Study: Misperceptions Between Health System, Health Plan Leaders May Inhibit Patient-centered Specialty Pharmacy Partnerships

A recent qualitative study presented a potential explanation for why health system specialty pharmacies often find it difficult to partner with payers. The study showed that due to misperceptions regarding health system specialty pharmacies’ capabilities, outcomes, and pricing, health system specialty pharmacies can get pigeonholed by payers as being expensive providers of “commodity” services.

The study was conducted by the technology-enabled specialty pharmacy services provider Trellis Rx. The results revealed some ways in which leaders in both health system specialty pharmacies and health plan pharmacies can collaborate using specialty pharmacy services. Such a collaboration could lead to better value for patients and other stakeholders, according to the study.

“As cost and utilization of specialty medications continue to rise, health systems and health plans must collaborate to ensure value for all stakeholders,” said Andy Pulvermacher, principal consultant of Blue Fin Group and author of the foreword of the report, in a press release. “This first-of-its-kind research provides new insights to promote dialogue and foster partnership, and I have faith that leaders in both sectors will use this information to move the needle towards better patient care.”

In order to conduct the study, the researchers included blinded interviews with 10 pharmacy leaders across the United States with experience in building a specialty pharmacy and 10 regional and national health plan pharmacy leaders. In addition, the researchers spoke with 9 industry experts who contributed unblinded information.

From these interviews, the researchers observed some common misperceptions about how leaders from each area believes the other prioritizes cost and outcomes. Despite both being focused on the improvement of patient care, the researchers found that the current misperceptions were resulting in barriers that prevented them from partnering and collaborating on specialty pharmacy services in order to achieve a shared goal.

Some of the barriers found in the study that prevent mutually beneficial collaboration include:

• Health system and health plan leaders viewing each other antagonistically, with phrases such as “conflicting interests” used to describe current relationships.
• Most health plans not recognizing the potential value health system pharmacies can create for their business, their customers, and their members.
• Many health systems not investing in the specialty pharmacy capabilities and infrastructure necessary to provide value to health plans.

In contradiction to these observed barriers, the researchers found that all respondents agreed collaboration is critical in order to address and manage the high cost of specialty medications and improve care for patients.

The researchers were also able to identify some steps that leaders in both areas could proceed with in order to support more effective partnerships in the future. One key point among these would be breaking down the current barriers that are hindering effective collaboration so that both sides could better understand how to address one another’s needs and challenges.

“Based on my experience operating a health system specialty pharmacy, I can say firsthand that patients often receive the brunt of the aftermath created by the misconceptions health system and payors have of each other,” said Jerry Buller, chief pharmacy officer, Trellis Rx, in a press release. “This research allowed industry leaders to share their thoughts candidly, and I look forward to seeing leaders from both sides leverage these insights to work together to enhance patient care.”

REFERENCE

Research reveals health system and health plan misperceptions inhibit patient-centered specialty pharmacy partnerships [news release]. Atlanta, GA: Trellis Rx; May 27, 2020. Accessed June 24, 2020.