3 Key Take-Ways from Trellis Rx’s May Health System Specialty Pharmacy Webinar

Published 06/11/2020
by Brandon Newman

By Brandon Newman, Vice President of Clinical Affairs at Trellis Rx  

Trellis Rx recently hosted an educational health system specialty pharmacy webinar focused on how pharmacy leaders at health systems can enhance patient care and create value for other stakeholders by measuring disease-specific outcomes. 

During the webinar, we outlined steps health system specialty pharmacies can take to begin tracking clinical and qualitative metrics, in addition to operational and experiential ones. Courtney Zitterkopf, PharmD, and Colleen Donahue, RN, also shared a real-world case study from Memorial Hospital at Gulfport’s rheumatology clinic.  

If you couldn’t attend the webinar, here are three key take-awaysas well as our responses to questions asked by attendees. 

Miss the health system specialty pharmacy webinar? You can now access the webinar recording and slides here. Pharmacists interested in gaining continuing education credit can find instructions on how to do so here. 

Three Key Take-Aways 

1. Because of their integration with care teams and the EHR, health system specialty pharmacies are uniquely positioned to collect the clinical and qualitative data needed to assess therapy effectiveness and recommend interventions if needed. This allows a health system specialty pharmacy to create unique value for patients and other stakeholders, including health plans, by driving improved clinical outcomes and potentially reducing the overall cost of care.  

2. To successfully leverage disease-specific outcomes to enhance patient care and outcomes, health system specialty pharmacies need: 

    • Embedded, specialty-trained pharmacists who can not only conduct patient assessments, but also evaluate data to assess therapy effectiveness and trigger provider interventions if needed. 
    • EHR-integrated specialty pharmacy technology platform with disease-specific, evidence-based protocols, as well as advanced data analytics and reporting capabilities. 
    • Clear understanding of what metrics to track for specific patient populations. This isn’t always straightforward because some disease states do not have defined clinical markers that indicate treatment success. 
    • Buy-in from patients, providers and other stakeholders such as drug manufacturers and payors.  

3. Measuring disease-specific outcomes can directly translate into better patient outcomes. The case study shared by our health system partner, Memorial Hospital at Gulfport, provides a tangible example. Last year, the rheumatology care team began using the RAPID-3 assessment to assess disease severity in patients with rheumatoid arthritis. This validated patient-reported outcomes tool enables the care team to proactively identify and support patients with worsening symptoms. 

Earlier this year, the care team identified a patient who was experiencing disease progression while taking Etanercept. Courtney, our embedded specialty pharmacist, conducted an initial RAPID-3 which indicated the patient had moderate severity (11.3 score). The care team leveraged this data, as well as other clinical markers, to gain approval from the patient’s health plan to change her therapy to Tofacitinib, the provider’s preferred therapy. When Courtney conducted a second RAPID-3 assessment 8 weeks after the therapy change, the patient’s score had improved significantly to 4.3. 



We received many great questions from attendees during the webinar, which we have responded to below. If you have additional questions, please feel free to email me directly.  

  1. Does the patient need to provide consent prior to the pharmacist completing the RAPID-3 assessment? We recommend consulting your health system’s legal team on this question. 
  2. How would a clinical pharmacist track diseasespecific outcomes in patients with multiple sclerosis (MS)? Determining what clinical and qualitative metrics to track for patients with MS is not straight-forward, but progress is being madeBecause depression is a prevalent comorbidity associated with poorer outcomes for patients with MS, Trellis Rx and our health system partners are using the PHQ-9 assessment to screen patients for symptoms of depression. This allows us to proactively identify patients who may need additional support or therapy and alert their providers.  
  3. What is the best tool for measuring quality of life in patients with cancer? While there isn’t one “best” quality of life tool in oncology, there are several patient reported outcome surveys that have been validated or adapted for use in patients with cancer. These surveys are usually assessing symptoms, side effects, or supportive care medication use.  Additionally, many cancer centers do have distress score questionnaires already implemented in their workflow or in the EMR that can be used or adapted.
  4. The speakers mentioned 2 additional tools that can be used for patients with rheumatoid arthritis. What are these and why did you choose to use RAPID-3?
    The other tools are CDAI (Clinical Disease Activity Index) and DAS28 (Disease Activity Score 28).  We chose RAPID-3 over the other tools because we found that it is more commonly adopted, can easily be implemented into clinic workflows, and can be quickly administered to patients. 
  5. What software is being used that provides the longitudinal tracking via the dashboard. I love that the software will alert the team to 2 consecutive worsening of symptoms. 
    Trellis Rx’s health system partners use our ArborTM specialty pharmacy technology platform. 
  6. Have you been able to publish any of this data? If so, where could this be accessed? 
    We are in the process of conducting our first outcomes study in the rheumatology space. We expect to publish it by this fall! We have published other studies focused on the impact of the medically-integrated health system specialty pharmacy care model on medication turnaround times for patients with cancer and medication access and adherence for patients with Hepatitis C.
  7. Do the pharmacists and liaisons document their interventions in the health system’s EHR as progress notes? 
    This would depend on the EHR and the clinic workflow. The intervention is documented in a way to notify the prescriber of the problem which allows him/her to use clinical judgement for next course of action.
  8. If a patient with RA is having a flare with pain, how quickly can you get their medication approved from prior authorization?
    Our average turnaround time from script to mouth” at Memorial Hospital at Gulfport is 3 days.
  9. Is there a copyright to use RAPID3? Can any pharmacy use this?
    Yes, there is a copyright to use RAPID-3. We recommend contacting RWS Life Sciences for more information.
  10.  Do you still provide these services for patients who are not in-network or contracted with your specialty pharmacy?
    Yes, we offer administrative support (benefits investigation, prior authorization, financial assistance) and clinical services to all patients even if we cannot dispense their prescription due to their insurance. We believe providing our services to all patients is critical to driving the best patient experience.
  11. How does the patient complete the RAPID3 assessment (e.g. on paper, over the phone, via the patient portal)? How do you flag for clinicians to intervene? Is flagging automatically done via directly within the EMR software or through a third party software?
    We primarily collect RAPID-3 assessments via the phone, though we are also in the process of implementing a digital solution. We use our ArborTM specialty pharmacy technology platform to track RAPID-3 scores over time. After two consecutive worsening scores, ArborTM triggers an intervention for our pharmacist who alerts the care team via the EHR. 
  12. Do the pharmacists and liaisons document their interventions in the health system’s EHR as progress notes?
    This would depend on the EHR and the clinic’s workflow. You should seek to document the intervention in a way that notifies the prescriber of the problem in a timely manner and allows him or her to use clinical judgement to determine the best course of action. 

Miss the health system specialty pharmacy webinar? You can now access the webinar recording and slides here. Pharmacists interested in gaining continuing education credit can find instructions on how to do so here.