Health system specialty pharmacies (HSSPs) are increasingly making their mark on the industry by creating a more integrated care structure for complex patients in need of specialty therapies. On-site access to medication and better coordination between a patient’s primary physician, pharmacist, and specialty physician can help simplify care delivery, which provides patients with end-to-end quality of care that ultimately reduces costs and improves outcomes. However, despite the gains made by HSSPs in bringing patient care under one roof, following the patient journey still poses a challenge for providers and can lead to gaps in treatment history that negatively impact care.

Tracking the full patient journey and experience was one of several key discussion topics at this year’s Annual Specialty Network Design and Channel Optimization Summit at Integrate 2019. All stakeholders represented—pharmacies, health systems, payers and manufacturers—seek a more complete picture of patient history so they can better understand and optimize treatment regimens, improve outcomes and reduce total cost of care. Strategies for achieving insight into care history and the patient journey peppered the conversations at this year’s summit. Here are some more of the key takeaways from the summit.

Building a Better Patient Journey
The greatest benefit of an HSSP is “connected-ness” in the all-too-often fragmented world of health care. However, despite the power of integrated specialty pharmacy services to unify patient care, numerous roadblocks and detours remain on the difficult road complex pharmacy patients travel.

Different disease states have differing patient journeys
First, health systems must recognize that unique patient populations and disease states affect the patient journey differently. Although the evolution of integrated delivery networks (IDNs) is positively affecting the patient experience, streamlining care coordination is not a one-size-fits-all and partnerships are critical to impacting quality of care.

Case in point, during the IDN Perspective Panel at the summit, Tim Paine of Fairview Pharmacy described the health network’s clinical and patient support services for cystic fibrosis (CF) and blood pressure management. With Fairview’s integrated care model and HSSP, patients with CF in the program have seen a 70% increase in medication adherence.

Further, patients in the blood pressure management program are 22% more likely to fill medication prescriptions than those in benchmark studies. Paine's presentation illustrated how industry partnerships played a critical role in Fairview’s development of these and other unique care coordination programs, as they helped the health network navigate the intricacies of various disease states to build, operationalize, and optimize care coordination strategies based on known best practices.

Patient identification remains an industry-wide issue
Another hurdle comes from issues surrounding patient identification and tracking. A recent Ponemon Institute survey of hospital financial operations personnel attributes 35% of all denied insurance claims to inaccurate patient identification. These statistics, although impermissible in any aspect of health care, pose even more of a threat in the care of complex patients, for whom delays in treatment delivery can have dire consequences.

It’s no secret that our current system is mired by inconsistent paperwork, riddled with human error and disparate electronic health records that cannot share information with each other. Just recently, Intermountain Healthcare CIO Marc Probst joined a group of health leaders for a congressional briefing on using federal funds for a nationwide patient identification system.

Having a consistent, reliable way for all providers to access medical history would go a long way toward improving outcomes and the overall patient experience. Although the United States remains a long way from implementing, or even designing such a program, there’s little doubt it would save money wasted today on repeat tests and imaging. 

Medication Affordability Remains a Huge Barrier
Drug affordability still represents a significant roadblock in the patient journey. In a traditional physician/specialty pharmacist model that involves little to no communication between the providers, the patient care team typically does not discuss the price of therapy as a key consideration.

In this legacy model, the physician and specialty pharmacist have mutually exclusive relationships with the patient and are only connected by the specialty pharmacist attempting to decipher the physician’s handwriting on a script. Integrating the specialty pharmacist into the care team with the prescribing physician allows for open dialogue and gives the patient a voice.

Empowering patient choice has become increasingly important as patients want to be empowered in their health care decisions. An integrated care model puts the patient at the center of care and establishes a model that encourages the most cost-effective treatments and medications.

In addition to more control over the decision-making process, patients want quick access to the best and most appropriate medications and treatments available. The new regulations surrounding step therapy were a focus at the summit, as industry experts not only fear forcing patients to take cheaper, less effective drugs is wasteful and inefficient, it can also reduce overall patient satisfaction and trust in the system.

If payers approved coverage for the “right medication,” regardless of the presence of cheaper alternatives, it would spare patients the many frustrations inherent in the prior authorization process, reduce costs, and generally keep patients healthier.

Value-based Contracting is Part of the Solution
Discussions surrounding the patient experience must also include the adoption of value-based contracting to replace the traditional fee-for-service model. A national study of payer reimbursement conducted by ORC International found that nearly 40% of all payments in 2018 went towards fee-for-service.

By 2021, that number is expected to dwindle to 25%. Value-based care has proven to reduce unnecessary medical costs by nearly 6% and advancing it from a novel approach to the norm will allow patients to get the highest return for their money, according to the study.

Value-based contracting will provide the greatest impact on cell and gene therapies as personalized and precision medicine becomes more ubiquitous. Although these therapies have higher price tags, value-based contracting will increase accessibility as personalized medicine has been shown to increase the probability of improved patient outcomes. With more targeted, personalized therapies, precision medicine may ultimately reduce total cost of care as it more rapidly identifies the best treatment plans, reducing waste.

Effective Solutions Don’t Have to be Complex
Sometimes, a simple gesture made with the patient in mind can make a significant impact toward improving experience. A Mayo Clinic study found that on average, approximately half of patients make medication errors after discharge from the hospital, such as taking the wrong dose. Tracey Murrish, PharmD, specialty pharmacy manager at Billings Clinic, presented during the IDN Perspective Panel at the summit about a novel program at her health system called Medically Integrated Dispensing (MID), which can enhance the patient experience by physically bringing the pharmacist to the patient.

“MID is designed to improve the patient experience by having our specialty pharmacy deliver medications to patients while they are in the clinic,” Murrish said. “This program generates higher patient satisfaction, promotes drug adherence with same-day turnaround and has proven more cost effective. It allows the pharmacist to meet the patient in person and answer questions. Montana is a sparsely populated state, so our patients value a program that saves them from traveling considerable distances to a specialty pharmacy.”

The Journey Toward Improved Patient Experience
For decades, innovation in medication development has advanced at a tremendous pace, but the distribution models for those novel therapies have failed to keep up. All parties in the health care spectrum—manufacturers, payers, health systems, providers, and patients—need to work together to shift the delivery models to connect patients with the correct therapy as quickly and easily as possible. Ambitious undertakings, such as universal patient identification numbers, as well as simpler initiatives, such as pharmacist bedside visits, can all make the patient journey an easier road to travel.