Building a Specialty Pharmacy Organization Is More Intensive, Yet More Valuable Than Ever

Specialty Pharmacy Times, July/August 2017, Volume 8, Issue 5

Building a durable specialty pharmacy organization requires more than URAC accreditation and pharmacists.

WHEN WE LAUNCHED CURANT HEALTH in 2000, we knew there would be a few bumps and bruises along the way. We also knew how much individualized attention patients needed in order to adhere to their specialty medication regimens, particularly those with multiple chronic conditions.

What we did not know was the magnitude of how important patient support services and patient centricity would be to the business. More than a decade later, we have learned that building a specialty pharmacy organization to last requires more than URAC accreditation and pharmacists.

It requires an organizational philosophy built around patient care, which just happens to be supported by fulfillment of specialty prescriptions. Patient centricity, clinical expertise, commitment to acquiring outcomes data to prove value, and the ability to integrate into larger organizations within the continuum are 4 requirements specialty pharmacy organizations need to demonstrate to remain viable and competitive at a minimum, let alone thrive in the shift from fee-for-service to value-based care.

What Does Patient Centricity Really Mean to You?

At Curant Health, patient centricity means placing the patient at the center of every conversation, be it a business conversation, an individualized care conversation, or a population health conversation. We define value as improving outcomes while reducing costs. Placing outcomes first in this equation does more than make for a convenient numerator. It demands focus on the patient.

I would encourage those within existing specialty pharmacy organizations or those attempting to build new ones to create a laser-focused definition of patient centricity. What exactly does it mean to you? Write it down, share it with your team, build consensus, and commit to it. You will discover it means different things to different elements and individuals within your organization. Moreover, you will discover that every part of your organization—from the C-suite to administration to the clinical team to patient support staff and, especially, finance—affects it.

Clinical Expertise and Commitment to Outcomes Data

Highly qualified clinical pharmacists not only have the ability to communicate in the same language as traditionally defined health care providers, they also exhibit a thirst for new knowledge. New knowledge not only advances our science, it has the ability to improve the standard of care.

Specialty pharmacy organizations must prove their worth through data that must be acquired from payers, providers, and patients. This will be quite the challenge. Securing partners with an interest in obtaining outcomes data must be a shared goal. Otherwise, this will be a massive challenge. You can’t do this by yourself. It must be a strategic decision to which you commit on the front end, early on in partner discussions of any kind: payer, pharmacy benefit manager, provider, or manufacturer.

Studies involving large university hospitals, particularly those that require internal review board approval, are not for the faint of heart, but they have tremendous value. A shared commitment to improving the standard of care for patients with inflammatory bowel disease (IBD) motivated our team, along with Johns Hopkins Medicine, to embark on Project ALIVE (Adherence and Long-term IBD Value-added Effectiveness).

According to Sharon Dudley-Brown, PhD, the project’s principal investigator and assistant professor of medicine at Johns Hopkins, Crohn’s disease and ulcerative colitis are chronic, debilitating conditions that can have significant economic and clinical implications.

In 2004, the annual cost of IBD in the United States was estimated at $1.84 billion. IBD also is associated with high morbidity, loss of work productivity, and impaired quality of life. While there was much heavy lifting by clinical members of both teams, we have generated data that indicates medication therapy management improves adherence by 30% over the standard of care in a large hospital setting.

“Project ALIVE is well on its way to measuring program value for patients with IBD and their caregivers with preliminary results showing improved adherence in the treatment arm,” said Vickie Andros, PharmD, director of clinical services for Curant Health. “We anticipate that our enhanced medication therapy management and patient support services will continue to demonstrate project value through outcomes improvement and impact on cost through a reduction in hospitalizations and emergency department visits for this patient population. Continuing to validate our work alongside Dr. Dudley-Brown, her colleagues, and, most importantly, improving the lives of people suffering from IBD, is central to our mission.”

These types of programs and data not only accomplish our primary goal of improving outcomes while reducing costs, they provide us with the fuel we need to accelerate growth and improve the lives of more chronically ill patients than ever before.

Specialty Integration: It’s Coming Sooner Than You Think

The exploding costs of specialty pharmaceuticals, slated to be more than $550 billion by 2020, continued to exert pressure on specialty pharmacies through reimbursement policies and network designs. The maturity of pharmacy systems are driving specialty pharmacies to link with integrated delivery networks (IDNs) and accountable care organizations (ACOs). Several retail pharmacies are already moving ahead with these types of integrations.

As the shift to value-based care accelerates, IDNs and ACOs need to mitigate risk by improving adherence to, and thus value derivation from, specialty therapies. Specifically, IDNs must look for mechanisms to better control the payer component and in-home support of their most costly patients.

Ongoing, consistent medication management for chronically ill patients in the home will be critical to the success of any IDN or ACO specialty pharmacy integration, whether it’s a buy or partner scenario. The focus of stakeholders is now on improving the patient journey, not the prescription journey. What is clear is that this full-scale integration is coming sooner than you probably think.

We have long spoken about the value in placing a clinical pharmacist at the center of a patient’s in-home care team. It appears specialty pharmacy organizations—with a well-defined, well-understood approach to patient centricity, robust patient support services, a commitment to developing rock solid outcomes evidence, and an ability to integrate into larger organizations within the care continuum—are poised to both survive and thrive within the grinding shift to value-based care.