Health System Specialty Pharmacies Impact Medication Adherence, Total Cost of Care

Bill McElnea, vice president of Population Health at Shields Health Solutions, discusses the growing body of research demonstrating the value of health system specialty pharmacies (HSSPs) in improving patient outcomes and reducing health care costs. HSSPs also improve medication adherence rates, which is a key quality metric in value-based care arrangements. For chronic conditions like diabetes, COPD, and CHF, HSPs can increase adherence from the national average of 60% to 65% to over 90%. Overall, the research establishes HSSPs as an effective care model that can benefit patients, providers, and payers.

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Q: What is the impact of health-system specialty pharmacies on reducing the cost of care and improving clinical outcomes for patients?

Bill McElnea: There's been a growing body of research in recent years on this topic. I think probably the most recent study right now some that came out late last year in the Journal of Oncology Pharmacy Practice, which looked at about 25 different health systems, pretty large cohort of oncology patients, some that were filling with HSSPs, some that were not, and the study found that oncology patients filling through an HSSP were associated with about a 32% Medical Expenditure that was 32% lower than folks that were filling with a different type of pharmacy, and also found about 14% lower pharmacy costs as a result of filling with an HSSP. So that was one of the more recent studies that that came on out. Back in 2022, we were part of an effort with Optum Advisory Services to look at about 20 different health systems and their HSP programs, and that study was published in the Journal of Managed Care and Specialty Pharmacy, and found that patients filling with in an HSSP were associated with a total cost of care that was 13% less than patients dealing elsewhere. So definitely a growing body of knowledge and growing body of research that's been coming out recently supporting HSSP's impact on total cost of care.

Q: How can the pharmacist’s role in value-based care and population health help to improve patient outcomes?

Bill McElnea: I think I'll be the short answer is just adherence, I mean, HSSPs, real bread and butter, is medication adherence, and one thing you'll find in the range of value-based care arrangements is that quality measure. A lot of them include how a health system is doing on adherence, and depending on how they're doing on that, as well as other measures, that could have financial impacts for them as well. So one of the things that they'll I'm hoping to talk more about today is how HSSP can impact a wide array of measures under value-based care arrangements. Obviously, if you can get the adherence piece right, other measures like glycohemoglobin scores, blood pressure, even statin adherence and things of that sort. They're all impacted, and those are whole sort of common measures also in in a value-based care arrangement.

Q: According to the presentation, HSSPs have been expanding to include disease-specific care, such as for diabetes, COPD, and congestive heart failure. What are the advantages of disease-specific care provided by HSSP have for patient outcomes?

Bill McElnea: One thing to keep in mind is that for some time now, HSSPs have been servicing those disease states as a comorbidity, pretty much since HSPs. You know, got started, what is a bit newer is HSSPs, servicing those disease states for patients that have that as a leading disease, and that has turned into a real game changer and a real growth area in the HSSP space. What we're seeing is adherence rates markedly going up. Something important to note that national adherence rates in those disease states diabetes, [chronic obstructive pulmonary disease (COPD)], [congestive heart failure (CHF)], tend to on a good day, hover around 60% to 65%. So we're talking now about the HSSP model coming in and be able to bring those rates to higher than 90% PDC, and everything that kind of blossoms from that. So because of that we're seeing a lower level glycohemoglobin scores; we're seeing admissions go down. It's clear now that HSSPs is having similar impact in these non-traditional spaces that it's had for a long time and traditional specialty.

Q: How can evolving technology play a role in helping to optimize HSSP for patient care?

Bill McElnea: I'm happy to try to answer this from a population health perspective. There's been a lot of great sort of interesting new digital platforms that have been emerging. Pearl Health is one that are really helping health systems to identify those patients that that are most at risk for a hospital admission or other type of exacerbation, as well as patients that are on their way to that category. I think what's an exciting development is is the potential to pair the power of the HSSP care model with that type of software. So providers can really, increasingly, get that HSSP care to those patients that that really need it most. I think another really interesting area is remote monitoring technology as well. Some of our pharmacist programs are already using this in diabetes, making sure that they're keeping an eye on patients glucose trends. So not just being able to know when a patient is having like a high or a low, but also how they're trending and to be able to take those trends and take that information and really deliver a lot more comprehensive care.

Q: How do you see HSSPs growing and evolving in the coming years?

Bill McElnea: I think one sort of basically I think that the recognition that this is a great care model and one that is really, really meaningful to patients. Full disclosure, I myself I use a hospital-owned specialty pharmacy for my own care, and it has saved me countless hours of having to manage pharmacy bureaucracy has been a real game changer. I think it's been a real game changer for clinics and clearly for health systems and payers as well. So I think you're going to see growing recognition of that and in a lot more adoption of HSSP. Another area that I think will be impacted is the menu of disease states that HSSPs service, it's still pretty early innings in the diabetes, COPD, and CHF world in terms of HSSPs doing stuff in that in that area. So I think we're going to probably see a lot more of that and probably just a growing menu of disease states that HSSP can service.