How health systems can break into the specialty pharmacy services market

Entering the expanding market of specialty pharmacy services can produce many benefits for health systems, such as improved patient medication adherence, better care outcomes and higher levels of patient satisfaction. However, building a specialty pharmacy program is no easy feat.

There are significant barriers to entering and achieving success in the specialty pharmacy space, including overcoming health plan and manufacturer network restrictions and leadership engagement. To succeed in the market, hospitals and health system leaders first must assess their understanding of the specialty pharmacy market and determine whether how they are currently managing these medications is positively influencing patient care.

During a Feb. 6 webinar hosted by Becker's Hospital Review and sponsored by Trellis Rx, two industry experts explored the growing opportunity for health systems in the specialty pharmacy services market. Tony Zappa, PharmD, chief solutions officer at Trellis Rx, detailed five key strategies hospitals can implement to overcome barriers and succeed in the market, while Jerry Buller, DPh, chief pharmacy officer at Trellis Rx, detailed the success of a real-life health system specialty pharmacy program.

Frame – and reframe – the opportunity

Before implementing a specialty pharmacy program, health systems must create a vision for future success and establish a business plan focused on enhancing patient care and outcomes. When doing so, it is important to think critically about the hospital's current operations and potential for future growth.

Because the specialty pharmacy market is changing rapidly, hospitals must continually frame, and reframe, their business plans when launching a specialty pharmacy program, Dr. Zappa said. Additionally, it is important to acknowledge how specialty pharmacy services could affect a hospital's current and future investments in areas such as capital projects and new health system practices.

The concept of framing, or establishing a plan of action, will ultimately help the health system focus on properly integrating specialty care to support all its service lines. To do this, Dr. Zappa said hospitals must view integration as a systemwide strategy rather than just a pharmacy strategy.

Build enterprise-wide alignment and develop trust with physicians

After framing a plan of action, hospitals must focus on ensuring broad-scale alignment around the growth plan. It's critical to remember that integrating specialty services is not just a pharmacy project but a systemwide initiative because there are various areas of operations apart from pharmacy that specialty programs can affect, such as managing value-based contracts.

"If you think about your health system, it's very likely you're taking value-based contracts from large payers in your market and that usually is on an overall cost of care basis," Dr. Zappa said. "So, if you're not able to provide all care for all patients who are affected by that value-based contract, you may not be able to manage your risk appropriately."

Health systems must acknowledge that pharmacy requires support from many other departments, including IT, marketing, human resources and finance. It will also require physician engagement. Health systems can achieve buy-in among physicians by fitting the specialty care model into established clinical workflows instead of retooling established workflows to fit the specialty care model.

Achieving buy-in and clear communication among all providers, not just physicians, is key because the pharmacy team's goal is to achieve better clinical outcomes by acting as a resource for patients by removing barriers that prevent patients from adhering to and initiating medication regimens. Providers need to be empowered to engage with patients in a way that supports the aims of the pharmacy team.

"Once you get the strategy built and in place, then you need to develop relationships with not just physicians but really all providers, because those are the people that have the existing relationships with patients," Dr. Zappa said.

Leverage data and analytics

Once the program is in place, health systems will need to leverage data analytics to analyze the program's performance. There are four critical points to pull data for: accreditation, network access, service improvement and performance improvement. Before implementing the specialty pharmacy program, hospitals need to create a baseline, which can be achieved by measuring pre-program data. Following implementation, hospitals can pull post-program data to compare to the pre-program data previously gathered.

Accreditation programs can help establish the development of the baseline, which is critical to determining the program's success, Dr. Zappa said. "… [Accreditation programs have] done a pretty good job of laying out, 'well here's what you should be collecting on the daily, weekly, quarterly or annual basis,' and what you should be reporting back as far as quality markers to show how your program is performing," he said.

Show alignment with manufacturer and health plan goals

To ensure continued success of a specialty pharmacy program, a health system needs to consider the health plan and manufacturer's objectives. Essentially, health plans want to know why they should work with the health system and what value its specialty pharmacy program will bring them, Dr. Zappa said. One question that often comes up from health plans is will costs go up if they work with health systems.

"We're very careful to counsel people [at health systems] on [the idea that] you need to help the health plans understand you're not asking for any more money for providing services," Dr. Zappa said. "You're really willing to do this at parity with other pharmacies in the marketplace, and just because you're a health system doesn't mean that you're going to ask for more."

From the manufacturer's perspective, health systems must be prepared to answer questions regarding program efficacy and have prescribing use data available. While this doesn't mean health systems must reach the same data requirements as other specialty pharmacies, it does mean hospitals should work with their IT vendors, IT departments or system vendors to collect and extract prescribing use data to report back on.

Success at Southern Ohio Medical Center

Portsmouth-based Southern Ohio Medical Center was able to significantly enhance patient outcomes, while also achieving immediate profitability, after implementing its specialty pharmacy program with Trellis Rx. Among other accomplishments, the health system’s specialty pharmacy program led to a 100 percent completion rate for patients prescribed an oral therapy for hepatitis C, Mr. Buller said.

One obstacle Southern Ohio Medical Center leaders faced when launching the program was gaining physician buy-in. "We did have to deal with the same challenges that everybody does to overcome initial provider resistance," Mr. Buller said. "We wanted to make it clear that we weren't there to replace or make changes to their care… it was really that we wanted to enhance the great care there already provided."

By establishing specialty pharmacy services, SOMC has been able to provide personalized care to their hepatitis C and HIV patients who often struggle with therapy adherence and ongoing treatment.

"I think the big takeaway is you don't have to be a large academic medical center or health system to have an impact, and from a financial standpoint, realizing that [you have an] impact in your localized patient care," Mr. Buller said.

To listen to the full recording, click here.

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