Specialty Pharmacy and Care Coordination: A Beneficial Relationship

Data plays an increasingly important role in improving health care services.

Care coordination has become the focus of many health care professionals and their respective organizations. By giving patients highly coordinated care, the expectation is that their health will improve.

In the traditional health care model, a patient’s primary care provider would typically not be in contact with other specialists the patient sees. This type of fragmented care can lead to duplicate tests and diagnostics, especially if the patient recently received care at a hospital.

This model can also cause a financial burden to both the patient and the health care system. A coordinated care model can link multiple stakeholders through different means, such as electronic medical records that can be accessed by both the physician and a specialty pharmacy.

This link can reduce the amount of “back and forth” associated with each provider calling or faxing information to each other.

Increased care coordination can benefit patients as well, according to a session at the 7th Annual Specialty Product Distribution and Channel Optimization conference held on October 26 and 27, 2016. This care model can lead to increased coordination of health plan benefits.

Patients will also benefit from refill management and medication adherence monitoring. Adhering to specialty drugs is extremely important since some medications may become ineffective if they are not taken properly.

For example, at the Cleveland Clinic, once the prior authorization is approved for a patient with hepatitis C virus, they typically receive their antivirals within 1 to 2 business days. By making treatment seamless, patients are less likely to forget to follow-up, or get frustrated from having to navigate the process alone.

After antiviral treatment is finished, patients are then referred back to their primary care providers to receive follow-up care, according to the session.

A recent study found that patients with hepatitis C virus met several barriers that impacted their adherence to antivirals. One such instance was a lack of transportation, and researchers suggested that integrating services would be a way to increase adherence in this population.

Another patient group whose adherence was stressed by the presenters was those with multiple sclerosis. Patients treated at the Cleveland Clinic’s Specialty Pharmacy typically receive their treatment within 3 business days after the prescription is received.

Under their coordinated care model, 90% of patients taking Tecfidera remain adherent to the drug despite serious side effects. After enrollment in their coordinated care program, utilization of the emergency department decreased from 13% to 8% among patients with multiple sclerosis.

According to the session, 50% of patients treated by a different specialty pharmacy utilized the emergency department over a 4-month period of time, compared with only 25% of patients treated by a Cleveland Clinic Specialty Pharmacy.

Some specialty pharmacies and other health care providers may not exactly know how to go about creating a coordinated care model that will benefit both patients and the health care industry.

Certain accreditations, such as URAC accreditation, are becoming more popular, and some insurers even require specialty pharmacies to receive this accreditation. Some of these accreditations are very costly, but they show patients and providers that the specific pharmacy meets high standards.

Technology is perhaps the most integral part of implementing a coordinated care model. Using electronic medical records will lessen the likelihood of duplicated care, and ensure that each patient is receiving the optimal care.

Data warehouses are also important since they can provide different metrics that can be used to track the performance of the pharmacy as well as patients, according to the session.

Coordinated care is largely beneficial to the health care industry, and through using data and electronic medical records, more specialty pharmacies will be able to provide more in-depth services to their patients.