More
health systems are tapping specialty pharmacy to drive managed care, but these
new pharmacy models are posing some challenges.
By Sara Heath
October 28, 2019
- The role of the specialty pharmacy is evolving and growing, and as more
health systems integrate these entities into their facilities, industry
collaboration will be key to for understanding the level of managed care needed
for complex patients.
A specialty pharmacy is almost exactly as it sounds – a
medical practice that keenly focuses on medication therapy management for
patients with exceptionally complex medical conditions. The medications
administered in a specialty pharmacy can range from traditional oral drugs to
cutting-edge therapies treating cancer, multiple sclerosis, rheumatoid
arthritis, or any number of rare genetic diseases.
Specialty pharmacies
can exist in a variety of practice settings. While some exist on a standalone
basis, others are a part of a larger health and hospital system or a retail
pharmacy chain.
Increasingly, health
systems are looking into that second option, noting the benefits of embedding
their current managed care strategies into the patient engagement tactics
needed for a successful specialty pharmacy.
But with that change
comes a period of transitions, and health systems are working to fully
understand the specific requirements they must fulfill as a part of hosting a
specialty pharmacy.
The Core Measure Set from the Pharmacy Quality
Alliance (PQA), certification requirements from the National Association for
Specialty Pharmacy, and other quality measures from specific payers present
challenges for health systems that are just getting into – or may even have a
long history in – the specialty pharmacy business.
That’s where Excelera
Network comes in. The network, established in 2009, helps unite health systems
with specialty pharmacies for industry collaboration, helping to share datasets
and best practices with the shared goal of better serving a health system’s
patient populations.
“We have members who
are health systems that own specialty pharmacies, and we provide insights to
them through our data platform,” Jami Schell, PharmD, CSP, the director of
pharmaceutical accounts at Excelera, said in a recent interview. “And then we
also give systems access to that data as well as working with them on getting
access to products so that they can take care of their complex patients.”
Excelera, which
currently consists of over 20 health systems across the country, facilitates a
high level of collaboration between like health systems. Through that
collaboration and access to shared data, Excelera aims to help organizations
drive better specialty pharmacy performance in key areas, namely medication adherence.
Medication adherence,
which is infamously a billion dollar issue in chronic care
management and specialty care, is a key metric for understanding how well a
specialty pharmacy is meeting quality metrics and fulfilling patient needs,
according to Jennifer Craig, the senior manager of clinical services for the
specialty pharmacy at Banner Health, one of the first Excelera Network members.
“It's very important to be able to see overall
how well your patients are able to fill their medications, access your
pharmacy, and then look at your pharmacy growth and expansion across all of the
different specialty pharmacies that are in Excelera,” Craig told PatientEngagementHIT.com.
“As we look at our
proportion of days covered – the number of days in a performance period covered
by a medication compared by the total number of days in a performance period –
we're tracking how well we're doing towards our goal, and then across other
members,” Craig added.
If Craig and her team
sees even a small dip in proportion of days covered (PDC), they will dive
deeper into the data to understand why. Did the pharmacy begin serving a new
patient population? Is the call volume different? Did another external factor
change?
“It really helps us
determine where we're at clinically, and the services we provide for our
patients to take care of them,” she said.
Using this metric has
been effective across the Network, Excelera reports. Between 2014 and 2018, PDC
for oncology patients in the network increased from 84 percent to 89 percent.
More modest improvements emerged for those with inflammatory diseases and
multiple sclerosis, from 85 to 87 percent and 89 to 90 percent PDC,
respectively.
And those
improvements aren’t just a sign that specialty pharmacies are doing a good job engaging their patients. Improving PDC is
a key quality metric that will help specialty pharmacies in various value-based
reimbursement models and accreditation programs.
“PQA and NASP are working
on coming up with benchmarks for PDC, for different disease states within
specialty,” Schell said. “There have been benchmarks out there for the
traditional primary care type of disease states, but they're just getting into
specialty disease states now. And because that's becoming such an important
measure in the marketplace, Excelera decided to focus there.”
“We want to show the
value that we can provide for our patients, which is why proportion of
days covered, or PDC, is so important,” Craig added, outlining the
benefits PDC measure has for individual specialty pharmacies. “You look at all
of these chronic disease states where patients are going to be on therapy
lifelong, and you want to make sure you're providing the best possible care and
giving them the best possible outcome.”
But collaboration
goes beyond sharing PDC and other performance data. Network members benefit
from a friendly, collaborative environment in which different health systems
can offer input and advice about various care management and patient engagement
efforts, Schell and Craig stated.
Through the Excelera
Network, health systems can tap into a deep knowledge base to consult about new
engagement efforts they plan to implement.
“The network has been
most successful when a new medication comes out or there's a new area to
specialty pharmacy,” Schell explained. “For example, Parkinson's has not
previously been served in the specialty pharmacy, but now it’s moving in. There
have been discussions among the network and the different health systems on how
they're going to approach that. Whether they're going to place liaisons in the
clinic, how they're going to service these new medications that they haven't
before and how they're going to manage those patients.”
And Banner, being one
of the major leading health systems in the nation, has naturally answered many
of those calls for advice and benefitted from health system cooperation.
“The collaboration is
just extremely valuable,” Craig said. “Being able to run something by another
expert within specialty pharmacy makes it a little bit easier and makes our job
that much more empowering to provide solutions for the patient. We can find
answers maybe that we didn't think of, or change a service that would better
the patient. This is more efficient rather than just trying new things over and
over again and hoping it works.”
As health systems
work to tamp down on high costs using managed care and specialty care
approaches, these types of pharmacies will likely continue to grow. Through a
commitment to patient engagement and collaboration, organizations can work to
establish a successful care management strategy.
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