Patient Satisfaction in the Specialty Pharmacy Space

As is the case with any service-driven industry, the need to continually assess end-user satisfaction is paramount. The experience of patients, customers, or other stakeholders who are the object of the client’s services must be accounted for when assessing a business’s performance, both internally and externally.

As any business school teaches its undergraduate students from the outset of their program, the leadership of a firm cannot simply take into consideration financial performance metrics when assessing performance. Although financial statements are extremely important and indicative of a firm’s overall health, abstract factors that do not appear on a profit and loss statement or balance sheet also play a pivotal role in the success of a business. One such abstract factor is patient satisfaction.

No matter how profitable a particular service or product may be, if the end-user is dissatisfied with the service or product for any reason, ultimately the end-user will look for other options. Hence, to ignore end-user satisfaction is a mistake that may be able to be overlooked in the short-term, but will end up adversely affecting the health, success, and sustainability of the business in the long-term.

In the service industry, particularly within health care, there have historically been processes that take an important, yet abstract factor that affects a firm’s success—such as patient satisfaction—and turn it into something more concrete, tangible, measurable, and comparable. One such tool used particularly often within health care is the patient satisfaction survey.

Over the past few years, the need to accurately and uniformly assess patient satisfaction in the specialty pharmacy space has become overwhelmingly important. Specialty pharmacies cannot expect to improve upon the services they provide if they have no baseline to compare the success of their endeavors. Patient satisfaction surveys enable specialty pharmacies to identify and pinpoint ways in which they can improve.

Although not many would dispute the importance of assessing patient satisfaction, the main challenge currently faced by specialty pharmacies is navigating the peculiarly unclear guidelines that various accreditation agencies have placed upon specialty pharmacies related to this topic. Thomas Reid, an 18^th-century Scottish philosopher, noted, “There is no greater impediment to the advancement of knowledge than the ambiguity of words.”

Similarly, but perhaps even more germane to specialty pharmacy, Janna Levin, Tow Professor of physics and astronomy at Barnard College of Columbia University, once said “…ambiguity is very interesting in writing; it’s not very interesting in science.”

Therein lies the problem with the current state of patient satisfaction surveys and assessment in specialty pharmacy. Patients who are in the care of a specialty pharmacy are dealing with life-changing therapies, potentially life-sustaining in some cases. The need for clear guidance on how the satisfaction for the care these patients receive is assessed is becoming ever more apparent.

Take URAC for example, which most in the industry currently recognize as the gold standard for the accreditation of specialty pharmacies. At the time of this writing, URAC was approaching 400 specialty pharmacies nationwide who have obtained their accreditation in some form (full, conditional, or provisional).

URAC accreditation enables specialty pharmacies to demonstrate their value to payers and manufacturers in delivering the specialized clinical services that are so highly valued by these stakeholders. In fact, URAC accreditation is increasingly becoming a requirement that specialty pharmacies must hold in order to participate in a payer’s network, and/or as a component of a request for proposal with manufacturers.

However, per the URAC website describing the multiple factors that comprise a URAC-accredited pharmacy, it is noted that these pharmacies “...maintain methods to measure customer satisfaction.” That’s all there is, without a mention of what to measure, how to measure it, the frequency or the methodology involved in collecting, analyzing, and sharing these data.

Currently, URAC includes the consumer’s experience with specialty pharmacy services as an exploratory measure of its accreditation process, as opposed to the 5 mandatory measures that a specialty pharmacy must fully pass inclusively in order to obtain and keep full URAC accreditation. The exploratory measures may be adjusted in the future to be included as mandatory measures, but as of now there is more equivocality with their execution.

Similarly, specialty pharmacy accreditation through the Accreditation Commission for Health Care (ACHC), which itself currently has accredited more than 500 specialty pharmacies, is another manner through which a specialty pharmacy can show payers and manufacturers that they are committed to providing the highest-quality service to patients. ACHC accreditation includes a quality outcomes/performance improvements component. Although of note, per the ACHC website, one must first register as an organization desiring accreditation to download the accreditation standards that ACHC incorporates into its accreditation. Hence, any further specifics regarding patient satisfaction assessments are unclear.

Seeing the increased need to assess patient satisfaction coupled with the vagueness in the necessary components of such an assessment, there are currently 2 firms on the market who provide specialty pharmacies with a means to assess patient satisfaction. Both Zitter Health Insights (ZHI), and the SullivanLuallin Group (SLG) offer patient satisfaction survey services to specialty pharmacies, which allow the pharmacy to comply with accreditation agency regulations and improve their patient services.

ZHI

ZHI is an independently maintained firm that provides services to pharmaceutical and biotech manufacturers, managed care organizations, and specially pharmacies. Working with a variety of stakeholders affected by access and reimbursement issues—including but not limited to physicians, practice managers, employers, benefits consultants, pharmacy directors, pharmacy benefit managers, and specialty pharmacy patients—ZHI seeks to provide its clients with the most inclusive, comprehensive, and actionable market research on medication access.

Services they assist with include product launches, payer segmentation and targeting plans, pricing and contracting strategies, and patient satisfaction improvement plans. ZHI has partnered with Specialty Pharmacy Times

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to co-sponsor the annual Specialty Pharmacy Patient Choice Award presented at the Asembia Specialty Pharmacy Summit each spring. This award recognizes specialty pharmacies that achieve the best-in-class customer satisfaction and overall patient care metrics based on ZHI’s Specialty Pharmacy Patient Satisfaction Survey—in essence, pharmacies are awarded for their commitment to patients.

In terms of assessing its patient satisfaction surveys, ZHI developed an algorithm to compare responses of any specialty pharmacy by obtaining some benchmark data via the survey. Data gleaned from the survey are used to assess patient satisfaction and customer loyalty across a variety of therapeutic categories. Currently, insights given by ZHI are based on 80% of specialty pharmacies’ market share across the United States, with data collected quarterly.

Although no sample survey with example questions can currently be seen online without scheduling a demonstration, some features of utilizing the ZHI Specialty Pharmacy Patient Satisfaction survey include:

• ZHI’s proprietary Net Promoter Score, which assesses and ranks specialty pharmacies compared with others. This enables pharmacies to satisfy patient satisfaction survey accreditation requirements for URAC, ACHC, and other agencies.
• The ability to gain operational insight into competitors.
• Increased understanding of how a specialty pharmacy is viewed by patients.

SLG

SLG is a privately-owned company that has worked with more than 2500 nationwide health care organizations to increase patient, provider, and employee satisfaction. Recently, SLG partnered with the National Association of Specialty Pharmacy (NASP) to develop and provide a patient satisfaction survey for accurate and precise measurement of variables that contribute to patient satisfaction and engagement related to specialty pharmacy. Cost savings, quality, outcomes, prescription access, clinical services, and patient education are all assessed with the SLG patient satisfaction survey.

By participating in the SLG-NASP survey program, a specialty pharmacy will gain online access to results such as national benchmarking for all survey questions, ranking against the SLG-NASP database as a whole, analysis and insight into how the pharmacy can improve their patient satisfaction scores, and a presentation of the findings to review all survey results.

An accessible online sample of the SLG-NASP patient satisfaction survey includes questions related to a patient’s phone interactions with a specialty pharmacy (including the call itself and the call center staff member the patient spoke with), overall communication with the specialty pharmacy, satisfaction with the prescription/medication provided, and overall satisfaction with the specialty pharmacy.

Summary

At their core, specialty pharmacy patient satisfaction surveys are meant to provide the pharmacy with actionable, insightful information to both comply with their regulatory accreditation agencies requirements and to assess their own performance against their competition, hopefully improving their own customer service over time.

As mentioned previously, accrediting agency requirements that require specialty pharmacies to survey their patients are increasing in prevalence, but most continue to provide no clear specifications as to how to do this. In the coming years, as specialty drug spend continues to grow and gain more market dominance, expect to find accreditation agencies providing more specific guidelines as to how specialty pharmacies should collect, assess, and report patient satisfaction data.

With two providers currently offering the ability to obtain third-party results related to specialty pharmacy performance, it affords some options for pharmacies that choose to forgo an internally-offered survey that may lend itself to an internal bias.

About the Author

Lee Feigert earned his PharmD from Duquesne University in Pittsburgh, PA. For over five years, he was employed in a transitional-care pharmacist role at a 300+ bed inpatient psychiatric hospital. Currently he is employed as a consultant pharmacist for a Program of All-Inclusive Care for the Elderly (PACE) program in Pennsylvania. He is currently enrolled in the Master of Science in Pharmacy Business Administration (MSPBA) program at the University of Pittsburgh, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines.