Data: Helping Define Value-Based Care

On Tuesday at the Asembia Specialty Pharmacy Summit 2019, AmerisourceBergen's Integrated Health Systems Outcome Coalition (IHOC) hosted a panel discussion on why health system specialty pharmacies (HSSPs) are uniquely positioned to provide valuable data and superior care to the patients they serve. Panelists included Champ Burgess, vice president of specialty pharmacy for University Hospitals; Liz Forner, director of national oncology pathways for Eisai US; Diane Giaquinta, president of StrategiCare; and Tom Koenig, executive director of biosimilar access for Boehringer Ingelheim. Liz Forner The session was moderated by IHOC’s Kristin Chambers, vice president of strategic development.

Given that half of large bed hospitals own and operate a specialty pharmacy¹ and more are entering the HSSP space, AmerisourceBergen created IHOC, a collaboration with key stakeholders to uncover market needs, use data to improve patient care, and drive access to specialty medications. IHOC knew that to create a successful access strategy, payers, manufacturers, and HSSPs must work together to ensure seamless care for patients. However, gaining access to some limited distribution networks and narrow payer networks has proved challenging for HSSPs.

In the past few years, manufacturers have recognized the value of the coordinated care model that HSSPs provide and have worked with HSSPs to include them in their network, with only a few exceptions. HSSPs must continue to be part of an access strategy for manufacturers while still devising ways to gain access to payer networks. Payers are often interested in managing only 1 or 2 specialty pharmacies to lessen costs and administrative burden. IHOC asked their panelists to weigh in on the importance of data—both hard, outcomes data and soft data, which include satisfaction data—to solve for access, value, and more.

Outcomes-based data are essential to tell the value story, but the story becomes even more compelling with the addition of electronic health record (EHR) data. “We’re interested in seeing appropriate time on therapy and how the therapy is scaled with disease progression,” Forner said. “These data can really give us insight into how the patient is being managed in multiple sites of care, not just the hospital or at home but both."

Chambers referenced the importance of collecting more than Tom Koenig just dispensing data to start getting to the bottom of coordinated care and its economic and clinical impacts. “If you can show that coordinated care saves money through reduced hospitalizations and results in happier, more compliant patients, that’s the holy grail,” she said. There was a consensus among the panel that HSSPs deliver faster time to treat, better adherence, and more frequent touch points as key differentiations for their patients, but that assertion is reinforced in the patient and provider experience.

“As a former payer, if you can reduce patient and provider calls to me, I am grateful,” Giaquinta said. “Couple that with an enhanced data set that supports robust outcomes and quality measurements, and I would consider providing access.”

The panel also referenced the importance of patient and provider satisfaction results. Burgess shared the significance of understanding that both patients and providers value having a specialty pharmacy integrated within their health system. Not only was this validating for his efforts, but he also learned a lot in the process, he said.

“We scored very well. Although 100% of providers were satisfied with our services, we received feedback on improving the communication process with providers to enhance the experience even more,” Burgess said. “Similarly, with our patient satisfaction survey, we had a net promoter score of 86 that’s driven by the pharmacy staff’s attentive treatment of the patient. That is a great message to deliver to manufacturers, payers, patients, and my team.”

When asked about the future of HSSPs, the group readily agreed that defining and delivering on value-based contracting is a huge opportunity.

“Rethinking how we approach value is essential. With so many options, including biosimilars and cell and gene therapy, working with a trusted partner to define meaningful outcomes can create a win-win for all,” Koenig said.

When wrapping up the panel, Giaquinta offered advice to HSSPs and payers.

“By working together, HSSPs and payers can streamline the process for starting patients on these important therapies by documenting diagnosis, supportive testing, and other therapies tried, then quickly initiating treatment [in compliance with] payer coverage policies,” Giaquinta said.

She added that “utilizing the information in the EHR coupled with the patient experience on therapy [adherence, adverse effects, disease or symptom improvement] provides an opportunity for outcomes-based contracting and other real-world research opportunities.”

Forner closed the panel by reminding attendees, “Above all, assume best intentions. Whether you are a manufacturer, trade partner, or pharmacy, the patient is at the center. Keeping open communication and trusting that a solution can and will benefit everyone across the care continuum is vitally important.”

Reference

1. Craig A. Pederson, BSPharm, PhD, FAPhA, Philip J. Schneider, MS, FASHP, FFIP, FASPEN, et al., ASHP National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing — 2016, American Journal of Health-System Pharmacy, July 2017, accessed January 2018 at ajhp.org