Why is Value-Based Care Key for Specialty Pharmacies?


Christopher W. Kennedy, MSM, Chief Operating Officer, Heritage Biologics, discusses the importance of value-based care for the specialty pharmacy industry.

Kennedy: Specialty pharmacy today survives on the drug margin—really, the competition is: what can you with that drug margin to reinvest towards a patient’s outcome. I think that question resonates throughout all of health care.

If health care, unfortunately, is a business—and as a patient it’s not always comforting knowing that—but if in fact it is, what are we doing to compete on the dollars we are reimbursed for a medical service? How are we reinvesting those dollars towards a patient outcome?

That’s really where the patient experience initiative kicked off and took root because nobody holds health care more accountable than patients themselves.

Whether it’s myself, we just went through this with my 3-year-old daughter when we went to a doctor, paid a co-pay, and were prescribed a medication. She was allergic to it, we went back because she had an allergic reaction and they prescribed her the same medication a second time. My voice gets lost in the system—I couldn’t talk to the same doctor twice who prescribed the medication my daughter reacted to.

That cycle continues not only in traditional medicine in primary care but in pharmacy as well. So, a patient has a negative experience, which we are not in a vacuum so it’s inevitably going to happen. It’s not so much the negative experience but what are we going to do to fix it and learn from it?

Value-based specialty, the approach there is then how do we proactively create a model in which my patient is onboarded within a specialty pharmacy, there’s an outcome at the end, and if those parameters and if the actual care continuum doesn’t run its correct course and there’s a variance, what are the consequences? Who’s accountable?

I think you’ll see a driver—and we’ve already seen this specific to our pharmacy—around pharmacies working directly with employers. Our employer program today has experienced tremendous growth around shared risk contracting, where we as a pharmacy say, ‘hey we’re really good,’ they say, ‘prove it,’ and we say, ‘okay we will.’ And if we do, there’s a reward and if we don’t there’s a consequence.

Much like baseball, there’s a scoreboard. I think as scoreboards become more prevalent in our industry, performance goes up and my mom and dad as a patient or my daughter as a patient or yours out there as a patient becomes more in tune to know if things aren’t going the way they want them to go, they can do something about it.

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