This blog is the first installment of a five-part series on Navigating Your Entry Into Specialty Pharmacy and serves as a step-by-step guide for integrated healthcare systems.
The secret is out.
There’s no denying any longer that your health system needs to be in specialty pharmacy, and that’s (probably) why you’re reading this series, right?
Spending in the U.S. on specialty drugs in 2012 was nearly $87 billion; and estimates suggest it could quadruple by 2020, reaching about $400 billion (or 40% of a health plan’s drug spending).
The time is now for your health system to get into the rapidly expanding specialty pharmacy industry.
Today, large insurers have their specialty pharmacy programs, independent specialty pharmacies are organizing into networks and regional/national chains are launching specialty pharmacies as well. With this increased competition comes increased opportunity for your health system to attract and retain more of your patient base.
Is getting into specialty pharmacy complex? Sometimes. Does it involve a lot of moving parts? You bet. Is there any reason you shouldn’t be entering into this exciting, dynamic field? Not a chance.
In the following blogs, we explain how to navigate your entry into the specialty pharmacy industry with a step-by-step guide created just for integrated healthcare systems like yours.
Let’s get started.
Why Should Your Healthcare System Enter Specialty Pharmacy?
So, why are the majority of hospital systems jumping onto the specialty pharmacy bandwagon? In addition to what has been outlined in the introduction to this series, there are several reasons for a hospital executive or a hospital pharmacy director to consider when deciding to enter the specialty pharmacy arena.
For starters, the increasing rate of change within Accountable Care Organizations (ACOs) and Medicare creates a growing need for hospital systems to develop additional revenue sources.
Typically, the pharmacy within a hospital is nothing more than a cost center. Although hospital systems come in different sizes, shapes and colors across all areas, for sake of this conversation, we are focusing on integrated healthcare networks with specific focus on academic medical institutions.
Specific outcomes drive the model of care provided by an integrated healthcare network. There is a big movement to measure the cost of patient outcomes, with the increased emphasis on bundled payments and programs.
It’s All About the Patient Experience
The integration of a specialty pharmacy with your health system also creates a real opportunity to advance patient care. In fact, health systems are in the ideal position to help coordinate care for patients requiring ongoing, high-touch pharmacy services.
By having access to a specialty pharmacy, your health system can collect clinical data from a number of sources to help demonstrate clinical outcomes and quality of care – all while promoting medication adherence.
Pharmacy professionals look at the time necessary to fill a prescription as an indication of how well a patient can do with their therapy.
If a hospital system has the ability to take a patient and have everything done before the patient is discharged, it allows for continuity of care at the home as well. Many hospital systems that CSI Specialty Group has worked with have noted the time to initiate therapy has been much lower than in judicial specialty pharmacies, which translates into better compliance ratings. In other words, the patient has a better overall experience.
For example, let’s consider a transplant patient who is receiving care from an academic institution – or any hospital system – who is ready for discharge with their medications and then sent home. However, if this patient goes home without their medications, they will be required to call a specialty pharmacy and work with a patient care coordinator who knows nothing about their personal journey; effectively starting over. The patient has already been through enough emotionally, and now they have to talk to a vastly different group of individuals outside the hospital setting. Talk about frustrating.
Continuity of Care is Essential
Continuity of care is essential for the overall patient experience. Since health systems have access to all the data points, they are in a unique situation to make clinical decisions that other organizations are not – and they can do so in a quicker fashion. This unique data sharing and care coordination among various providers cannot be easily duplicated, and would thus give the health system an edge while creating another benefit for patients.
The pharmacy is an arm of the physician’s office or the hospital that prescribes the medication and is, therefore, an extension of the patient’s therapy. Specialty pharmacy drugs are all about quality of life and extending a better quality of life, therefore, there’s no better place for them to be treated than in the hospital setting.
The prior authorization team, the pharmacists doing the medication management, and all of the different components are interacting with the nurse and prescribing in a physician’s office. They know each other and have regular face-to-face visits, making this relationship a unique upside as well.
The key takeaway here is that by having an integrated specialty pharmacy within your health system, you’re able to increase patient satisfaction and continuation of care for the population you serve.
Better Outcomes = Decreased Rehospitalization
This probably doesn’t come as news to you.
Within today’s integrated health networks, physician offices are being purchased regularly. For example, that oncology office down the road from you may be owned by a hospital system.
Within said hospital system, the physicians will do their infusions, chemotherapy, Remicade infusions, IG infusions, and even subcutaneous injections for patients completely under the healthcare system. More and more hospital systems are using infusion suites versus physicians infusing.
It becomes a natural progression for hospital systems to take on specialty pharmacy products because they are already taking care of everything for their patients. An added benefit when this occurs is that adherence rates have been shown to increase as well because prescribers are able to see what is going on with a patient from start to finish. They see the full cycle of treatment. The prescriber is then able to see when a patient from another prescriber has ordered a prescription, if they got it and if they are experiencing any side effects. Also, all entities within the integrated healthcare network have access to their patients’ Electronic Medical Records (EMR), which allows for even more specialized care.
There is an unspoken challenge in the market for a specialty pharmacy to perform at a rate comparable to what the hospital’s performance can be. Specialty pharmacies in the hospitals are raising the bar with better adherence and accountability.
By cutting out the middleman, patients can start therapy sooner, which reduces their risk for disease progression (another huge benefit).