Health Systems Disrupt the Specialty Pharmacy Market to Improve Patient Care

Today’s guest post comes from Vizient™ University Health System Consortium, the nation's largest network of academic medical centers (AMCs) who collaborate to exchange and advance knowledge. Vizient is the nation's largest healthcare performance improvement company.

The five authors of this article are employees of Vizient AMC members. Four of the five are leaders and participants of the organization's Pharmacy Network and its Specialty Pharmacy Committee.

The authors argue that specialty pharmacy programs at health systems provide significant advantages to hospitals, health systems, and patients. They highlight the specific benefits for organ transplant and hepatitis C patients.

Read on for their interesting perspectives.

Health Systems Disrupt the Specialty Pharmacy Market to Improve Patient Care
By:

• Scott Canfield, Clinical Programs Manager, Johns Hopkins Home Care Group
• Tara Feller, Health-System Pharmacy Administration Resident, The Johns Hopkins Hospital
• Andy Pulvermacher, Specialty Services Supervisor, University of Wisconsin Hospital and Clinics
• Kyle Skiermont, Chief Operating Officer, Fairview Pharmacy Services
• Nathan Thompson, Senior Director, Outpatient Pharmacy Services, Johns Hopkins Home Care Group

As health care payment models shift from volume to value, hospitals and health systems are realizing that the quality of care coordination throughout the patient journey affects both the well-being of the patient and their own financial viability. Nowhere is this coordination more important than in patient populations with the highest needs and highest costs—the commonly-cited five percent of patients that account for 50 percent of all health care expenditures.

Comprehensive pharmacy services, inclusive of a specialty pharmacy program, are critical to care alignment for emerging high need, high cost populations—patients with complex medical conditions requiring specialty medications. Health systems are increasingly disrupting the specialty pharmacy market and evolving care for their system’s neediest populations.

There are multiple facets of high quality specialty pharmacy services. In addition to providing comprehensive clinical services, the health system specialty pharmacy program must also meet the current expectations of the industry, such as call abandonment and prescription turnaround time metrics. Health systems are increasingly demonstrating these capabilities. In fact, according to the 2017 Economic Report on US Pharmacies and Pharmacy Benefit Managers, outpatient pharmacies owned by healthcare providers were the fastest growing category of accredited pharmacy locations.

Health systems recognize that successful patient management transcends the acute event and align services around the patient in the clinic and the community. While an external specialty pharmacy does not begin providing services until the patient returns home, the health system pharmacy model follows the patient through the continuum of care with a focus on shared outcomes and cost effective patient-centric services, which include:

Coordinated transitions in care management: A core component of the care delivery model in health systems is to ensure continuity in care through transitions among the inpatient, ambulatory, and community settings, with full transparency of patient status to prescribers and other members of the care team.
Effective electronic medical record (EMR) integration to support appropriate medication use: Patient management supported by EMR integration allows specialty pharmacists to more closely monitor and intervene in the patient’s use of therapies. This ensures that patients responding to therapy continue their regimen, while those who need alternative therapy are referred to providers in real-time to reduce medication waste and incremental cost.
Facilitated medication access: Health system specialty pharmacy services often include assistance with enrollment in patient assistance programs and/or initiation of insurance prior authorizations at the point of diagnosis. This service enables patients to initiate therapy as soon as possible, regardless of whether the patient is insured, underinsured, or uninsured.

Solid organ transplantation, which ranges in price from $330,000 for a kidney transplant to more than $1.2 million for a heart transplant (2014 charge data), demands integrated care to avoid additional costs for the patient, the payer, and the health system. Medication adherence is critical to the long-term success of this patient population, as patients experience frequent dose changes and typically require at least three medications taken multiple times per day. A study being conducted at the University of Wisconsin will allow clinic-based pharmacists to identify key time points after transplant when patients are at the highest risk for medication non-adherence. Facilitated communication via the EMR allows pharmacists working at the bedside, in the clinic, and in the health system community pharmacy to make timely interventions to minimize risk of organ rejection from not following the medication plan.

Optimal use of medications to treat patients living with hepatitis C is pivotal in controlling costs. Health systems have developed a treatment approach that considers the individual patient’s risk for medication non-adherence, and varies the frequency of physician, nurse, and pharmacist follow-up based upon their needs. Medication is not provided to the patient until the pharmacist conducts an assessment of “treatment readiness” and provides education specific to this assessment. Results of this model are evident in the outcomes. In May 2016, Johns Hopkins celebrated the cure of more than 1,000 patients previously infected with chronic hepatitis C. Providing care centered around the patient achieved therapy abandonment rates comparable to clinical trials, reducing costs related to therapy discontinuation and retreatment.

By integrating their own specialty pharmacy services within the care continuum, health systems are providing care that aligns with the needs of their patient populations. The patient deserves to be the center of the care model.

Will you join us in meeting this challenge?

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