Health system-based ambulatory pharmacies are not a new phenomenon – infusion and retail pharmacies have been staples within health systems for years. These existing onsite pharmacies allow hospitals to push their care beyond the physician diagnosis and create higher quality patient experiences. Health system-based specialty pharmacies offer similar opportunities to optimize patient outcomes by providing greater transparency into post-diagnosis factors affecting patient health. The result is a vastly improved patient-centric care model.
The best run health system-based specialty pharmacies are improving medication adherence rates 36% to 50% above national averages, improving time to therapy by 50%, improving physician approval rankings to almost 100%, and improving disease specific patient outcomes. For those on the fence about outsourcing vs. owning a health system specialty pharmacy, there are a few important points to consider with regards to patient care.
Outsourced Specialty Pharmacy Falls Short
Health systems must ensure all patients, including the 5% with chronic illness who require more than 50% of total healthcare costs, are receiving the highly personalized care prescribed by providers. To ensure the best care is provided for the most vulnerable 5%, health system specialty pharmacies must perform benefits investigations, assist with prior authorizations, search for and secure financial assistance, fulfill medication dispensing, and perform initial/on-going and time consuming clinical pharmacist assessments and interventions, among other duties.
Not only is it critical to provide these services, but it is essential that all functions are integrated as part of a multidisciplinary care team embedded within clinic workflows. Documenting each element of care in the electronic medical record is the keystone that holds up the entire arch of the care continuum. Outsourced providers of specialty pharmacy services, such as CVS, Accredo, Walgreens, Briova, etc., are unable to meet these needs.
In the outsourced specialty pharmacy model, patients and health systems are not privy to real-time patient prescription information. Consequently, the clinical care team cannot be fully integrated with outpatient care. As patients walk out of their specialty clinic visit, providers lose visibility into their patients’ medication adherence and all of the factors that influence their health outcomes. If phone calls are made or emails sent – none of this is visible to the clinical care team. The continuity of care stops at the clinic doors with an unspoken “good luck” to patients.
The fragmented outsourced specialty pharmacy model causes health systems to detach from their patients, and discontinue their high standards of care. It is only upon patients’ return visits that the clinical care team re-engages and catches up on patient progress since their previous appointment. An obvious but pervasive disconnect in the care continuum.
Higher Quality Patient Care, As Prescribed
On the other end of the spectrum, an integrated specialty pharmacy care model, with a pharmacy physically located within the health system facility, allows health systems to provide higher levels of care by extending its patient touch capabilities - the continuum of care - to the outpatient setting. From the clinic to the pharmacy to the patient home, and back. Every element of care inside and outside the clinic is recorded in the patient EMR. As a result, quality of care is managed and maintained, and data shows that patients are retained by health systems at rates 60% to 80% above national averages.
In addition to improved outcomes and integrated, coordinated care, a health system-based specialty pharmacy provides benefits to the broader health system. Most notably, it alleviates the back-office work that takes doctors and nurses away from direct patient care. According to one physician, benefits investigations, prior authorizations, financial assistance, clinical assessments and clinical follow-up processes used to take up more than 80% of a provider’s time in his clinic. Now with the health system specialty pharmacy’s care model in place, all of that non-clinical work is taken off the table, returning providers to the rewarding work of healing patients.
A successful specialty program is possible with the right strategy and support in place. The result is a holistic, patient-centric program that places patient care back where it should be – with the health system.
About the author:
Brian S. Smith, is the Vice President of Clinical Services at Shields Health Solutions. Prior to his current role, Brian was the Director of Clinical Services and Education at UMass Memorial Medical Center. Brian is also an Assistant Professor of Surgery and Graduate Nursing at the University of Massachusetts Medical School. He holds a BS and PharmD from the Massachusetts College of Pharmacy and Health Sciences.