PBM- and health plan-owned pharmacies continue to dispense the majority of specialty medications, but patients’ experiences can be impersonal and less-than-timely. For this reason, many health systems have sought specialty pharmacy solutions by offering clinic-based specialty pharmacy services to improve patient care and outcomes. This approach, which embeds pharmacists and patient liaisons into care teams, started at academic institutions and larger integrated delivery networks and is now being successfully adopted by local and regional health systems too.
The growth of health system specialty pharmacies isn’t surprising given the organization-wide impact these programs have. Results from health systems using a clinic-based approach show that direct pharmacist-patient engagement enhances outcomes by providing more coordinated, high-touch care to people with chronic and complex conditions. Specialty pharmacy programs also offer financial benefits, often lowering the total cost of care for patients and creating a substantial financial opportunity for many health systems.
5 reasons health systems should seek specialty pharmacy solutions that accelerate program growth
In addition to improving clinical and financial outcomes, a specialty pharmacy program enables a health system to adapt and differentiate itself in the ever-changing marketplace. Five key market trends should drive health system leaders to consider how to accelerate their specialty pharmacy strategies to recognize:
- Continued vertical integration of health plans, PBMs, and retail providers: Consolidation among health plans, PBMs, and retail providers will continue to impact health systems. In addition to differentiating outpatient services to compete with retail providers, vertical integration in this sector will mean health systems need new and enhanced approaches to working with health plans. A specialty pharmacy program can help, especially for health systems with at-risk or value-based contracts. However, health systems must first prove the clinical and financial impact of their program. This requires operationalizing a specialty pharmacy program and collecting, analyzing, and presenting data that proves cost-of-care reductions beyond what the plans can achieve by themselves.
- Specialty pharmacy reimbursement shifting from medical to pharmacy benefits: To reduce costs, health plans are increasingly shifting coverage of provider administered “buy-and-bill” medications from medical to pharmacy benefits. This trend has led to “brown bagging” and “white bagging,” which create a confusing patient experience. “Brown bagging” and “white bagging” also increase expense due to waste of non-administered medications and pose a compliance risk for health systems. Health systems prepared to fill and administer specialty medications in-house will have a distinct financial advantage and reduced risk compared to other organizations.
- Heightened focus on patient experience to differentiate: The shift in control and buying decisions from providers to patients was widely discussed at the recent Becker’s Hospital Review annual meeting. As big players like Amazon enter the market and local competition increases, health systems must differentiate themselves by providing a convenient, data-driven, and personalized experience to attract and retain patients. Offering a specialty pharmacy program is a strategic way to create a superior patient experience that increases loyalty and builds brand equity.
- Clinician burnout: Patient satisfaction depends heavily on provider satisfaction, but recent research indicates many U.S. physicians and nurses are burnt out. Providers often spend up to 2 hours per day managing administrative tasks required for specialty drug prescriptions, time that could be spent on direct patient care. Health systems with specialty pharmacy programs alleviate this burden by placing pharmacy liaisons directly in specialty clinics to manage this work. Doctors and nurses then have more time to focus on patient care.
- Continued margin pressure: As health systems invest in outpatient services to combat inpatient revenue declines and improve margins, offering on-site specialty pharmacy services can bolster this strategy. In addition to creating a multi-million-dollar revenue stream, a specialty pharmacy program can improve a health system’s bottom line by attracting more patients to its outpatient clinics and reducing the total cost of care (and, thus, exposure under value-based contracts).
Evaluating specialty pharmacy solutions to make the best choice for your health system
When it comes to choosing a strategy for building and operating a specialty pharmacy program, health system leaders have two options: develop a specialty pharmacy program internally or collaborate with a specialty pharmacy services partner. To determine which approach is most appropriate, health system leaders must first assess their organization’s capabilities. Next week, we will outline capabilities required to accelerate a specialty pharmacy program and share questions health systems can use to evaluate potential partners.
Request an opportunity estimate to see the clinical and financial impact a specialty pharmacy could have for your health system or to determine if your current program is reaching its full potential.
Contact us to discuss how Trellis Rx can partner with your health system to develop and grow a specialty pharmacy program under your brand.
Ernie Anderson and Tony Zappa both have over 30 years of experience in pharmacy, including inpatient, ambulatory care, managed care, and specialty pharmacy. Mr. Anderson has held pharmacy leadership positions at Steward and Lahey Clinic Medical Center in addition to teaching at Northeastern University. Dr. Zappa has held pharmacy leadership positions at Fairview Pharmacy Services, Visante, Wellpartner, BioScrip, and more. Dr. Zappa is Co-founder and Chief Solutions Officer at Trellis Rx, and Mr. Anderson serves on Trellis Rx’s health system advisory board.