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Specialty Pharmacy Continuum • November/December 2021
OPERATIONS & MANAGEMENT
DIY, consultants, partnerships among strategies used by hospitals
Many Paths to Specialty Success Summa Health, a hospital system in Akron, Ohio, chose to enter a partnership with Trellis Rx to launch its specialty pharmacy. The University of Illinois Chicago and University of Utah Health each built their own from scratch. Texas Children’s Hospital took a middle approach, using a consultant to help plan and launch, and ran it from there on its own. Regardless of the route, specialty pharmacy is an area many hospitals want to get into to improve the specialty medication experience for their patients and gain revenue they otherwise are outsourcing to commercial entities, said Ernest R. Anderson Jr., RPh, MS, a pharmacy consultant in Brockton, Mass., who also serves as an advisor to Trellis Rx, which helps health systems build specialty pharmacy services. A major decision is whether to take a do-it-yourself approach or hire someone with expertise to help, Mr. Anderson noted. Specialty pharmacy services can play a critical role in furthering a health system’s strategy in today’s health care environment, said Jerry Buller, DPh, the chief pharmacy officer at Trellis Rx. But many health systems misunderstand or underestimate what it takes to launch a specialty pharmacy, he said. “You are effectively starting a new business. This is not just another pharmacy program,” Dr. Buller said. “You will need not only significant time and money but also functional expertise to get this new service line off the ground and scale it. To achieve the clinical and financial results you want, you have to do it right. You have to invest in building a differentiated care model to produce a measurably better experience and results. Otherwise you won’t be able to get patients’ and providers’ buy-in; you won’t be able to collect the data you need; and you ultimately won’t be able to unlock network access.” Allow plenty of time, Mr. Anderson advised. “It’s not like you flip a switch and all of a sudden you have your own specialty pharmacy service. There’s always a ramp-up phase, but a partner or consultant can help you shorten this phase and get results faster. You really have to develop relationships with physicians in your clinics to get them on board.” Additionally, he said, be aware of two major barriers: getting managed care contracts, and gaining access to drugs in limited distribution networks. “Insurance companies often have an exclusive agreement with a commercial specialty pharmacy company, and they have to be convinced to allow a new
player—namely the health system—into that space,” Mr. Anderson said. If pharmacists at the health system don’t have experience in these areas, a partner or consultant can help. As a further aid, Specialty Pharmacy Continuum interviewed pharmacists who took different roads to building specialty pharmacies.
specialty pharmacy services in April 2019, in the oncology clinic, and planned to expand from there. The model was so well received by the executive team and clinicians “that I actually had folks calling me from other clinics wanting to know when we were going to bring
The Partner Model Within months of becoming eligible to participate in the federal 340B drug discount program in 2017, Summa Health’s CEO approached pharmacy leaders about starting an in-house specialty pharmacy service. Since the health system also owned its own health plan, hospital leaders thought this might provide an opportunity to improve the continuity of care while creating a new revenue stream, said John Feucht II, MBA, RPh, the vice president of pharmacy services. ant to get into the specialty pharmacy business? Jerry Buller, DPh, the chief pharmacy After exploring several officer at Trellis Rx, recommended asking these five questions to determine the best path for your health system when going it on your own versus hiring a partner or consultant: options, they moved forward 1. Is specialty pharmacy a core competency for your organization? with Trellis Rx. The compa2. Is your organization able and willing to make the up-front investments required to ny’s model for integrating and build a differentiated service? providing staff under Summa’s 3. How many specialty patients does your health system have who would quality for brand and its ability to ramp specialty pharmacy services? up things quickly made it a 4. How long will it take you to scale? clear choice, Mr. Feucht said. 5. What are the risks if you fail (clinical, financial or experiential)? “It’s probably one of the best Next, if you’re looking for a partner, determine what type of arrangement will best decisions that I’ve ever made support your goals, Mr. Buller said, who suggested five key questions for making that in my career.” determination: Trellis Rx implementation 1. What care model will a partner help you to establish—a remote, call center model experts engaged health system in which pharmacists operate via telephone, away from the clinic? Or an embedded stakeholders, including the model wherein pharmacists work alongside physicians and nurses as part of clinicC-suite, and pharmacy, finance based treatment teams? and IT departments to create 2. How much ownership will the partner give you? launch plans, establish medica3. How much risk will a partner take on? tion ordering and mail-order 4. What measures of success has the partner achieved before in terms of financial and capabilities, and integrate clinical outcomes, patient and provider satisfaction, payor contracting access, and so specialty pharmacy software on, and what will the partner commit to? If the partner has multiple customers, are with Summa’s EHR. Trellis Rx these results consistent? also worked with clinicians to 5. What work and expense are they going to leave or pass on to you? establish workflows and embed Additional factors to consider include the following: pharmacists and liaisons into Real estate. Summa Health’s specialty pharmacy expanded so much that it maxed out care teams to support patients. the retail pharmacy space and will be relocating later this year to a larger space. Scope. Providing specialty pharmacy services to all medical clinics requires a lot of coorToday, Trellis Rx handles all dination and time, and you need to be ready before you open the door. Pick one or two day-to-day operations and areas to start with, and get everything fine-tuned before expanding. manages growth and quality Buy-in. Find good champions from your clinics, such as a clinic pharmacist, medical initiatives, such as accreditadirector or providers, to support your cause. tion and drug manufacturer Resources. ASHP and other associations have forums available to ask questions and and payor contracting. share best practices. —K.B. Summa Health launched
What to Consider When Developing a Specialty Pharmacy
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