At St. Louis-based Ascension, pharmacy is not treated as a separate business line. It is seen as the connective tissue of care — a way to keep patients healthy long after they have left the hospital.
“We’re a collection of hospitals,” Michael Wascovich, PharmD, Ascension’s vice president of medication management and chief pharmacy officer, told Becker’s. “But we do a lot of work outside the four walls of the hospital.”
That work now extends deep into the ambulatory landscape. Across its multistate network, Ascension owns and operates nearly 50 community pharmacies, a national specialty pharmacy, a home delivery mail-order service and several Programs of All-Inclusive Care for the Elderly. The pharmacies are not open to the public; they serve Ascension’s own patients, providing continuity of care once a hospital stay ends.
For Dr. Wascovich, ambulatory care is less about procedures than prescriptions. Fewer than one-third of Ascension’s patients undergo surgery, he said, which makes the cost and accessibility of medications “a massive issue.” With the closure of chain drugstores leaving “pharmacy deserts” across the country, Ascension sees its expanding outpatient network as a way to fill that void.
“We don’t want access and affordability to be a gap for anybody,” he said. “We’re discharging them just for them to find out, ‘I can’t afford this medicine, I’m going to be right back in the emergency room.’”
The goal of addressing that gap is both practical and strategic.
“We spend the most money in certainly any first world country on healthcare, and a big part of that rising premium healthcare dollar is medications,” Dr. Wascovich said. “So if we can give someone their medicine and make sure that they can afford it or take it, and remove that barrier, that has to be part of our investment.”
To make those investments count, Ascension is using its data to pinpoint where gaps exist. Prescription records show who is getting medications filled, and who is not.
“We have fantastic data looking into our EHR to see who’s on that periphery, who’s getting a prescription written but maybe not filled,” Dr. Wascovich said. “Even if one of our brick-and-mortar pharmacies isn’t conveniently located in someone’s community, we can still land their medicine right on their front porch — meet them where they’re at.”
To gauge whether those efforts are working, Ascension applies the same rigor to pharmacy as it does to clinical operations. The system measures satisfaction through Net Promoter Scores, which consistently rank in the 90s, and monitors medication adherence using a metric known as proportion of days covered. About 15% of emergency visits and readmissions are tied to medication issues, Dr. Wascovich said — the kind of avoidable cost the program is designed to prevent.
As Ascension’s ambulatory footprint has grown, so has its pharmacy workforce. The system now runs nearly 100 residency programs that train pharmacists to practice across acute, post-acute and outpatient settings. These pharmacists, he said, “are embedded in our clinics alongside the physician and the nurse. We want patients to be on the right medicine at the right time, in the right site of care.”
Pharmacy technicians — about 1,600 total — remain the foundation of the system’s operations. New AI tools are helping them automate routine tasks, from paperwork to data entry, freeing time for more clinical work.
“They don’t replace technicians,” Dr. Wascovich said. “They augment them, and can make them anywhere from 25% to 40% more proficient.”
Technology has also reshaped logistics behind the scenes. Prior authorizations and financial assistance tasks that once tied up pharmacists on long calls with insurers are now automated. Data tools track drug purchasing across Ascension’s footprint to avoid shortages and reduce waste.
“We spend a lot of money on drugs,” he said. “How do we make sure we’re buying the right drugs on the right contract? We don’t want to have a shortage where our patients and our providers have to deal with that.”
In the next few years, he expects ambulatory pharmacy to keep expanding, but with intention.
“We’re going to continue to invest in our people, in our processes, in our capital equipment,” he said. “We don’t want to build for building’s sake; we’re going to have to go where it makes some sense.”
Rather than add retail space, Ascension is leaning on home delivery and digital access. The system’s mail-order pharmacy, paired with apps, reminders and wearables, lets patients receive and manage prescriptions wherever they are.
“That home delivery operation allows us to expand without having to build a lot of brick and mortar,” Dr. Wascovich said. “As patients have gotten more comfortable ordering things through e-commerce and online, including healthcare, we can now marry those investments in tech with that shipping capability.”
