Lurie Children’s and Children’s National are rewriting the pediatric growth playbook – with specialty pharmacy
Key Takeaways
- Pediatric hospitals are using specialty pharmacy as a strategic growth and sustainability tool. Children’s National Hospital and Lurie Children’s Hospital are investing in hospital-owned specialty pharmacy programs to diversify revenue, offset reimbursement pressures, and support continued investment in complex pediatric care services.
- Expanding outpatient and community-based services helps pediatric hospitals meet families where they are. Leaders highlighted the importance of accessible, patient-centered care through outpatient clinics, infusion and site-of-care programs, school-based services, travel clinics, and other community-focused initiatives designed to improve convenience and care coordination.
- Innovation is becoming essential as pediatric hospitals face Medicaid and regulatory uncertainty. Panelists emphasized that political uncertainty, Medicaid reimbursement pressure, Medicare redesign, and evolving regulations are driving pediatric health systems to pursue new business models, specialty pharmacy innovation, and advanced therapies such as cell and gene treatments to strengthen long-term resilience.
Pediatric hospitals are taking aim at ways to protect, defend and strengthen their market share with focus in areas such as investment in strategic innovation, expanding specialized services, strengthening partnerships and enhancing patient-centered, family-focused care that is accessible and convenient.
In a live webinar this month with Becker’s Hospital Review, I moderated a panel of pharmacy leaders and industry experts including Eric Balmir, MS, PharmD, CIM, vice president of clinical ancillary services and chief pharmacy officer at Children's National Hospital; Rich Lehmuth, MHA, senior vice president and chief strategy officer at Lurie Children’s Hospital; and Nicole Faucher, MA, president of Clearway Health.
Facing political uncertainty and pressure on Medicaid reimbursement, pediatric hospitals are rethinking their strategies. In the webinar, we discussed how Lurie Children’s Hospital and Children’s National Hospital are expanding outpatient care, building hospital-owned specialty pharmacy programs and meeting community needs in unexpected ways, from travel clinics to school-based care. Specialty pharmacy has emerged as a key growth opportunity. With Clearway Health’s support, these top pediatric hospitals identified missed revenue and built a scalable, sustainable program.
A few highlights:
“I think it's important that pediatric hospitals take strategic opportunities to broaden their business opportunities,” said Balmir. “We can't just do what we were doing in the past. We need to strive to be different, new and innovative.”
“Pediatric hospitals tend to be at the forefront of care complexity and often find themselves working through that challenge with different or lesser tools than large, adult-focused systems,” said Faucher. “Pediatric systems are trying to meet patients where they are through services in outpatient clinics, infusion or site of care, school-based services and cell and gene therapies. The regulatory volatility and the unknowns involved, whether it's Medicare redesign, carve outs, reduction in access will hit pediatric hospitals disproportionately and especially their pharmacy programs. We're heavily focused on helping pediatric hospitals innovate specifically through the lens of specialty pharmacy and the FDA pipeline.”
“I've had experience with specialty pharmacy at other health systems, and this strategy has been on my agenda since the very beginning when I joined Lurie Children’s Hospital and my CEO asked me what I might want to focus on and the value it can bring to the organization,” said Lehmuth. “When you think about what specialty pharmacy can do, it gives you another way to handle the shortfall of hospital reimbursements. It gives you another revenue stream and opportunity to support and reinvest in your providers. It unlocks some profit pools that make investments in essential programs like endocrinology easier. When you look at pediatrics, we see statistics around declines in fertility, but what the statistics don’t show is that while the number of children may be declining, the number of children with complex conditions is increasing. So, there’s more demand for complicated treatments, and specialty pharmaceuticals are changing children’s lives.”