How Health System Specialty Pharmacy Can Be An Engine for Improving Health Equity

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The COVID-19 pandemic has elevated the urgency of addressing health equity and the role of social determinants of health (SDoH) in health disparities. The dynamism and growth of the specialty pharmacy field holds extraordinary opportunity to demonstrate what already works and to develop additional innovative approaches.

At Shields Health Solutions (Shields), we are confident—we see it in practice every day—that an integrated specialty pharmacy care model is effective in helping our health system partners address health disparities. As a high-touch model intentionally designed to take care of the most complex patients, “the sickest of the sick,” specialty pharmacies that are fully integrated into large health systems routinely help the most vulnerable patients get access to and pay for their medications and therapies. This model offers the unique ability to focus on the needs of patients as individuals, while also implementing and refining protocols and processes that can improve population health and reduce the total cost of care.

Given the prevalence of polypharmacy (WHO describes as “the routine use of five or more medications… by a patient” [i]) which can increase the risk of adverse drug reactions, and the extremely high cost of some specialty medications, a high-touch care model including therapy management is crucial to good clinical outcomes—for all patients—and to reducing hospitalizations and other events that increase cost of care. Therapy management is made simpler when the specialty pharmacy is part of the health system, with access to patients’ health records. The real-world impact of managing adherence, for example, is significant. According to data cited in a 2021 URAC white paper, ‘The Future of Specialty Pharmacy,’ medication non-adherence accounts for up to 125,000 deaths, up to 50% of treatment failures and up to 25% of hospitalizations each year.[ii]

Integrated specialty pharmacies are positioned to actively engage with other nodes of the health system and the local community to create a structure for high levels of support and outreach to counteract disadvantages that may exist or be exacerbated by SDoH. An integrated specialty pharmacy’s sophisticated monitoring protocols, grounded in close relationships with patients and enhanced by creative outreach methods, can help make sure that all patients have the best chance of success in their treatment. Patients can also be connected to assistance with co-pays, transportation, food, housing, mental health and language barriers, as well as medical co-morbidities.

As a policy decision by payers and pharmaceutical companies, incorporating health system specialty pharmacies into networks increases access and choice for patients, allowing them to have agency in decisions that impact them and to receive care where they have already built relationships and trust. Specialty pharmacy carve-outs, by contrast, create discontinuity and unnecessary barriers to quality care. Any given health system or academic medical center is often one of the larger, more trusted institutions in its community. It makes sense to harness, rather than stymie, that potential.

A recent study of the integrated specialty pharmacy model, conducted jointly by Shields and Optum Advisory Services and presented as a poster at AMCP 2021, found that risk-adjusted per member per month (PMPM) costs were 13% lower for the integrated specialty pharmacy intervention group as compared to the control group. In another initiative, we are gathering data on how embedded clinicians in specialty clinics can reduce administrative burden on providers and optimize every touchpoint with a patient, minimizing the impact of events such as delays in initiation of therapy.

Shields partners with more than 70 health systems across the country, working alongside teams at health system-owned specialty pharmacies that we help accelerate. We and our wholly owned subsidiary, ExceleraRx, LLC, have been at the forefront of integrating high-performance specialty pharmacy into clinical, operational and financial models. Many of our partners operate in communities with highly vulnerable populations, putting health equity front and center for our partners and for us.

TelemetryRx®, our integrated care technology and analytics platform, and Excelera’s Complex Patient Data Platform capture a wide range of longitudinal medical, pharmacy and patient journey data, holding great promise for addressing SDoH. TelemetryRx allows patients in need to be identified and followed through therapy—connecting those patients with the medical providers, specialty pharmacists, patient liaisons and financial support professionals required to deliver the best possible outcomes.

Given the outsized clinical and financial impact that specialty therapies have on individual patients and on measurements of population health, the integrated specialty pharmacy model is an ideal laboratory for innovation in addressing health disparities and an example of methods that already support equitable health for all.

[i] https://blog.cureatr.com/defining-polypharmacy-and-understanding-its-risks-and-benefits

[ii] Data cited is from: Specialty Pharmacy Trends: What’s Impacting the Industry Now and in the Future? (2020, October 30). Infowerks. https://infowerks.com/specialty-pharmacy-trends/

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