Working Together to Distinguish Hospital, Health System Specialty Pharmacy Services

As an increasing number of health systems strive to enhance patient care through in-house specialty pharmacies, a tremendous opportunity exists to come together and demonstrate how our services drive superior clinical outcomes and quality of life for patients. Yet today, getting health systems to align around clinical and operational benchmarks and practice standards that are meaningful to other stakeholders remains an opportunity.

As a result, the performance of health system specialty pharmacies (HSSPs) continues to be defined by the standards accrediting bodies and payers use to assess traditional mail-order specialty pharmacies (SPs). But these standards don’t account for the unique capabilities and characteristics that enable health systems to deliver differentiated care and results.

It’s time for this to change. Defining commonly-accepted clinical and operational benchmarks and practice standards specific to HSSPs will enable us to distinguish our services and further our impact for patients while opening the door to greater collaboration with other stakeholders.

So how do we achieve this? Transforming how we leverage data and rethinking how we work with our industry partners will be key.

Transforming how we leverage data

As spending on specialty medications continues to increase, there is mounting pressure to ensure patients are achieving desired therapeutic outcomes from these high-cost therapies.

Health systems that embed specialty pharmacists into care teams and invest in advanced IT infrastructure are well-positioned to proactively use lab values, patient-reported outcomes measures, and other data sources to do this.

However, HSSP efforts to uncover clinical and operational insights are often more retrospective research or a reporting exercise than a way to inform care delivery. For example, health systems will mine data on the back end to conduct outcomes studies or collect information required by accrediting bodies, pharmaceutical manufacturers, or payers. The focus is typically on surrogate metrics such as adherence, time to treat, and therapy abandonment rates.

Defining agreed upon HSSP benchmarks for these surrogate metrics remains a need. However, to elevate our value, HSSPs have to develop practice standards that promote the use of data as a tool to inform care delivery and enable proactive interventions.

By using technology to share actionable data with embedded pharmacists in real-time, HSSPs can positively alter outcomes and reduce cost of care, creating tangible value for our stakeholders. In other words, we must turn data analysis from a research function into a day-to-day part of patient care.

One of Trellis Rx’s hospital partners provides a strong example of this in action. Last year, the hospital expanded its in-house specialty pharmacy services to care for patients with diabetes.

Although all patients receive support from an on-site pharmacist and pharmacy liaison to ensure they can afford, access and adhere to their therapy, high-risk patients are enrolled in an intensive patient management program via electronic health record-integrated specialty pharmacy technology platform, Arbor^®.

Pharmacists and pharmacy liaisons embedded on-site at the hospital work in-person with these high-risk patients and their care teams to provide intensive administrative and clinical support. Patients use a mobile app to report their glucose readings and these data are fed to pharmacists via the platform so they can proactively monitor patients and trigger interventions between appointments. Within just 6 months of launching this service, the average hemoglobin A1c score for patients enrolled in this program has decreased 1.7 points.

The need for collaboration

If more sophisticated use and analysis of data are the first step toward optimizing outcomes and demonstrating value, then greater collaboration among HSSPs, payers, manufacturers, and other stakeholders is the next step.

Consider this example: Another one of Trellis Rx’s partner health systems recently fostered a strategic relationship with a large regional health plan. Through collaborative discussions, the 2 organizations recognized an opportunity to work together to enhance care for patients with inflammatory diseases while ensuring effective use of high-cost therapies.

The health plan has also committed to providing data so the health system can assess the impact of its services. Of particular interest? How cost of care and outcomes can be improved by integrating the rheumatology patient-reported outcome measure RAPID3 into Trellis Rx’s Arbor^® specialty pharmacy technology platform and using advanced tests such as Myriad’s Vectra^® (an advanced blood test for rheumatoid arthritis activity) to trigger pharmacist interventions for patients with consecutive worsening scores.

Constructing the full cost/quality picture is like creating a single jigsaw puzzle from pieces owned separately by many different stakeholders. That is why moving the needle in specialty pharmacy requires a collaborative approach to industry-wide benchmarks and standards.

All stakeholders—providers, payers, manufacturers, and trade organizations—need to contribute to the development of HSSP recommendations. They must work together to identify those elements critical to medication affordability, medication access, and care outcomes so that everyone understands the true benefits for patient outcomes.

The industry cannot continue to analyze data and develop benchmarks and standards in isolation. This approach leaves gaping holes in the puzzle to the detriment of patient care.

Together, though, HSSPs and other stakeholders can set meaningful metrics and determine best practices to optimize every aspect of the patient journey and, in turn, better manage their businesses.

Time to work together toward value

To achieve value, we must first align around a common definition of what success looks like. In February, the American Society of Health-System Pharmacists is hosting the first-of-its-kind Specialty Pharmacy State of Practice in Hospitals and Health-Systems—Future Directions Summit to foster this conversation.

This interprofessional event will bring together health systems and their industry stakeholders, including payers and manufacturers, to discuss how to further advance the HSSP practice to optimize patient health outcomes.

Fortunately, the concepts of shared data and collaboration aren’t new to health care. Academic institutions do it all the time to advance breakthroughs in medicine. Likewise, HSSPs partnering with payers, manufacturers, trade associations, and others can set the standards for better and more affordable patient care.

It’s time to get everyone to the table.

About the Author

Jerry Buller, DPh, MMHC, is chief pharmacy officer of Trellis Rx.

References

• https://academic.oup.com/ajhp/article/77/14/1118/5857351?login=true
• https://www.lipidjournal.com/article/S1933-2874(19)30003-0/fulltext
• https://academic.oup.com/ajhp/article/71/6/463/5111163