In this edition of Specialty Pharmacy Times, we focus on the key role that technology plays in specialty pharmacy, and we have engaged experts in the field. Inside you will find articles on the study of the value of data, the importance of systems to drive work flow, the utilization of systems to process the patient, and more recently, the role of data in Accountable Care Organizations.
When I started my pharmacy practice in the early 1980s, initially in retail, we were just experimenting with the use of computers to help create efficiencies in the practice of pharmacy. At first, the systems were essentially word processors and some tools for managing our pharmacy business. However, changes in technology and the business environment quickly expanded the use of pharmacy systems to where today’s technology, especially in specialty systems, performs these essentials:
Enrollment—Data are consolidated for the patient to process the transaction.
Insurance Verification—Confirms the patient’s eligibility, insurance coverage, and appropriate prior authorizations.
Clinical Management—Facilitates several elements around the particulars of a disease state and various components around patient management as well as regulated programs such as Risk Evaluation & Mitigation Strategies.
Fulfillment—Includes patient screening, dispensing of the prescriptions, quality assurance, and ultimately, delivery of the medications.
So, the basics have not changed; however, with data aggregation, specialty pharmacy has raised the bar for the value of the data in several key areas that we will explore.
Each patient that gets enrolled in a specialty pharmacy program is an opportunity to collect a number of behavioral and demographic attributes. The pharmacy is able to develop a profile of every patient in its database. The greater the number of attributes collected, the more robust the opportunity to leverage the data from several perspectives depending on the stakeholder. By aggregating the data, the pharmacy can measure patient and product performance as well as track the patient to measure the efficacy of the therapy and the safety of the product. With the integration of outside data points, ultimately the patient outcome from both a quality and economic point of view can also be measured. These data points are critically important to caregivers, payers, and the manufacturer as well as the patient. Every stakeholder can benefit from the responsible use of the data.
By utilizing reimbursement support and clinical management programs, specialty pharmacies are able to increase patient satisfaction. Regardless of the political outcome of the national election, specialty pharmacy needs to plan for the emergence of Accountable Care Organizations. The importance of quality, reliable information detailing patient care across a vast continuum cannot be overstated. Specialty pharmacy must communicate and share data—all of which facilitates better coordinated care.
For those patients who began their treatment in a hospital setting or any closed setting, providers must link inpatient and outpatient data to provide a full picture of patient care and better allow for outcomes measurements. The die has been cast and the experiments are working. Thus, the business of specialty pharmacy must implement these resources to have the ability to provide clinical information to other medical professionals who may interact with their patients and build reliable measures if we are to participate in the emerging models.
Specialty pharmacy is rich with data. Because of the close collaboration with all stakeholders, we are often the coordinators of care. We must learn to better voice the value of our services, which can only be measured by leveraging the data that stream into our systems with every transaction. The better we are able to present our information, the higher likelihood we can get compensated more fairly for our services. Those who are making those investments in systems today will be the leaders of the future. We are confident you’ll learn much from the great sharing our authors have afforded our readers in this edition—and we challenge you to make sure your organization takes the best of what they offer and join their ranks.
Mr. Steiber is a principal of D2 Pharma Consulting LLC (d2rx.com) and is responsible for commercial operations, tradesupply chain strategy development including 3PL selection, regulatory oversight, and “operationalizing”organizations. Mr. Steiber has served in several senior positions in pharmacy, distribution, and industry over the course of his 35-year career. He is a licensed pharmacist in Texas, Washington, California, and Pennsylvania, and is affiliated with several professional associations and publications as well as a frequent speaker on behalf of many professional organizations. Mr. Steiber graduated from Washington State University College of Pharmacy. He has participated in a variety of postgraduate programs in law and business development/ marketing at Harvard University and Northwestern University. Mr. Steiber currently resides in Highland Village, Texas.