As of June 2023, Azina’s corporate brand has sunset and become a part of the singular CPS brand. Although we will continue to offer the same specialty and outpatient pharmacy solutions in the market, they will appear under the CPS corporate brand instead.
The healthcare landscape in the United States is complicated for patients and providers alike. Patients are dealing with multiple providers, labs, pharmacies and insurance plans. Meanwhile, hospitals and health systems are struggling to manage the end-to-end patient journey, while competing directly with payors that have merged with pharmacy benefit managers.
Becker's Hospital Review recently spoke with Keith Cook, president of Azina, about hospitals and health systems expanding into specialty and ambulatory pharmacies to better serve their patients and improve revenues.
Note: Responses have been edited for length and clarity.
Question: What significant challenges do hospitals and health systems have today with keeping their patients on one continuum of care?
Keith Cook: As you know, healthcare in the United States isn't simple. Payors hold health systems accountable for the successful treatment and care of patients, even beyond the four walls of the hospital. Yet, many times they have no control over what happens with patients post-discharge. With Medicare patients, hospitals are penalized for readmission within 30 days of discharge. It's a challenging situation because hospitals and health systems operate on very thin margins. They simply can't afford to keep patients in the hospital any longer than necessary. At the same time, discharging a patient without a comprehensive transition of care solution isn't acceptable from the perspective of complete patient care.
While some readmissions are necessary, hospitals could greatly reduce the overall readmission rate with an effective transition of care program. This would enable hospitals to maintain control of the patient journey once people transition to an outpatient setting. To effectively manage patient care, hospitals and health systems must own the patient journey, which includes both inpatient and outpatient care.
Q: What are some ways that hospitals and health systems can confront the challenges in today's market?
KC: If hospitals have an outpatient retail or outpatient specialty pharmacy, they can maintain the patient relationship on an ongoing basis and better manage patients post-discharge. Hospitals lose that connection when patients obtain their medications from a nonaffiliated pharmacy in the community or via a mail order pharmacy.
Effective healthcare is best managed at the local level, where the hospital, physician provider, pharmacy and nursing support are functioning as a team and always acting on behalf of the patient. Hospitals must view large health plans and pharmacy benefit managers as competitors in today's market. Without an aggressive strategy to protect and maintain patients' total health, hospitals and health systems will see patients treated outside of the system and in many cases, that will lead to less-than-optimal outcomes.
Q: What is the best way for hospitals and health systems to accelerate growth and ultimately own an integrated delivery network?
KC: Hospitals can improve the patient journey and create additional revenue streams if they own and operate pharmacies for ambulatory and outpatient settings. Unlike the inpatient pharmacy that bills the patient's medical benefit for medications received in the hospital, outpatient pharmacies assume care of the patient upon discharge, and they bill the patient's pharmacy benefit. It's a completely different model and a completely different benefit plan.
This approach also enables hospitals to maintain patient relationships post discharge. In my opinion, the hospital is in the best position to care for patients in their community, not just while they're in the hospital, but after they leave the inpatient setting as well. When hospitals own or manage patient care from beginning to end, they achieve the status of an integrated delivery network.
Q: CPS SPARx just rebranded to Azina. Can you tell us about the new brand and what difference you bring to your clients and customers?
KC: We are very excited about the launch of the Azina brand. It's much more than just a name change. As we have grown over the last five years, we realized it was time to relaunch the brand and to focus on all the services that we offer our hospitals and health systems in the areas of specialty and retail pharmacy.
We've refreshed our brand, mission and vision statements to reflect the full level of support Azina offers to hospital clients and ultimately to the patients that benefit from these services. One of our tag lines for Azina is "Everything from A to Z in your approach." It's a complete offering. Our clients can relax, knowing that when they partner with Azina, we will take care of all the concerns that come along with an ambulatory setting. The outpatient setting is usually new and different for hospital systems. They've spent their entire life cycle focused on inpatient, so they welcome the opportunity for a partnership like ours.
Q: Could you forecast what you think will happen over the next five to seven years in the pharmacy world? Do you think we'll continue to see the same challenges or different ones? What will the next era of healthcare look like for patients?
KC: I think we'll continue to see rising healthcare costs across all aspects of the industry. This will force providers to be more efficient in the way they provide quality healthcare. I also think we'll see technology continue to be a tool for driving costs out of the system by eliminating manual processes.
Hospitals and health systems will look for alternate revenue streams, like owning a specialty or retail pharmacy so they can better control the entire patient journey. Over the past year, we've seen some changes in the 340B market. Eight manufacturers have now instituted some type of restriction on the use of contract pharmacies for 340B eligibility. Hospitals and health systems can eliminate that risk by owning their own ambulatory and specialty pharmacy.
As more health plans consolidate with PBMs, hospitals must realize those integrated models are now competitors. Payors will continue to look for the least expensive site of care and hospitals must be prepared. The savvier hospitals are already identifying ways to protect their patient base. We'll continue to see payors remove hospitals from their infusion networks and move those patients to alternate sites of care or to home settings for infusions, enforcing a white bagging type of model. Hospitals can prepare for those changes by filling the infused meds in their own specialty pharmacies and billing the pharmacy benefit manager. They can also infuse in the hospital setting and bill the patient's medical benefit for administration fees.
From a patient perspective, I am concerned that healthcare will become more confusing and complicated. I find it difficult to navigate and I work in the industry, so you can imagine what it's like for an 85-year-old individual at home managing a complex disease state like cancer. The number of phone calls they receive is overwhelming. If local hospitals can streamline that process for patients into one site of care and provider system, both the hospitals and patients will win.