Key Metrics That Support the Integrated Specialty Pharmacy Model

What makes integrated specialty pharmacies so effective? Pharmacists are part of the patient care team and have access to the electronic medical record (EMR) and appointment schedules, which allows them to coordinate and advocate for patients through a high-touch, white-glove care model.

Credit: I Viewfinder - stock.adobe.com

These advantages enable the health-system specialty pharmacy (HSSP) team to defragment care, promote better patient outcomes, and reduce the total cost of care.

Patient and Provider Satisfaction

Health systems have begun to view patients as active participants who have a role and responsibility in their health care decision-making.¹ As HSSPs work to understand the wants and needs of their patients and providers, they can customize the specialty pharmacy care model to ensure it aligns with these priorities.

Patient satisfaction is an important measure for specialty pharmacies and accrediting agencies.^2-4 One way to measure satisfaction is to include a question about Net Promoter Scores (NPS) in patient surveys.

A high NPS reflects the increased likelihood that the patient would recommend the specialty pharmacy to a friend or colleague. Despite abysmal NPS scores widely reported across many non-health care industries, HSSPs achieve high NPS scores, typically in the 80s, which indicate excellent customer satisfaction. This metric can also be useful during payer contracting negotiations.⁵

Integrated specialty pharmacies have demonstrated that implementing patient-centered programs, such as centralizing prior authorizations (PAs), integrating therapy management into specialty clinics, and creating health coaching options, increases patient satisfaction.^6-8 HSSPs have also achieved significantly greater provider satisfaction ratings compared to external specialty pharmacies.⁹ Health care providers perceive HSSPs to be superior to external pharmacies in streamlining clinic workflow, reducing provider burden, increasing medication access, improving communication, and enhancing patient care.

Reducing Operational and Financial Barriers to Access

Time to treatment (TTT) initiation is the time between when a prescription is written to when the patient takes their first dose. HSSPs facilitate quick initiation to therapy, which can have an incredible impact on the outcome for the patient, particularly those with complex disease states.

Part of reducing TTT is improving the PA process, which typically requires an average of 2 days per week of paperwork by clinical and administrative staff. More troubling was a 2020 physician survey completed by the American Medical Association in which 94% of respondents noted a delay associated with PA, with 79% reporting that PA delays can lead to treatment abandonment.¹⁰ HSSPs can help expedite the PA process by accessing EMRs, allowing pharmacy teams to complete the paperwork themselves.

Restrictively high insurance co-pays for medications can create a financial barrier to specialty medications. This is especially true toward the beginning of each year when insurance deductibles are unmet.

For example, novel oral anticancer agents are increasingly prescribed but their high cost can lead to financial stress and impact the well-being and quality of life for patients and caregivers.¹⁰

To promote quicker time to therapy, HSSPs often have staff dedicated to obtaining co-pay assistance for patients.¹¹ HSSP staff are trained in the nuances of co-pay assistance programs available through drug manufacturers and can complete the forms.

Some HSSPs also have dedicated medication assistance program coordinators who help patients apply for grants available through disease-specific foundations, track when grant funds are depleted, and monitor for new grants that become available. As a last resort, HSSP staff can help patients enroll in manufacturer patient assistance programs, which provide free drugs to patients when other financial assistance options are not available.

Total Cost of Care

There have been several studies that demonstrate not only improved health outcomes from the HSSP clinical model but significantly improved cost avoidance. The high number of touch points and the coordination of patient care between pharmacist and prescriber leads to a faster access to medication and improved adherence rates.¹³ These, in turn, lead to faster alleviation of disease symptoms, fewer acute care visits, and lower readmission rates.^14,15

Other helpful intervention outcomes identified in studies include prevention of therapy complications, resolved adverse effect challenges, elimination of therapy inappropriateness, and prevention of premature discontinuation.¹⁶

For example, a Cleveland Clinical Specialty Pharmacy study showed 547 pharmacist interventions on specialty hematology/oncology patients over a 5-month period, which resulted in a total cost avoidance of $1,508,131.¹⁷

Another study in 2020 across 26 HSSPs showed that for 56,772 patients on specialty medications, 7393 interventions by pharmacy staff resulted in a total cost avoidance of $15,292,883.¹⁸ These results are just a few examples of emerging analyses suggesting that the use of an HSSP is associated with lower total medical costs.

Better Data Mean Better Outcomes for All

An HSSP is distinctively positioned to generate exemplary patient outcomes through personalized engagements with patients and providers. Pharmacists can increase adherence, address affordability barriers, and identify medication interventions, all of which contribute to improved quality of life and lower disease severity.

Best practices and benchmarks continue to evolve. Although HOSP believes that HSSPs represent the gold standard, we encourage the US health care ecosystem to collaborate with key stakeholders to allow patients to have the choice to fill at their HSSP. After all, we want to see improved care for all patients and remove barriers to a successful treatment journey.

You can download our whitepaper and visit the HOSP website to learn the complete picture.

About the Authors

Jennifer L. Donovan and Agnes Cha, Health-system Owned Specialty Pharmacy (HOSP) Alliance Health Economics and Research Outcomes Committee (HERO) Committee Co-Chairs, with support from HOSP HERO Committee members.

References

1. Stamp B. How thinking of patients as customers can improve healthcare. 2018. October 23, 2018. Accessed July 23, 2021. https://www.beckershospitalreview.com/patient-experience/how-thinking-of-patients-as-customers-can-improve-healthcare.html
2. Shah NB, Jolly JA, Horst SN, Peter M, Limper H, Zuckerman AD. Development of quality measures for use of self-injectable biologic therapy in inflammatory bowel disease: An integrated specialty pharmacy initiative. Am J Health Syst Pharm. Sep 1 2019;76(17):1296-1304. doi:10.1093/ajhp/zxz142
3. URAC. URAC: Specialty Pharmacy Accreditation. URAC. Accessed July 27, 2021. https://www.urac.org/accreditation-cert/specialty-pharmacy/
4. Crothers G, Shah NB, Kim M, Zuckerman AD. Development of a quality measures tool for the utilization of tyrosine kinase inhibitors in non-small cell lung cancer: An integrated specialty pharmacy initiative. J Oncol Pharm Pract. Sep 2020;26(6):1441-1451. doi:10.1177/1078155220937754
5. Shay B, Louden L, Kirschenbaum B. Specialty Pharmacy Services: Preparing for a New Era in Health-System Pharmacy. Hosp Pharm. Oct 2015;50(9):834-9. doi:10.1310/hpj5009-834
6. Bagwell A, Kelley T, Carver A, Lee JB, Newman B. Advancing patient care through specialty pharmacy services in an academic health system. Journal of managed care & specialty pharmacy. 2017;23(8):815-820.
7. Rim MH, Thomas KC, Barrus SA, et al. Analyzing the costs of developing and operating an integrated health-system specialty pharmacy: The case of a centralized insurance navigation process for specialty clinic patients. American Journal of Health-System Pharmacy. 2021;78(11):982-988.
8. Simonson D, Wittenborg M, Snyder M, Wiest H, McNamara A. Evaluation of a specialty pharmacy health coaching program. Journal of Drug Assessment. 2019;8(sup1)
9. Anguiano RH, Zuckerman AD, Hall E, et al. Comparison of provider satisfaction with specialty pharmacy services in integrated health-system and external practice models: A multisite survey.American Journal of Health-System Pharmacy. 2021;78(11):962-971
10. 2020 American Medical Association. Prior Authorization Physician Survey. https://www.ama-assn.org/system/files/2021-04/prior-authorization-survey.pdf.
11. Coughlin SS, Dead LT, and Cortes JE. Financial Assistance Programs for Cancer Patients. Curr Cancer Rep. 2021;3(1):119-123.
12. Espinosa AM, Chisholm JM, Kandah HM, et al. Expanding nonclinical roles in specialty pharmacy: How to grow a high-performance specialty pharmacy team. Am J Health-Syst Pharm. 2021;78:1004-1008.
13. Health System Specialty Pharmacies Provide Rapid Access to Medications. Pharmacy Practice News.
14. Kibbons AM, Peter M, DeClercq, et a. Pharmacist Interventions to Improve Specialty Medication Adherence: Study Protocol for a Randomized Controlled Trial. Drugs: Real World Outcomes. 2020. https://doi.org/10.1007/s40801-020-00213-8.
15. Autumn D Zuckerman, PharmD, BCPS, AAHIVP, CSP, Josh DeClercq, MS, Leena Choi, PhD, Nicole Cowgill, PharmD, CSP, Kate McCarthy, PharmD, BCACP, Brian Lounsbery, RPh, CSP, Rushabh Shah, PharmD, MBA, AAHIVP, CSP, Amanuel Kehasse, PharmD, PhD, Karen C Thomas, PharmD, PhD, MBA, Louis Sokos, BS Pharm, MBA, Martha Stutsky, PharmD, BCPS, Jennifer Young, PharmD, BCPS, CSP, Jennifer Carter, PharmD, BCPS, Monika Lach, PharmD, BCPS, Kelly Wise, PharmD, BCACP, Toby T Thomas, PharmD, BCPS, Melissa Ortega, PharmD, MS, Jinkyu Lee, PharmD, CSP, Kate Lewis, PharmD, BCPS, Jillian Dura, PharmD, Nicholas P Gazda, PharmD, MS, BCPS, CSP, Lana Gerzenshtein, PharmD, BCPS, CSP, Scott Canfield, PharmD, CSP, Adherence to self-administered biologic disease-modifying antirheumatic drugs across health-system specialty pharmacies, American Journal of Health-System Pharmacy, Volume 78, Issue 23, 1 December 2021, Pages 2142–2150, https://doi.org/10.1093/ajhp/zxab342 Z.
16. Soni A, Smith BS, Scornavacca T, et al. Association of Use of an Integrated SpecialtyPharmacy with Total Medical Expenditures Among Members
17. Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Client-Level Data Report 2019. Published December 2020. Available at hab.hrsa.gov/data/data-reports. Accessed June 9, 2021.
18. Lankford C, Dura J, Tran A, et al. Effect of clinical pharmacist interventions on cost in an integrated health system specialty pharmacy. J Manag Care Spec Pharm. 2021 Mar;27(3)379-384.