares space with the Mount Sinai employee pharmacy in the Annenberg Building and functions like a traditional specialty pharmacy but with the advantage of full integration with Mount Sinai’s hospitals and physicians. The Health System also operates two other specialty pharmacies, which are part of the Institute for Advanced Medicine and specialize in treating patients with HIV. They are the West Village Pharmacy, at the Center for Transgender Medicine and Surgery, and the St. Luke’s-Roosevelt Outpatient Pharmacy in the Samuels Clinic at Mount Sinai West.

A new Call Center, adjacent to the Mount Sinai Specialty Pharmacy at The Mount Sinai Hospital, is centralizing all of the Health System’s specialty pharmacy services and fulfillment, with Call Center staff coordinating prior authorization, financial assistance, and delivery of medications. These services are essential as the Mount Sinai Specialty Pharmacy is seeking accreditation from URAC, the gold-standard accrediting body for specialty pharmacies. URAC accreditation will allow the pharmacy to gain access to more limited-distribution drugs and get contracts with more insurance plans.

“The Specialty Pharmacy is enabling Mount Sinai to provide seamless service for patients with complex and chronic illnesses, from diagnosis through treatment and long-term aftercare,” says David L. Reich, MD, President and Chief Operating Officer of The Mount Sinai Hospital, and President of Mount Sinai Queens.

Faculty and staff of the Department of Medicine (Cardiology) took part in International Yoga Day. Front row, from right: Annapoorna S. Kini, MD; Lori B. Croft, MD, Associate Professor; and Joseph M. Sweeny, MD, Assistant Professor.

Mount Sinai Heart faculty and staff recently participated in International Yoga Day at Guggenheim Pavilion, with multiple sessions starting at 7:30 am. However, the enthusiasm for the practice goes well beyond a one-day event. The organizer, Annapoorna S. Kini, MD, Director of the Cardiac Catheterization Laboratory at The Mount Sinai Hospital, and the Zena and Michael A. Wiener Professor of Medicine, Icahn School of Medicine at Mount Sinai, practices yoga herself and recently published a list of recommended yoga and meditation techniques in the CRT Times, including a 10-minute sequence specifically for physicians in the Cardiac Catheterization Laboratory.

Dr. Kini says, “At Mount Sinai, we strongly advocate yoga and meditation to counter musculoskeletal discomfort, to relieve stress, and to maintain focus and concentration.”

At the start of a meeting, give participants a few moments to reflect quietly on the subject at hand, then call on each person for their thoughts. When people do speak, “listen to understand, and not to reply.”

These were some of the specific and achievable strategies discussed in the inaugural Health Care Inclusion Summit, which was in June at the Corporate Services Center and sponsored by leadership in Service Excellence and Patient Experience.

The keynote speaker of the event was Mary-Frances Winters, founder and Chief Executive Officer of the Winters Group, a consulting firm that has been working with top leaders of the Mount Sinai Health System on inclusion strategies for more than a year. “It is important to recognize that inclusion is a developmental process,” Ms. Winters said. “We must address changes in attitudes one stage at a time.”

Leona Hess, PhD, left, and Ann-Gel Palermo, DrPH, MPH, led a discussion on the mindsets of inclusive change makers.

Ms. Winters used an interactive tool to ask the 150 attendees how they defined themselves. The anonymous answers appeared on a screen at the front of the room:  A daughter, a Buddhist, an African American mom, a gay man, a husband, a millennial, a person with ADHD. These “identity markers”—some visible and some not visible—influence how each person sees and reacts to the world, Ms. Winters said, and understanding this is the beginning of understanding and accepting others.

Panelists during the half-day summit were David Muller, MD, FACP, Dean for Medical Education, Icahn School of Medicine at Mount Sinai; Chaplain Rocky Walker, MDiv, Center for Spirituality and Health, Mount Sinai Health System; and Erica Rubinstein, LCSW, CPXP, Vice President, Service Excellence and Patient Experience, Mount Sinai Health System. Maxine Legall, MBA, MSW, Assistant Director, Patient Experience, Mount Sinai St. Luke’s, served as the moderator.

The panelists said that both staff and patients were benefiting from inclusion efforts—which have the overarching goal of making every person feel heard, understood, and respected. Among other measures, the Health System has revamped a panel that addresses patient complaints and created the Strategic Leadership Collaborative to improve equity in medical education. In addition, ODI has expanded its portfolio of education and training on unconscious bias, LGBTQ health care and workplace equity, and cultural and disability awareness.

Leona Hess, PhD, Director of Strategy and Equity Education Programs for Medical Education led a discussion on the mindsets of the inclusive change-maker with Ann-Gel Palermo, DrPH, MPH, and Chief Program Officer. Attendees were advised to focus on how their mindset as a leader was created and how it informs their interactions with staff and patients. “Understanding your own personal and social identity is critical for the development of the skills and behaviors needed to understand, work with, and integrate the perspectives of staff and patients with a diversity of identities.” Dr. Hess said.

Planning is already underway for a summit next year, said Pamela Y. Abner, MPA, CPXP, Vice President and Chief Administrative Officer. “The response has been overwhelmingly positive,” she said after the event.  “We see an opportunity to make inclusion and equity even more integral to patient care, medical education, and every other facet of the Health System.”

Takeaway thoughts

“You have to stay open to different perspectives and different mindsets. Be open to other voices that might challenge you.”

Erica Rubinstein, LCSW, CPXP

“I have learned that you have to have humility—professionally and personally. Just take a step back and listen to people.”

David Muller, MD, FACP