By Brandon Newman, Vice President of Clinical Affairs, Trellis Rx
Health system specialty pharmacies have traditionally tracked the same operational metrics as independent and PBM-owned specialty pharmacies – turnaround times, medication adherence rates and patient satisfaction to name a few. The focus on these performance indicators has predominantly been driven by a desire to achieve specialty pharmacy accreditation, not to improve clinical efficacy or performance.
While operational metrics remain important, they fail to provide the data needed to enhance clinical outcomes. They also fall short in demonstrating the role medically-integrated specialty pharmacy services can play in improving clinical outcomes and lowering the cost-of-care. This makes it difficult for health systems to communicate the value of their specialty pharmacies to drug manufacturers and payers, ultimately inhibiting their ability to build partnerships that would benefit patients.
Ensuring the appropriate and effective use of high-cost specialty medications is a priority for all stakeholders. Specialty medications can significantly benefit a patient’s health and quality of life. They can also prevent disease progression, adverse medical events and hospitalizations. The question lies in how to ensure patients are receiving these benefits.
To answer this question, leading health system specialty pharmacies have begun tracking disease-specific metrics. These data points help care teams enhance clinical outcomes by determining if patients have achieved desired therapeutic results from their specialty medications. They also enable providers to intervene more quickly to change patients’ therapy regimens when needed.
What your health system specialty pharmacy needs to measure disease-specific clinical outcomes
By tracking disease-specific metrics, health system specialty pharmacies can further improve patient care and outcomes. However, evaluating the effectiveness of specialty medications in clinical practice is not always straightforward.
Some disease states, including diabetes and hepatitis C, have defined clinical markers that indicate treatment success. Others, like rheumatoid arthritis and multiple sclerosis, lack such clinical markers. For these conditions, evidence-based assessments and patient-reported outcomes can help providers evaluate if patients are responding to therapy.
In either case, tracking disease-specific clinical outcomes requires collecting information from patients and effectively communicating it with providers. Compared to independent and PBM-owned specialty pharmacies, medically-integrated health system specialty pharmacies – which embed clinical pharmacists and specialty pharmacy liaisons directly into patient care teams – are uniquely positioned to do this. Because pharmacists work on-site at the health system and not off-site in a remote call center, they can build personal relationships with patients and closely collaborate with providers.
Furthermore, health system specialty pharmacy teams have access to patients’ electronic medical records. This streamlines care team communication and provides the data needed to determine the impact of specialty pharmacy services on patient outcomes and cost-of-care.
However, these capabilities alone are not enough to successfully leverage disease-specific clinical outcomes metrics in practice. Health system specialty pharmacies must have the clinical expertise to develop disease-specific outcomes metrics and protocols. A specialty pharmacy technology solution is also needed to ensure data is consistently collected and documented by all specialty pharmacy team members.
Although implementing disease-specific outcomes metrics in practice often proves challenging, health system pharmacy leaders must begin leveraging these data points as a tool to enhance patient care and demonstrate the unique value of their specialty pharmacy services.
How Trellis Rx and our partners are leveraging disease-specific outcomes metrics in 2020
Working together with our health system partners, Trellis Rx is measuring disease-specific clinical outcomes metrics across multiple patient populations in 2020. Here are three examples:
- Cardiovascular Disease / Hyperlipidemia: 80% of dispense opt-in patients taking PCSK9 inhibitors will achieve their designated LDL cholesterol goal within 6 months of therapy initiation.
Helping patients achieve their LDL reduction goals can lower their overall cardiovascular risk, reducing the likelihood of a heart attack or stroke. With PCSK9 inhibitors, peak LDL reduction is typically seen within 6 to 8 weeks of therapy initiation.
An initial study conducted with one of our health system partners found that patients who received clinical support and dispensing from the health system’s specialty pharmacy service had an average LDL reduction of 63 percent. Patients who received clinical support but had their medication dispensed from an external specialty pharmacy had an average LDL reduction of only 38 percent.
- Migraine: 95% of dispense opt-in patients will be assessed for treatment efficacy during the first 3 months of CGRP modulator treatment. Patients who do not have appropriate migraine control will be referred to their provider for treatment re-evaluation.
Obtaining control over migraines enhances a patient’s quality of life and can prevent emergency department visits, absenteeism, and long-term disability. CGRP modulators, the newest class of migraine therapy, can reduce the frequency of migraines up to 50 percent. However, these therapies are not effective for all patients.
Our embedded pharmacists will leverage an evidence-based survey to identify patients who do not have appropriate migraine control after three months of CGRP modulator treatment. These patients will be referred to their provider for treatment reevaluation. This approach of closely evaluating patients between their prescriber appointments will help these patients get on an effective medication faster, which can decrease the burden of migraines on patients and our society.
- Rheumatoid Arthritis: 95% of dispense opt-in patients will have a RAPID-3 assessment performed for disease management. Patients who have an increased RAPID-3 score in two consecutive assessments will have a prescriber intervention.
The RAPID-3 assessment is a patient-reported outcomes survey that evaluates how rheumatoid arthritis impacts patients’ day-to-day activities and quality of life. A high RAPID-3 score indicates a patient’s rheumatoid arthritis is not under control, while a low score indicates a patient is near remission.
Our embedded pharmacists use the assessment to understand if patients are responding to therapy and, if not, consult with their provider for an intervention. Given the influx of additional therapeutic options for the treatment of rheumatoid arthritis in recent years, we believe this approach will increase the adoption of “treat to target” utilization of biologics and ultimately improve patient outcomes.
To date, we have successfully used the RAPID-3 assessment to overturn initial coverage denials and ensure patients have access to the therapies that make a difference in their lives. We are also collaborating with Pfizer on rheumatoid arthritis and atopic dermatitis projects focused on how we can collect patient reported outcomes and leverage this data to optimize their care and treatment.
Looking ahead: 2020 outcomes studies
We believe that health system specialty pharmacies can improve patient outcomes by tracking these and other disease-specific metrics. This data will help care teams keep patients on the most effective treatments, switch or discontinue medications when high-cost therapies are ineffective, mitigate adverse events, and reduce hospitalizations. It will also help health systems demonstrate how their specialty pharmacies can further the goals of drug manufacturers and payers, enabling health systems to support more patients who require specialty medications
We look forward to leveraging disease-specific metrics in 2020 to partner with health systems and other stakeholders to enhance patient care and quantify the clinical and financial impact of medically-integrated health system specialty pharmacy services.
Learn more about how health systems are enhancing outcomes for patients and providers through medically-integrated specialty pharmacy services on the Trellis Rx blog or contact us to discuss building or growing your health system’s specialty pharmacy service.