powerhouse

Key steps for becoming an ‘outcomes powerhouse’

Health Systems Prove Value in Specialty Care

Compared with other types of specialty pharmacies, those based in health systems have superior access to patients and providers, as well as information in medical records, speakers said during a session at the virtual 2021 ASHP Specialty Pharmacy Conference. These factors can be leveraged to demonstrate value to various stakeholders.

“Metrics commonly used to measure specialty pharmacy services today focus mostly on operational requirements,” said Amber Skrtic, PharmD, CSP, AAHIVP, a clinical pharmacist with Trellis Rx at Parkview Health, in Fort Wayne, Ind. “While we perform better on these metrics, they don’t show the full impact of our integrated services. Proving our value lies in showing how our higher level of integration allows us to provide differentiated services [and improve] clinical and qualitative outcomes.”

Determining what metrics to measure is not always straightforward, especially in disease states that don’t have clinical markers, Dr. Skrtic said. She recommended looking to clinical trials, evidence-based guidelines, peer organizations and stakeholder colleagues for guidance. One metric all stakeholders agree on is better outcomes, she noted. Once you determine outcomes to measure, then decide what activities are needed to achieve them. A health-system specialty pharmacy should consider three critical strategies to become an “outcomes powerhouse,” Dr. Skrtic said:

1. Develop disease-specific pro-

tocols. These should account for the full patient journey, she emphasized. It’s also important to consider patient onboarding to ensure they can afford therapy and start in a timely manner, how to proactively manage refills, and how to determine what clinical activity is needed to ensure therapy is appropriate and patients receive support to remain adherent.

2. Leverage electronic health

records (EHRs). EHRs can be a critical technology for deploying these protocols and workflows, Dr. Skrtic said. Ideally, the programming/protocol should trigger interventions automatically based on data captured by the EHR or the specialty pharmacy team. The programming/protocol also should collect data in a consistent, reportable fashion.

3. Embed pharmacists and liaisons

on-site. The pharmacists should work closely with providers to see patients in person whenever possible, Dr. Skrtic said. The pharmacists also need access to the EHR to see pertinent information and document updates.

In one project, Dr. Skrtic and her colleagues at Parkview Health—a 10-hospital health system in Indiana and Ohio that launched integrated specialty pharmacy services in 2019 with Trellis Rx—evaluated their impact on lost work productivity among patients experiencing migraines. These patients were covered under Parkview’s employee health plan and prescribed calcitonin gene–related peptide specialty medications for migraine. Pharmacists routinely conducted patient-reported outcome measure assessments and performed interventions, if necessary, based on the results.

Over an eight-month period, pharmacists performed 29 interventions, such as dose or therapy changes, adherence counseling and adverse event management for 38 patients. The number of migraine days per month decreased by 55%, and lost productivity per month, including workdays missed and productivity lost during migraine attacks, decreased by 60%.

4 Steps to Demonstrating Value

When using metrics and measures to demonstrate value, consider four points, said Ann McNamara, PharmD, the director of clinical development at Fairview

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New Horizons in Migraine Management

RELEASE DATE: NOVEMBER 1, 2021 EXPIRATION DATE: DECEMBER 31, 2022

This activity is jointly provided by Global Education Group and Applied Clinical Education.

This activity is supported by an educational grant from AbbVie.

Distributed by CMEZone.com

Faculty

Jessica Kiarashi, MD

Assistant Professor Department of Neurology University of Texas Southwestern Medical Center Dallas, Texas

Mining Claims Data Can Make Your Case

There is an urgency for hospital and health-system specialty pharmacies to leverage and optimize their patient care models, a panel of experts said at the 2021 ASHP Specialty Pharmacy Conference, held virtually.

Such an approach is key to ensuring the sustainability and growth necessary to continue to care for patients and evolve in an increasingly competitive health care market, they noted.

Health-system specialty pharmacies do well helping patients with access to medications and education, making sure they are taking medications as directed and that they don’t have side effects, and are seeing improved outcomes in quality of life and health care costs, said Erin Hendrick, PharmD, BCPS, the senior vice president of Health System Strategy for Shields Health Solutions, in Atlanta. Now they need to show that investing in this area “really will pay off for the health system,” she said. Claims data are great to use to prove your point.

It’s key to have pharmacists embedded in physician practices and, if allowed by states, to have collaborative practice agreements, said Angela Ward, BSPharm, MSB, the senior vice president of specialty services for AmerisourceBergen, in Carrollton, Texas. “That lets the pharmacist really have that supercritical face time with the patient,” she said. A recent study (Am J Health Syst Pharm 2021;78[11]:962-971)showed that patient and provider satisfaction was significantly higher using inhouse versus external specialty pharmacists.

There are opportunities to showcase specialty pharmacy skills more broadly and creatively, said Denali Cahoon, PharmD, the chief operating officer for Trellis Rx, in Atlanta. She mentioned seeing hospitals use this model to support patients during transitions of care or for those with common chronic conditions, such as diabetes.

Marketing efforts can signify to pharmaceutical manufacturers and payors that there are benefits to working with hospital specialty pharmacies, in areas such as lowered product abandonment, said Thomas Renshaw, RPh, MBA, MCSD, the senior director of business solutions at Acentrus Specialty, in Lewisville, Texas. “But first we need several things to get truly meaningful outcomes data,” he said: • having access to robust, clean data; • having the clinical expertise to ask the right questions from that data; and • having some type of program to alert providers at the point of care to make those insights actionable. This can change care prospectively, not retrospectively.

Pharmacies tend to be insular and work on their own, Dr. Hendrick noted. Take advantage of the fact that health-system specialty pharmacies “have long tentacles,” she said: Being aligned with finance, network contracting, information technology and other teams provides great opportunities to leverage skills and resources across departments.

Even smaller hospitals are getting into the specialty pharmacy space, Ms. Ward added. “If we can work together, we’d be a force to be reckoned with.”

—K.B.

Specialty Pharmacy, in Minneapolis:

1. Look to the Quadruple Aim for

value. Consider metrics to prove how you lower costs, improve outcomes and the patient–provider experience, or that pursue health equity. For costs, describe how you decrease hospitalizations and emergency department (ED) visits, or how you encourage the use of less costly options, such as generics and biosimilars, when appropriate. For clinical outcomes, show cures in hepatitis C therapy completions or how you monitor disease activity, and how you document interventions when patients don’t meet treatment goals. “Activity metrics such as assessments and interventions are important, and help demonstrate your pharmacy takes an active role in meeting treatment goals,” Dr. McNamara said.

2. Partner with key stakeholders.

Look for opportunities with your clinics, pharmaceutical manufacturers or payors for areas where you have mutual goals. “Pharmacies that are part of a health system have great opportunity to collaborate with clinics to define and report metrics that can be used to demonstrate value,” she said, such as working with a hemophilia treatment center to showcase ED or medical resource utilization, or adherence to prophylactic regimens. There also are opportunities to find projects with drug manufacturers that don’t involve promoting their products. Go beyond adherence to show value.

3. Combine metrics with other information to tell a more holistic

story. Use metrics along with descriptions of your process, interventions and cases. “Often, cases tell the reality of the situations, the complexity of specialty patients, and how assessments and interventions over time result in supporting patients in meeting treatment goals,” Dr. McNamara said. Describe your strategic approach, services and metrics for each disease state. 4. Know your audience. It also is important to provide metrics that are most relevant to your audience, she noted. For many payors, health equity and costeffective use of anti-inflammatory medications are top of mind. To gain access to limited distribution drugs, think about what’s important to manufacturers, such as time to fill, patient adherence and experience. For internal audiences, demonstrate that you are efficiently providing services that affect the Quadruple Aim.

As an example, Dr. McNamara discussed a program in which the pharmacy worked with a hospital health coach and chaplain to provide extra help to patients whose needs went beyond the usual expertise of the pharmacy. This included adjusting to living with new diagnoses, the loss of loved ones or mental health issues. With COVID-19, many patients were isolated, gained weight or lost jobs. Together, the pharmacy, therapy management team, chaplain and health coach wrote a program description, process and services, and agreed on metrics to measure.

The health coach and chaplain intervened when necessary, referring patients to health care and other resources, therapists, physicians, palliative care, psychologists and social workers, among others. One patient with multiple sclerosis who had lost two loved ones and was caring for four young children was connected to county services for housing, child care resources during a hospitalization and financial assistance to purchase an air conditioner, and was able to seek grief counseling. “Cases really demonstrate how powerful the interventions are and the work that you do,” Dr. McNamara said. In patient surveys, 100% of respondents agreed that they were satisfied with the program, with the majority (85%-97%) stating their physical and mental health were positively affected. —Karen Blum

The speakers reported no relevant fi nancial disclosures.

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