Acentrus Specialty hosted its first Acentrus Specialty Conference on January 12-13, 2021, which brought together pharmacists, manufacturers, and suppliers to examine the challenges, opportunities, and best practices in advancing health system specialty pharmacy practice. A pharmacy paradigm shift is under way, as Integrated Delivery Networks (IDNs) are partnering to grow their specialty pharmacy operations.
“The conference highlighted the collaborative potential of our client network,” says George Zula, RPh, MBA, CSP, Acentrus Specialty Vice President. “It provided a valuable forum for specialty pharmacy leaders to network, share best practices, and focus collectively on working together to produce the data and operational insights that will drive excellence in patient care and outcomes.”
It is increasingly important for health system specialty pharmacies (HSSPs) to participate with a network administrator such as Acentrus, which allows data exchange to create metrics that demonstrate positive patient outcomes and cost-effectiveness.
—Chris Hatwig, RPh, MS, FASHP, Apexus President
Today, one in four hospitals operate specialty pharmacies, a ratio that increases to nine in 10 for hospitals with more than 600 beds. These specialty pharmacies deliver a continuum of integrated care provided to patients with conditions requiring complex treatment regimens.
“It is increasingly important for health system specialty pharmacies (HSSPs) to participate with a network administrator such as Acentrus, which allows data exchange to create metrics that demonstrate positive patient outcomes and cost-effectiveness,” says Chris Hatwig, RPh, MS, FASHP, Apexus President. “The subject matter experts that spoke at the conference examined how this data sets HSSPs apart from big-box specialty pharmacies.“
Accreditation is key
Accreditation, while not required, demonstrates a baseline competency in specialty pharmacy and is required to access Limited Distribution Drugs (LDDs) and payer contracts. Specialty pharmacies are required to report metrics as part of the accreditation process, but that will be changing in the future as accrediting bodies develop performance measures that are meaningful to the industry.
“It’s not as easy as looking at claims data to measure an outcome,” says Heather Bonome, PharmD, URAC Director of Pharmacy. “The surveyors report back that health system pharmacies have access to the complete Electronic Health Record (EHR) and can significantly impact patient care and outcomes.“
Performance metrics and patient outcomes will play a major role in future accreditation, and external benchmarking will demonstrate the capabilities of health systems to provide superior patient satisfaction and lower cost care.
Data is the advantage
Access to the EHR data is the key advantage HSSPs have over big-box pharmacies as they do not have access to this valuable clinical data. Health systems need to capitalize on this advantage. While HSSPs have access to the complete EHR, the challenge for most health systems is a lack of IT resources due to competing priorities and being able to collect and aggregate data from multiple sources to provide actionable metrics and information. Health systems will need to invest in data collection and data analytics or partner with a third-party analytics company to compete in the coming years.
A growing number of Acentrus clients are working with Acentrus Specialty’s network partner, Loopback Analytics, to consolidate data from multiple medical records into a usable format to facilitate this effort. This allows the opportunity to benchmark data with other pharmacies utilizing this platform.
“Having a standardized benchmarking tool is critical because everyone does data differently” says Jason Bailly, PharmD, AAHIVP, CSP, Specialty Pharmacist in Charge, UC San Diego. “Only then will IDNs be able to share information, learn from each other, improve best practices, and improve patient outcomes.“
“The ability to share data through external benchmarking will lead to innovation and improvement in services,“ says Melissa Ortega, PharmD, MS, Director of Outpatient Pharmacy at Tufts. This data is needed to validate what is already known; HSSPs provide faster time to therapy, better clinical outcomes, higher patient satisfaction, and lower total cost of care.
LDDs and Data
Access to LDDs may require submission of data to the manufacturer, and as more orphan drugs come to market, manufacturers will require more clinically focused data reporting that cannot be provided from dispensing data alone. This is a key advantage that HSSPs must exploit. Manufacturers are starting to ask for more clinically focused data such as ICD10 codes, diagnostic information, or outcomes to understand if the drug is providing its intended effect or are there other therapies needed to improve the distribution of their drug. The manufacturers are also requesting data to support additional FDA indications, issues around adverse event reporting, patent extension opportunities, and value-based contracts which link coverage and reimbursement to a drug’s effectiveness.
Payer access and tactics
“Payer access is the predominant problem HSSPs face in providing an uninterrupted continuum of care and has the most significant impact to the patient through lower adherence, higher total cost, and delays in treatment,“ says Lindsey Amerine, PharmD, MS, BCPS, Director of Pharmacy, UNC Health. Glenn Wachter, MBA, MPA, AVP Pharmacy, Credena Health, discussed tactics utilized to minimize these impacts to the patient.
- First place to start is make sure you can serve your own employees. Health systems have the most influence over how care is provided to their employees.
- Contract with every national and regional PBM in your market. Access may be granted but it will be a narrow network.
- Need to compete in request for proposals (RFPs) to become part of payer and PBM networks. This is the most difficult and mostly focused on lowest unit price.
A newer strategy is to consider the data payers and PBMs need to show plan sponsors lower total cost of care. Value-based contracts require performance guarantees such as adherence and time to therapy but health systems need to move to next level data by connecting these guarantees to downstream health care encounters demonstrating lower cost of care by disease state and payer. Being able to report out this next-level data will be pivotal to payer access in the future.
Panelists from three academic medical centers shared why patient outcomes are better when pharmacists are embedded in clinics. They collaborate with physicians in drug therapy management, provide patient education, coordinate initiation/continuation of drug therapy, and intervene as appropriate to reduce adverse drug events. Members of the health care team operate from a common medical record and in close proximity, which reduces the time to therapy, improves adherence, and minimizes drug side effects leading to superior patient satisfaction and an improved patient journey. As health systems transition to value-based care models, they must show how this integrated care decreases the total cost of care.
Home infusion is a $19 billion industry that has grown by 310 percent since 2010. With the growing number of specialty infusible medications and payers utilizing site-of-care strategies to reduce costs, home infusion and alternate site infusion centers are essential to maintain continuity of patient care and retain system revenue. Hospitals should utilize a multi-disciplinary team to work proactively and review site of care changes to move these therapies to their home infusion or alternate site infusion centers.
Specialty medications now account for nearly half of the nation’s drug spend and account for 8 in 10 new drug approvals by the U.S. Food and Drug Administration. This has fueled a struggle for control of specialty prescriptions that will continue as the baby boomer population ages. Selling the value proposition of health system specialty pharmacy is a priority. Data analytics is vital to strengthening this message as health systems seek to differentiate themselves from big-box specialty pharmacies. They will achieve this goal through peer benchmarking, more robust manufacturer reporting, and research coalitions to accelerate the data collection that drives innovation.
As health systems advance their specialty pharmacies, participation in a network will be important. The reasons are clear: data consolidation and benchmarking, ease of contracting and data exchange with drug manufacturers, and performance metrics that payer networks cannot afford to ignore. With these advantages, HSSPs will be in a strong position and well-prepared to meet the future requirements of value-based care. More information about Acentrus Specialty and specialty pharmacy can be found at acentrusrx.com.