Bridging the Gaps in Patient Care: The Value of Proactive Engagement in the Specialty Care Model

The patient care model employed by specialty pharmacies emphasizes communication and coordination among stakeholders.

A recent New York Times article, “Lost in Clinical Translation,” highlights the lack of effective communication in today’s health care delivery model.

“Well, that was as clear as mud,” said a patient to a nurse after her medical care team provided her with an overview of her diagnosis and treatment plan.

Many patients do not have the clinical education or background to translate the overwhelming amount of information being communicated to them by their health care team. Providers also lack the time to effectively communicate a diagnosis or therapy regimen so that patients fully understand their options.

This gap in communication is even more pronounced when there is a complex disease diagnosis—such as cancer. In a 2011 benchmark study performed by Biologics, we found that the average cancer patient saw more than 13 different health care providers in a 12-month period. In fact, more than 46% of these patients saw more than 21 unique health care providers. When trying to navigate through such a complicated health care system where communication can be fragmented and misinterpreted, patient outcomes suffer, resulting in unnecessary and excessive health care costs.

Patients are left feeling confused, with a lost sense of control over their own health, and are often unaware of questions that should be asked. In a recent Johns Hopkins study, patients expressed their desire to be more involved in their medical decision making.¹ Patients unanimously believed that it was “very important” for physicians to involve them in their medical decision making, and to explain how their disease affects them, discuss treatments, listen to their complaints and concerns, and counsel them.

Specialty therapies are by their nature complex, and the health care community cannot assume patients understand all the benefits and potential consequences associated with treatments. This is especially true as newer specialty therapies move outside of the physician’s care setting where they have been traditionally administered. Specialty pharmacies are specifically designed to support patients undergoing chronic treatment who require a great deal of education, intervention, and support, with specialty pharmacists adding value by helping avoid unnecessary costs, providing proactive counseling, and managing patients through the course of therapy. Perhaps what makes specialty pharmacies most valuable is their ability to help bridge the gap in communication.

Specialty pharmacies help close this communication and coordination gap by providing a high-touch, clinically relevant patient care model so that patients have the knowledge and confidence to be more in control of their disease. By assigning a multidisciplinary team to the patient rather than assigning the patient to a facility, specialty pharmacies are able to support patients through their entire treatment journey. This allows specialty pharmacists to provide complete visibility into the patient’s profile so caregivers and providers can help support and enhance future care.

Patient Engagement to Establish Trust

The patient journey for those with complex conditions, such as cancer, begins at the point of diagnosis. Throughout this journey, many are faced with clinical, financial, and emotional hardships. Assigning a dedicated care team that supports the holistic needs of the patient helps establish consistent communication between the patient and health care team. This consistent communication builds trust and confidence.

One of the most critical factors in supporting patients through their treatment journey is recognizing that every patient, and every therapy, is different—therefore, communication and care need to be tailored to support the individual.

This communication must start early. Upon receipt of a prescription, many specialty pharmacies have specialists perform a benefits investigation to understand a patient’s insurance coverage. These specialists also work very closely with foundations and biopharma copay programs to help facilitate financial assistance when needed, all of which is communicated back to the treating provider. This process adds value by alleviating the financial burden for the patient and the administrative burden for the provider practice, while helping to ensure that the payer is covering appropriate, evidence-based care.

This high-touch model continues once a patient’s benefits are verified and they receive therapy. Many specialty pharmacies provide a pharmacist and a nurse to perform assessments throughout a patient’s journey. The relationships formed through this engagement add value to the health care delivery system by helping improve medication adherence and time on therapy. This proactive engagement also allows the team to anticipate and mitigate potential adverse events that are commonly associated with certain specialty therapies.

For therapies that have complex dosing regimens, issues of overadherence can become a factor that negatively affects patient response and outcomes. In these situations, the use of big data becomes more unreliable and more difficult to accurately leverage as a patient management tool. It takes strong engagement and a close relationship with the patient to identify and develop strategies to avoid potential overadherence. This is where the capabilities of a high-touch specialty pharmacy really shine.

Deep Clinical Expertise to Help Support Emerging Therapies

As more targeted therapies come to market to support small patient populations, biopharmaceutical companies are recognizing the need for high-touch, clinically relevant specialty pharmacies as part of their distribution model. Today, many of the oral oncology drugs that are approved by the FDA have strict risk evaluation and mitigation strategies requirements that intensify the need for specialty pharmacies to provide ongoing counseling and a deep level of clinical expertise.

Our understanding of cellular biology has exploded over the past decade, identifying many potential pathways that can be targeted by novel therapeutics. Innovative diagnostics, coupled with these new targeted therapies, offer a great deal of promise in the treatment of a number of previously fatal conditions.

However, many of these newer therapies have complicated dosing regimens that require significant diligence on the part of the patient, and dosing schemes that require modifications based on response and side effects. This can be extremely challenging for a patient who is not being actively monitored to understand when it is appropriate to modify their own dosing regimen. Having a specialty pharmacy care team, with deep clinical expertise that the patient can rely on, helps to address these issues and optimize the treatment success rates.

Visibility into the Full Patient Profile to Optimize Care

Most specialty pharmacies have significant data infrastructure and robust monitoring programs that are able to identify potential adherence deviations based on utilization. Patient care plans that accompany every patient and every therapy are continuously measured to ensure effectiveness, including tracking the reasons for discontinuation and rationale for changes in a patient’s therapy.

These data are captured throughout every patient touch point and provide valuable insights to the pharmacy, providers, biopharmaceutical companies, and payers. By attaching a dedicated care team to the patient, specialty pharmacies are able to track patient specific outcomes throughout the entire continuum of care. Data captured include over- and underutilization, medical therapy management, time on therapy, adverse events, and payer mix, to name a few.

Specialty Pharmacies: Part of a Larger Health Care Team

While specialty pharmacies help deliver care to patients, it’s important to recognize that they are part of a larger health care team that includes providers, partner pharmacies, payers, and biopharmaceutical companies. Communication, coordination, and collaboration among all the stakeholders are imperative in supporting effective and efficient patient care.

As health care evolves, more lines of communication among stakeholders will need to open. Drug manufacturers should continue publishing results early and educating the health care community about therapies in development. Physicians, pharmacists, nurses, and others on the health care team should have an open and ongoing dialogue throughout a patient’s therapy. Health plans will need to continually adapt to create benefit designs and payment models that support patient care and ultimately improve outcomes as well.

The value that specialty pharmacies bring today—and will bring in the future—is their experience and ability to collaborate with all stakeholders on behalf of the patient.

Ron Smith, PharmD, MBA, is chief operating officer of Biologics, Inc. He previously served as chief operating officer of Physicians Pharmacy Alliance and as vice president of strategic development and health innovation for Blue Cross and Blue Shield of North Carolina.

References

• Study reveals significant gaps in patient self-management of diabetes in Trinidad and Tobago [press release]. Johns Hopkins Medicine website. www.hopkinsmedicine.org/news/media/releases/study_reveals_significant_gaps_in_patient_self_management_of_diabetes_in_trinidad_and_tobago. Published February 28, 2013.