It’s no secret that hospitals and health systems continue to face pressure to improve patient outcomes while managing the total cost of care.
This requires improving safety, lowering readmissions, enhancing quality of care and the patient experience, all while refining data collection in order to succeed in a value-based reimbursement landscape. As market leaders begin to better understand the benefits of specialty pharmacy, many health systems are now considering the strategic opportunities that can be created by opening and integrating their own. In addition to enhancing patient care, a health system owned specialty pharmacy has the additional benefit of improving employee benefits, increase revenue and controlling costs.
Leveraging specialty pharmacists to support adherence and drive better patient outcomes
Studies show that about 30% of medications are taken inconsistently, and in 2014, health care providers cited patient decision-making as the primary reason for medication nonadherence.1 There are myriad reasons why a patient might be nonadherent, from confusion on administration to difficult life circumstances, but there is one constant: patients who require specialty pharmaceuticals have particularly complex journeys. When a specialty pharmacy exists within the health system, the dispense occurs closer to the patient’s medical record which makes it easier for the health system to empower the entire care team to ensure appropriate utilization; leading to a better clinical outcome. This is particularly important when you consider patients with a combination of both infused and oral (or self-administered products) as part of many new treatment regimens such as oncology. As hospitals focus on reducing readmissions by supporting patient adherence and outcomes post-discharge, specialty pharmacy services can extend the reach and impact of the health system.
As reimbursement models are shifting to rewarding quality of care over quantity of care, pharmacists have an opportunity to elevate their role in patient care. Creating a specialty pharmacy within a health system provides a particularly important means for pharmacists to positively influence patient outcomes. Patients on specialty medications rely on a specialty pharmacy for clear guidance and customized clinical care that reduces complexity and increases adherence. Patients and their caregivers often need help understanding their benefits, finding funding, and leveraging clinical and educational resources specific to their therapy and individual needs. This could include education on the appropriate dosing regimens, possible side effects and importance of remaining adherent to obtain the full benefit of their specialty treatment.
It is ideal if this augmented patient support can be accessed through the hospital or health system a patient is relying on for treatments. Hospitals and health systems are uniquely positioned in health care – having most of a patient’s providers and specialists under one roof – to provide a level of care coordination that can maximize patient benefits, especially for those who require ongoing, high-touch pharmacy services. But, only if a specialty pharmacist is clinically integrated in to the patient care team early and often. In fact, research shows that care coordinated with specialty pharmacists integrated in to the care team at the outset improves medication adherence and clinical outcomes, and pharmacist-provided medication management creates cost-savings.
Additionally, when integrated with a hospital, providers and pharmacists have access to a consistent set of EHRs and clinical data, which is easier to collect in-house. For example, the American Pharmacist’s Association reported on a specific case where the health system opened a specialty pharmacy and enhanced its EHR system to integrate with pharmacy records. Pharmacy staff had a broader view of a patient’s visit history across departments, their labs and other prescribed medications. This type of data sharing and care coordination among different types of providers cannot easily be duplicated and can give hospitals and health systems an edge when competing for inclusion in specialty distribution networks.
In fact, when an in-house specialty pharmacy was implemented at a cancer center in New Haven, CT, researchers found that 80% of patients received oral treatments within 72 hours of prescribing. Previously, patients anecdotally reported two-to-three week wait times for their medication. This allowed prescribers to more quickly identify and mitigate adherence and side effect issues. The addition of the specialty pharmacy allowed the health system to add $1.5 million in revenue per month in medication assistance programs as well.2
Investing in specialty pharmacy to derive value throughout the organization
In addition to capturing patient data, an in-house specialty pharmacy can create value in other areas of the organization. For example, in a pilot study, the participating pharmacist took on 28 medication-related visits that would have been handled previously by the provider, freeing up valuable time. An additional 12 unnecessary visits were canceled, often because required workups had not been completed. This resulted in 82% and 62% drops in time-to-medication approval and time-to-medication initiation, respectively. The team that facilitated the study found patients doubled their rate of follow up appointments with their providers, and the hospital saw a 9% increase in new patient visits. An additional study found that by communicating patient concerns with the physician and coordinating access and training for therapy, specialty pharmacists improved compliance, appropriate medication use and safety.3
The issue of how to improve hospital value is one that concerns senior health care management at every level. Maximizing ROI – while remaining attuned to the needs of key employees and delivering a high standard of patient care – is pivotal to the success of a health care organization. Pharmacy leaders can help address industry challenges, especially concerning efficiency and safety in pharmacy workflow, and these efficiencies correlate to increased value generated for the health system. Creating this added value will only become more important and provide more return as specialty pharmacy continues to grow in the industry – it is estimated to represent half of the total drug spend by 2020.4
Partnering with experts to address the challenges of implementation head on
Despite its benefits, implementing a specialty pharmacy into the health system is not without challenges. Hospital executives have to consider utilization management, care management and drug dispensing. But, they also have to plan for contracts with insurers, clinical training of staff on specialty disease states, nursing support and software for case management. It is crucial that a business plan for implementation include all of the pieces necessary to not only establish a specialty pharmacy but also one of high enough quality to unlock its full value. Hospital executives should ask themselves, “What can be done via resources that exist in the hospital, and where will assistance from external partners be most important?”
Start with contracting and drug access. Without access to the specialty product, the other considerations are irrelevant. Nearly half of the specialty medications approved in 2015 were managed under limited distribution networks. Certainly, for these highly specialized products, manufacturers want to ensure they have direct line of sight to their distribution and administration. While well intended, channel decisions like these can lead to unintended consequences in the practical delivery of care and create operational inefficiencies for the hospital pharmacy.
It’s best to collaborate with experts who have a broad view of all stakeholders very early in the process of opening and implementing an in-house specialty pharmacy. These partners can give manufacturers a full understanding of the challenges faced by hospital providers and pharmacists, and why it’s important that a manufacturer’s products be made available in the hospital setting. These insights can show a manufacturer how a specific distribution strategy can help or hinder bringing the full benefit of pharmaceutical innovation to the patient.
Ultimately, the age of highly specialized treatments is upon us. Patients have the opportunity to benefit from treatments that are unique to their disease or genetic makeup, requiring a more coordinated treatment plan among appropriate health care providers. Hospitals with specialty pharmacies in-house can help bring this type of personalized patient care to this ideal state.
As such, hospital executives would be remiss not to investigate how a specialty pharmacy strategy can create value for their businesses, improve patient outcomes and generate critical clinical data. Partners with expertise in the entire pharmaceutical process can help hospitals make a seamless transition to specialty pharmacy and begin the process of driving business, while also providing high-touch patient care. When patient care is coordinated appropriately under one roof, we all benefit from the positive outcomes of a healthy patient population.
1 Risk Management & Healthcare Policy. Adherence and health care costs. Accessed 2/28/17. Accessible at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668
2 American Society for Clinical Oncology (ASCO). In-House Specialty Pharmacy at Cancer Center Improves Quality of Care, Reduces Medical Errors. Accessed 5/11/17. Accessible at: https://www.asco.org/about-asco/press-center/news-releases/house-specialty-pharmacy-cancer-center-improves-quality-care
3 Specialty Pharmacy Continuum. Hospitals Reaping Benefits From SP Market Growth. Accessed 2/28/17. Accessible at: http://www.specialtypharmacycontinuum.com/Policy/Article/08-16/Hospitals-Reaping-Benefits-From-SP-Market-Growth/37156/ses=ogst
4 Express Scripts Drug Trend Report, http://lab.express-scripts.com/lab/drug-trend-report, accessed February 29, 2017.
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