Our March 2022 Becker’s Hospital Review webinar focused on the important role that specialty pharmacy services can play in a health system’s journey from volume to value. The panel discussion featured both health system executives and pharmacy leaders who reviewed key areas of focus for outpatient and specialty pharmacy as part of a broader value-based care strategy. The panelists included:
- Greg Wozniak, President and CEO, Denali Health and Executive Advisor to Trellis Rx (Moderator)
- Joyce Markiewicz, RN, BSN, MBA, CHCE, EVP & Chief Business Development Officer at Catholic Health in Buffalo, NY
- Paul Krogh, PharmD, MS, BCPS, System Director, Pharmacy Services at North Memorial Health in Minneapolis, MN
- Michele Chulick, MBA, Formerly CEO at Wyoming Medical Center and current Executive Advisor to Trellis Rx
- Brandon Newman, PharmD, CSP, MMHC, Chief Operating Officer at Trellis Rx
The discussion centered on three topics that support the role specialty pharmacy can play in the journey to value:
- The panelists talked about their experience in evolving specialty pharmacy services and the strategic impact of those services. They underlined the key point that specialty pharmacy services touch multiple strategic objectives for a health system and represent an opportunity to implement or accelerate an enterprise-wide program.
- The panelists reviewed the importance of identifying, measuring, reporting, and leveraging clinical outcomes as a driver of success for specialty pharmacy services. Joyce discussed how Catholic Health has focused its efforts on diabetes and improving access to care for the patients they serve. Paul reviewed specific metrics in Rheumatology and Infectious Disease and revealed how those outcomes impact both provider and payor interactions.
- Finally, Brandon reviewed other disease states that Trellis Rx routinely tracks and reports the clinical outcomes of, pointing the audience to our recently-published patient impact report.
The webinar concluded with the panelists offering their recommendations and advice on how to accelerate specialty pharmacy services as a strategic imperative. They offered five action items for health systems trying to elevate the role of specialty pharmacy services, and Michele in particular articulated how to approach the C-Suite on this topic.
Below are the questions received during the webinar from audience members with responses from the panelists and Trellis Rx experts. For more information on the webinar and topic, watch the on-demand version HERE.
How are your organizations measuring clinical outcomes and quality?
As the panelists reviewed during the discussion, Catholic Health and North Memorial Health have an intentional and focused approach to measuring, reporting, and leveraging clinical outcomes and quality in their specialty pharmacy services. Both organizations leverage data collected during clinical interactions with pharmacists and data from the EHR to evaluate and impact patient outcomes on an ongoing basis. The technology platform (Trellis Rx’s Arbor® system) underpins those efforts to drive day-to-day clinical work and provide the analytics associated with outcomes reporting.
Joyce reviewed the approach Catholic Health has taken for patients with diabetes, including risk stratification and more intensive and frequent engagement for patients with A1C greater than 10.
Paul reviewed examples of patient-reported outcomes collection in Rheumatology and the use of the RAPID3 score. He outlined how the ongoing collection and monitoring of that data leads to interventions from North Memorial’s pharmacist for patients with worsening scores. He also discussed how North Memorial Health has used this methodology and the outcomes that it drives in their discussions with health plan partners.
Brandon reviewed the overall approach Trellis Rx takes with our health system partners to outcomes measurement and quality reporting highlighting metrics across nine disease states.
You can access those metrics and results through our patient impact report HERE.
Where are pharmacists involved in the Clinical Outcomes at Catholic Health? What is the revenue generated?
At Catholic Health (and North Memorial Health), the pharmacists engage directly with physicians and patients in the clinic setting and they follow up telephonically to support patient adherence to therapy. The pharmacists collect and evaluate clinical data and patient-reported outcomes to support therapeutic choices and counsel patients and providers on medication-related questions and issues (i.e. side effect management), as well as potential changes to medication regimens. The revenue to the health system comes from prescriptions dispensed in their pharmacies.
Brandon discussed clinical outcomes as a strategy. Coupled with clinical outcomes (strategic service as Brandon put it), to what degree are your systems putting the Health System Specialty Pharmacy at the center of clinical/treatment decisions, formulary decisions, etc? How much weight is being given to that pharmacist to drive patient therapy for the entire Health System?
Across our Trellis Rx partner health systems, we see that as the impact of the specialty pharmacy services grows for patients, so grows the pharmacist’s impact on overall treatment decisions and therapeutic choices. Given the nature of the specialty pharmacy model, pharmacists working directly with the providers must earn their trust and earn the right to provide increasingly meaningful advice and guidance. And while the ultimate therapeutic choice rests with the provider, we see that pharmacists become trusted advisors to the physicians as they demonstrate the ability to impact patient adherence and outcomes. For example, pharmacist interventions can result in the conclusion that a medication is no longer effective – something the provider might not see or catch until the next patient visit. By intervening between visits, the pharmacist can enhance therapeutic effectiveness in collaboration with the physician.
This also happens because the specialty pharmacist and specialty pharmacy patient liaison often become the most frequent point of contact for the patient within the practice. As Paul pointed out in the discussion, they provide an important and valuable service to all patients (irrespective of whether the health system dispenses their prescription) and as such, contribute significantly to overall patient satisfaction and patient experience. This positive impact translates to their relationship with the provider and in turn, builds the trust required for the pharmacists to impact therapeutic decision-making. Over time, this can lead to broader implications for the way that specialists across the health system think about therapies, and results in more consistent outcomes-driven decision-making.
With nearly 75% of specialty meds dispensed by three national PBMs, how do IDNs gain network access to those patients? What was your first step in getting into new networks? How did you start the conversation with payors?
One of the key reasons for measuring outcomes and quality in health system specialty pharmacy is to drive access to payor networks. Those health system specialty pharmacies that have successfully accessed payor networks (both locally and nationally) have consistently and repeatably demonstrated clinical, operational, and patient satisfaction results that outperform traditional PBM-owned or retail specialty pharmacies.
This begins with the clinical model: Specialty-trained pharmacists and pharmacy liaisons working side-by-side every day with physicians and their staff to engage patients and drive adherence and results. That model must be underpinned by a technology solution that ensures consistent application of clinical protocols and evidence-based guidelines that support best-in-class clinical care. In addition, the health system must have a deliberate approach to collecting, monitoring, and acting on clinical outcomes, to improve care and analyze/report on those outcomes.
Accreditation is “table stakes,” and is not sufficient to merely mimic the PBM-owned specialty pharmacy model that relies on remote call center engagement and waits for prescriptions to be written. Health systems have the opportunity to demonstrate a differentiated approach to specialty pharmacy services and must do so to achieve and maintain network access.
More advice and insight for health systems on payor engagement for specialty pharmacy services can be found in the research study we commissioned in 2020. Access a copy of the research findings HERE.
Could you describe your leadership structure within your specialty pharmacy?
Both North Memorial Health and Catholic Health have similar leadership structures in their specialty pharmacy services since both are Trellis Rx partners. We provide a dedicated site leader who owns the day-to-day operational and clinical responsibilities for the specialty pharmacy services, and is accountable for the pharmacy leadership at the respective health system.
For those that chose to partner instead of starting their own specialty pharmacy, what are you doing to navigate the 340B restrictions being placed by manufacturers?
Starting or growing an in-house specialty pharmacy service, whether on your own or with help from Trellis Rx, is the best mitigation against the restrictions we have seen from manufacturers. Manufacturers are restricting the use of contract pharmacies by health systems, but will grant exceptions for specialty pharmacies that are owned by the health system. If you choose to partner, it is important that the specialty pharmacy be owned by your health system and not the third-party partner. With Trellis Rx, our health system partners own the pharmacy, are responsible for licensing, and can ultimately “insource” the entire specialty pharmacy service at the end of our partnership agreement if they wish.
For more information about contract pharmacy restrictions and options to mitigate those risks, you can review our Executive Insight report HERE.
For health systems that are considering starting a specialty pharmacy, what ways can senior leadership provide support to the pharmacy team to accelerate the advancement of their pharmacy technicians to ensure they are achieving the patient satisfaction and outcomes that are desired?
As you are likely aware, technicians represent a critical component of the specialty pharmacy service model. Their work is vital in helping patients gain access to medications, ensuring patients remain compliant with their regimens, and getting the financial assistance patients need to remain adherent to therapy. Technicians also remain some of the hardest roles to fill across the country in the current job market, irrespective of setting or type of pharmacy. Given this, health system leadership can and should underline the critical importance and value of the technician/liaison role for the specialty pharmacy service. They can invest in certification and training programs for their team members, and promote the patient-focused nature of specialty pharmacy services. These are distinct from the retail setting, particularly in large retail chains. Technicians in health system specialty pharmacies are relied on as important members of the care team and not just operational contributors. Because the service is aligned with the health systems specialty practices, working hours reflect those of the physician’s office, typically Monday to Friday during the day. Underlining these advantages and making investments in certification and training will help to attract and retain the top-notch technicians and talent required to drive success in the health system specialty pharmacy arena.
Some new to market specialty medications require administration by a health care provider but are billed under pharmacy benefits. How are various organizations addressing this issue? One solution is clear-bagging, but there are many challenges with that model. Additionally, white-bagging and brown-bagging present even more challenges.
To address this complex and ever-evolving topic, we published an Executive Insight report written by our Chief Pharmacy Officer, Jerry Buller. In the report, Jerry discusses the site of care shifts that health systems are facing and the trend for specialty medications to be reimbursed under the pharmacy benefit. Jerry suggests strategies that health systems can deploy to combat these trends and create win-win scenarios with their key payor stakeholders. The report also includes links to other helpful resources on the topic. You can find a copy of the Executive Insight HERE.
If you have additional questions about this topic, please contact us.