New York City-based Mount Sinai Health System’s outpatient pharmacy is undergoing a major digital transformation, one that Senior Director of Outpatient Pharmacy Mark Makhinson, PharmD, said is redefining efficiency, patient experience and staff engagement.
“We’re really moving toward a digital-first strategy,” Dr. Makhinson said on an episode of the Becker’s Pharmacy Leadership Podcast. “When patients go online, whether it’s Amazon or CVS or to any other retailer, they expect a digital experience that is easy and streamlined and meets their needs, and that’s where we’re trying to go.”
Mount Sinai’s specialty pharmacy, launched in 2020, operates seven locations across New York City, three of which hold specialty accreditation. The program integrates with about 90% of the system’s outpatient practices, aiming to keep patients within the continuum of care — which in turn improves adherence, outcomes and readmission rates, Dr. Makhinson said.
Until recently, the pharmacy relied on legacy systems that required patients to call in for refills or updates. The team is now developing a digital front door that allows patients to refill prescriptions, schedule deliveries and access clinical information through MyChart. The goal, Dr. Makhinson explained, is to connect every part of the patient experience, from prescriptions and discharge summaries to side-effect information, into one seamless digital platform.
Behind the scenes, the team is also leveraging automation and AI to streamline routine administrative tasks — consolidating workflows like benefits investigation, prior authorization, financial assistance and delivery coordination into one integrated system.
“At the end of the day, we really want to focus on our employees, whether it’s our technicians or pharmacists, working at the top of their license and being able to have those conversations with patients that are value-add,” he said. “We want our people to be a resource for our patients, somewhere they can go to for trusted information, versus individuals doing repetitive tasks day in and day out.”
One of the biggest advances has been the automation of prior authorizations. An AI-enabled tool extracts relevant information, such as diagnosis codes and past therapies, directly from the medical record and automatically populates payer forms.
“Previously, this was a fully manual process,” Dr. Makhinson said. “A liaison had to go into the record, pull diagnosis codes and previous therapies, and answer the multitude of questions that come from payers, and every payer is different. Now the software pulls the appropriate form and populates it with answers and references, so the liaison just needs to verify and submit.”
The change has cut completion time by at least 50%, with the team targeting a 75% to 80% reduction. “It gets patients to therapy sooner, with less interference,” Dr. Makhinson said. “And it frees up staff to do more patient-facing work.”
Dr. Makhinson said his team defines success by two measures: patient experience and operational efficiency. “If we can repurpose staff to do more beneficial work for patients, that’s success,” he said. For example, reducing the number of liaisons assigned to prior authorizations allows others to focus on financial navigation or adherence outreach — efforts that can improve access and outcomes.
But implementing new technology in a large academic health system hasn’t come without hurdles.
“Anyone that’s worked in a health system or a large matrix organization knows the word ‘governance,’” he said. “It takes a lot of time, effort and persistence to get anything live, and when you start talking about AI, governance is being built as we speak.”
He said close collaboration with IT, legal and vendor partners has been critical to getting projects across the finish line. “A lot of times, vendors come to us with new ideas that aren’t fully baked,” he added. “We know that in order to be successful, we need something that’s ready to be deployed and has a proven use case.”
The pharmacy’s digital upgrades are also improving transparency and affordability for patients. New online features link patients to manufacturer discount cards, charitable foundations and other assistance programs — all supported by liaisons who guide them through the process.
“Medications are not getting any cheaper,” Dr. Makhinson said. “It’s so important to have that ability to connect patients to funding options so they can continue on therapy.”
Looking ahead, he envisions health systems becoming patients’ primary digital health resource.
“There’s a lot of untrustworthy information out there,” he said. “Health systems can be that single, trusted source, a place where patients can find everything from condition education to drug-interaction guidance. That’s where I see the future of digital specialty pharmacy.”
