Creating a superior specialty pharmacy experience for patients

How health systems can overcome barriers to entry to drive better outcomes

Given the increasing prevalence, cost and complexity of specialty medications, patients today require a much stronger support system to encourage participation and ongoing adherence to their prescribed treatment. 

The numbers are startling. A review published by the National Center for Biotechnology Information (NCBI) estimates that, “patient adherence to chronic medications is only about 50 percent.” A recent study in U.S. Pharmacist notes that “nonadherence can account for up to 50 percent of treatment failures, around 125,000 deaths, and up to 25 percent of hospitalizations each year in the United States.”

It’s no surprise, then, that getting a handle on specialty medication management is an important area of focus as hospitals and health systems increasingly take on at-risk contracts.

In fact, health systems can and should take the leading role in implementing specialty pharmacy programs by focusing on effective patient engagement and individualized service. By doing so, these efforts can lead to significant improvements in therapy adherence and improved outcomes.

U.S. PharmacistWhile a few of the largest health systems in the U.S. have already tackled this issue to great success, barriers to entry like capital constraints, risk management, payor relations, and manufacturer network access make the prospect challenging for many health systems’ leaders.

Organizations are hard pressed to rationalize the significant expenditure on additional team members to support the model, not to mention the capitol allocation required to expand operations. Along with those complexities, health systems often don’t possess the expertise to accelerate and optimize the model, nor the risk tolerance to see the program to maturity.

That could explain why only 8.7 percent of hospitals currently have a specialty pharmacy operation (although that percentage is increasing). This runs counter to the fact that health systems are uniquely positioned to change the specialty pharmacy experience for patients.

And as studies indicate, health system specialty pharmacy services drive better results and deliver significant clinical and financial benefit to their organizations. For example, in 2016 The Vanderbilt Specialty Pharmacy (VSP) at Vanderbilt University Medical Center (VUMC) achieved 96 percent medication adherence for patients with chronic inflammatory disease, achieved high patient satisfaction rates (4.93 out of 5 & Net Promoter Score of 93%), and assisted patients in saving over five million dollars through “various copay or other patient assistance programs, helping to dispense 14,068 prescriptions that may not otherwise have been obtained.”

Key to specialty pharmacy success: Embedding pharmacists in the clinical workflow
Organizations like VUMC that have succeeded in moving forward with a specialty pharmacy strategy have something in common. They recognized early on that the key to success required embedding the pharmacist and patient liaison resources into the clinical workflow.

This direct, coordinated-care approach primarily builds trust with physicians and staff, ultimately driving much higher patient engagement. This model also cuts through the barriers to adherence offering the patient direct, personalized assistance in their therapy journey – not being a disembodied voice on the end of the phone in a call center.

Additionally, this individualized approach drives faster and more affordable access to prescriptions, more coordinated care, and better health outcomes. These are the very elements that can help ensure patients adhere to their treatment regimens over time and realize the full benefit of their specialty medications. It’s an approach offering significant downstream impacts on payor relations as well, thanks to demonstrable impacts on cost of care.

Putting specialty pharmacy resources in the care process also creates efficiency in clinic and practice operations. As these team members manage issues like authorization, patient financial assistance, and ongoing medication adherence, physicians and their staff gain more time to focus on other important tasks. 

Patient liaisons can help manage authorizations with a patient’s insurance company and coordinate with foundations, manufacturers’ assistance programs and other financial resources to help patients afford their medications. And filling the prescription right at the hospital or via overnight delivery can help eliminate access delays and inefficiencies that patients face when filling their prescriptions in a store or mail-in pharmacy.

The argument for action here is compelling, but how do health systems overcome the barriers to entry mentioned above that keep them from taking control of this process for their patients? It starts with setting a solid foundation.

Setting a solid foundation
Health systems should consider the following fundamental steps to lay the groundwork for specialty pharmacy operations. Utilizing these strategies will help to maximize patient engagement and deliver results quickly:

Clearly understand the opportunity – and the implications. To get started, health systems should identify current specialty medication prescribing patterns and assess the ability of the current infrastructure to support them in the existing clinics.

With a clear understanding of these elements, health systems can identify the opportunity of adding specialty pharmacy services within their practices and clinics as well as the potential associated costs and profitability.

Clarify the requirements. To gain access to limited distribution drugs and secure insurance contracts to fill higher cost specialty medications, certain measures need to be in place. Accreditation is a key first step. Putting processes in place to provide patients with access to pharmacists 24/7 will also be necessary. Having a mechanism in place to field calls from patients is also important, as is the ability to dispense and send medications via overnight delivery.

Evaluate your current technology. In addition to the existing electronic health record (EHR), health systems will need an effective opportunity and referral management system to track patients throughout their entire specialty journey. Crucial operational and clinical metrics including time to treat and medication adherence are captured to ensure and then demonstrate a positive outcome.

Strengthen relationships with the specialty medications manufacturers. In recognizing that pharmaceutical manufacturers also desire positive outcomes for patients, health systems can begin to build stronger relationships with these stakeholders. Health systems are in an outstanding position to affect a patient’s outcome with the high-touch specialty model. In many cases hospital-based specialty pharmacy results mimic those of clinical trials. With increasing frequency, health systems are earning the trust of Pharma and securing access to more limited distribution drugs.

Earn the trust and business of large commercial payors. Health systems can leverage their larger medical and provider contracts to secure a preferred specialty pharmacy agreement, but this opportunity to participate must coincide with a capable specialty pharmacy data infrastructure. Payers want data and results; a clinically driven data model is the only way a preferred specialty pharmacy contract can be obtained.

Since this type of investment can require a significant amount of resources, health systems should analyze the benefits of self-developing these capabilities or working with a third party to build and/or accelerate their service offerings. A specialty pharmacy partner may be able to help with pharmacist integration into the clinics as well as provide the funding, technology, and people needed to support a full-fledged specialty pharmacy program that can scale much more quickly and with greater certainty of outcome. Doing so can go a long way to insulate the health system from unnecessary risk.

Health systems are in a unique position to greatly improve adherence and outcomes for patients on specialty medication therapy. By evaluating the opportunity, identifying ways to reduce risk, and building strong partnerships with organizations that can help, health systems can deliver the improved outcomes and positive experiences that put patients on the path to better health.

About the Author
Jerry Buller is Chief Pharmacy Officer at Trellis Rx, a leading technology-enabled service provider focused on helping health systems change the way patients experience specialty medication therapy. Leveraging more than 20 years of industry experience, Buller is responsible for ongoing client-based activities including the operational, clinical, and financial performance of each of the Trellis Rx’s customer programs. Before his time at Trellis Rx, he previously served as Executive Director at Vanderbilt Health Rx Solutions where he was responsible for developing and growing the organization’s specialty pharmacy program to become one of the largest and most clinically effective health system operations nationwide.

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