How integrating specialty pharmacy into care delivery can lead to better patient outcomes, payer partnerships and revenues

Pharmacy teams and operations have traditionally stood on the sidelines of care delivery, but recognition of their value to the patient and physician experience is growing — and they are getting pulled into the action.

During a September Becker's Hospital Review webinar sponsored by Clearway Health, three healthcare leaders discussed how elevating pharmacy to an active participant in integrated care delivery can bolster patient compliance, provider satisfaction and revenue. Panelists were:

  • Alastair Bell, MD, Executive Vice President, Strategy & Chief Operating Officer for BMC Health System in Boston
  • Nicole Faucher, President, Clearway Health (Moderator)
  • Jigar Thakkar, PharmD, Chief Pharmacy Officer and Vice President, Ancillary Services, OU Health in Oklahoma City

Four key takeaways were:

1. High-cost specialty drugs present challenges for patients, providers and other healthcare organizations. Transformative therapies such as hepatitis C cures typically come with an extraordinarily high price tag and a demanding adherence regimen. This translates into access difficulties for patients and an elevated administrative burden for providers due to payers' stringent approval criteria. Without a strategy for comprehensive medication management for such drugs, clinical pharmacy programs can turn into a cost center, hurting organizations' operating margins and revenues. 

"We saw it as an obligation to have a comprehensive program to be able to meet patient needs, provider needs and the financial complexity associated with specialty drugs," Mr. Thakkar said, explaining how OU Health arrived at the decision to set up a specialty pharmacy program in partnership with Clearway Health.

2. Involving non-pharmacy team members is critical to the success of a pharmacy program. Ideally, the stakeholders to be involved in forming an integrated specialty pharmacy program include the providers and staff at individual clinics, the facilities group, the legal team, the clinical data warehouse team, the clinical operational leadership team and the executive leadership team. "In my experience, in those organizations that have done it well, it becomes a top-five topic within the health system," Dr. Bell said.

3. A successful pharmacy program improves patient outcomes and provider satisfaction. Clinical areas in which patients stand to benefit most from a comprehensive pharmacy program include oncology, HIV and reproductive health services, where the programs can support users through the financial assistance aspect; and hepatitis C, where the side effects of medications can be so significant that patients often fail to complete the course of therapy, and the programs can help by extending regular follow-ups. 

A high-functioning specialty pharmacy program can also go a long way toward alleviating physician burnout by integrating pharmacists, technicians and liaisons into care delivery teams to lift workload off of clinic staff and even complete patient intake, insurance pre-authorizations and patient education related to their specialty prescriptions. "The providers in our health system have enjoyed that collaboration," Mr. Thakkar noted.

4. Specialty pharmacy programs contribute to lower costs of care. Organizations that set up specialty pharmacy programs can expect to see a marked decrease in their total cost of care as those initiatives optimize patients' adherence to treatment. "We were helping people stay on [expensive] specialty medications, but payers were seeing that it's actually lowering specialty drug spend because patients were just taking one run at therapy, not three or four or five attempts with $1,000-a-pill medications," Dr. Bell said.

Mr. Thakkar added that OU Health has observed a similar reaction from Oklahoma's Medicaid agency. The safety net health system has entered into a yearlong value-based agreement with the government payer that includes tracking the extent to which its specialty pharmacy program impacts patients' total cost of care.

Hospitals and health systems have a lot to gain by building or strengthening their specialty pharmacy programs. For inspiration and help with building and operating a program, they can look to partners such as Clearway Health to support those efforts.

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