This blog is the last 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.
Why is Accreditation Important?
If you’re planning to enter the specialty pharmacy race, you’ve got to pay the admission price to be a participant. In this case, the cost of accreditation not only ensures better care for your patients, but it is also a required entrance ticket into a billion dollar industry.
Accreditation is extremely important for a specialty pharmacy. There are different types of accreditation depending on the individual hospital system. Things are changing very rapidly in the marketplace, so it is important for hospital systems to stay on top of these changes.
What is Accreditation?
Accreditation is quickly becoming the hallmark of what a lot specialty pharmacies are seeking. Some of the most predominant accreditations include:
- Utilization Review Accreditation Commission (URAC)
- Center for Pharmacy Practice Accreditation (CPPA)
- The Joint Commission Association
- Accreditation Commission for Health Care (ACHC)
- Verified Internet Pharmacy Practice Sites (VIPPS)
- Pharmacy Compounding Accreditation Board (PCAB)
- The Compliance Team: Healthcare Accreditation Organization
Which Accreditation Does My Specialty Pharmacy Need?
The Centers for Medicare & Medicaid Services (CMS) has several options for accreditation, but the gold standard tends to be URAC, ACHC or CPPA for specialty pharmacies. There is a lot of rationale behind which one to get and it has a lot to do with the payers that the specialty pharmacy would like to contract with.
URAC accreditation, for example, has certain payers and many times pharmacies are looking at URAC as one of their solutions for the accreditation piece. URAC has really become the gold standard, and as a result, has the higher price tag to go with it. During the accreditation process, they are looking at how you are taking care of patients and what you are doing for the patient in clinical programs and your adherence programs.
ACHC is another accreditation for specialty pharmacies. It not only looks at how you are caring for your patients, but more importantly, making sure of your processes in place.
CPPA is one of the newer accrediting bodies and has a stronger focus on hospitals. It is becoming a niche in the hospital area and very patient centric.
Typically, most hospitals have accreditation from Joint Commission. This serves as a great secondary accreditation. As, it is beneficial to have multiple accreditations associated with your offering.
Many times it is a requirement to be involved in either a payer network or a limited distributed drug network. Certain plans are now requiring pharmacies to have two different accrediting bodies; typically URAC accreditation with ACHC, CPPA, Joint Commission or VIPPS.
As there is accreditation for other lines of business, it is also necessary for hospitals. If you have a home health entity already, you may be accredited through ACHC compounding or PCAB.
It is important to look at the different distinguishing accrediting factors. So, within your accreditation, you can also get your call center and your website accredited while you get your pharmacy accredited.
It is important that you choose the right accrediting body for your pharmacy, whether it be the specialty pharmacy, infusion pharmacy or a compounding pharmacy.
Having a call center is important for many pharmacies as well. While building the call center, it is important to meet the metrics required for URAC accreditation in particular. For example, simple call center metrics include your abandonment rate needing to be less than 5 percent, answer speed less than 30 seconds and the blockage rate less than 5 percent.
How Payers Relate to Accreditation
Payers look for quality service for their members. Payers are also required to have accreditation of their own. They monitor quality and have dedicated member services take care of member questions about their benefits.
If an employer is going to contract with a firm, they want to make sure that their members are being taken care of as well as they put forth the quality. The quality of care is a significant reason payers and manufacturers require such accreditations of their pharmacies.
Payers want to make sure patients are taking care of and select a pharmacy that demonstrates their clinical effectiveness. Having required clinical programs in place creates a platform that allows communication with patients about adherence and keeping patients.
How Long Does Accreditation Take?
The accreditation process, like most things, varies.
With URAC it can take approximately seven months to complete a desktop submission. That desktop submission involves submitting standard operating procedures, making sure you meet the standards that URAC has set forth and even submitting your clinical program to show what you are doing from a clinical perspective.
They will check that you are doing the right things for the patient from a contract perspective. This could be with your payers, the manufacturer or the PBM.
From there it can take anywhere from three to six months before an onsite evaluation. During the onsite evaluation, they will review your Standard Operating Procedures (SOPs). They usually spend a day, but depending on how many locations you have it could take several.
You can typically expect a day to go over all your SOPs and review your operations.
Above all else, what should you take away from this series?
For your health system to really be successful in the specialty pharmacy world, you must possess a sense of urgency and be willing to act quickly. Along the way you will have to set up communications, expectations and budgets – but the longer you wait the more ground your competitors are gaining.
So the question, really, is this: are you going to make this your year? Are you going to be an early adopter and really get ahead of the curve are are you going to wait until the market has passed you by and you’re struggling to catch up?
The choice is yours.
The time is now. Call CSI Specialty Group to discuss your next move at 866-484-4752.