UnityPoint Health–Trinity, a four-hospital system serving the Quad Cities of Iowa and Illinois, was worried about a steep increase in its pharmacy costs until an aggressive intervention changed its course.

By implementing 58 medication utilization initiatives in 2012, the system saved $1.9 million — nearly 14 percent of its pharmacy budget. More cost-cutting moves have been introduced this year, racking up another $1.4 million in savings in the first two quarters.

The keys to success: appropriate benchmarking, a multidisciplinary team, physician support and relentless focus.

"This is not something you enter into on a part-time basis," says Cinda Bates, the medication utilization-management specialist in charge of the effort. "You definitely have to have a plan, and it has to be monitored continually."

The financial wins are coming from many directions. Oncologists agreed to replace an expensive chemotherapy drug with a clinically equivalent alternative that costs 90 percent less — and saves the health system more than $100,000 a year. A new infusion process for an antibiotic reduces the dosage, which saves $165,000 a year while improving patient outcomes. And a protocol that avoids wasting chemotherapy agents saved more than $185,000 in the first six months of this year.

UnityPoint Health–Trinity is part of a large, multistate system in the Midwest, but to start its pharmacy utilization assessment, it needed benchmarking data from outside the system. Consultants gathered data that allowed a comparison of pharmacy spending with hospitals that match each of the four UnityPoint Health–Trinity hospitals in size and patient acuity.

"In those areas where we were above the benchmark, we took a deeper dive to evaluate the variance," Bates says. "Then we worked with physician groups to determine what we could do to reduce that spend."

Bates' team includes two pharmacists and representatives from the revenue-cycle and finance departments, which track results of various initiatives and report monthly so the team can monitor its progress.

Equally important is that the system's chief medical officer Paul McLoone, M.D., and associate chief medical officer Ahmed Okba, M.D., have worked closely with Bates to win cooperation from physician groups. For each major initiative, the team collaborates with physician champions who are most likely to influence their colleagues and move initiatives forward.

"We approach the physicians as a team to present the information and have some back-and-forth discussions so that we can hear what their practice concerns are," she says. "Then we can partner with them to reach our financial and clinical goals."