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For health systems, many paths to specialty success
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.
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.
After exploring several options, they moved forward with Trellis Rx. The company’s model for integrating and providing staff under Summa’s brand and its ability to ramp up things quickly made it a clear choice, Mr. Feucht said. “It’s probably one of the best decisions that I’ve ever made in my career.”
Trellis Rx implementation experts engaged health system stakeholders, including the C-suite, and pharmacy, finance and IT departments to create launch plans, establish medication ordering and mail-order capabilities, and integrate specialty pharmacy software with Summa’s EHR. Trellis Rx also worked with clinicians to establish workflows and embed pharmacists and liaisons into care teams to support patients. Today, Trellis Rx handles all day-to-day operations and manages growth and quality initiatives, such as accreditation and drug manufacturer and payor contracting.
Summa Health launched 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
What to Consider When Developing a Specialty Pharmacy
Want to get into the specialty pharmacy business? Jerry Buller, DPh, the chief pharmacy 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: 1. Is specialty pharmacy a core competency for your organization? 2. Is your organization able and willing to make the up-front investments required to build a differentiated service? 3. How many specialty patients does your health system have who would quality for specialty pharmacy services? 4. How long will it take you to scale? 5. What are the risks if you fail (clinical, financial or experiential)?
Next, if you’re looking for a partner, determine what type of arrangement will best support your goals, Mr. Buller said, who suggested five key questions for making that determination: 1. What care model will a partner help you to establish—a remote, call center model in which pharmacists operate via telephone, away from the clinic? Or an embedded model wherein pharmacists work alongside physicians and nurses as part of clinicbased treatment teams? 2. How much ownership will the partner give you? 3. How much risk will a partner take on? 4. What measures of success has the partner achieved before in terms of financial and clinical outcomes, patient and provider satisfaction, payor contracting access, and so on, and what will the partner commit to? If the partner has multiple customers, are these results consistent? 5. What work and expense are they going to leave or pass on to you?
Additional factors to consider include the following:
Real estate. Summa Health’s specialty pharmacy expanded so much that it maxed out 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 coordination and time, and you need to be ready before you open the door. Pick one or two areas to start with, and get everything fine-tuned before expanding. Buy-in. Find good champions from your clinics, such as a clinic pharmacist, medical director or providers, to support your cause. Resources. ASHP and other associations have forums available to ask questions and share best practices. —K.B.
specialty pharmacy services to them,” Mr. Feucht said. They expanded to 23 clinics by the end of their first year and now are in 27 clinics.
Trellis Rx secured access for Summa Health to numerous limited distribution drugs including Pfizer’s oncology and cardiology portfolios, Mr. Feucht said, as well as three payor networks. He cited other measures of success, such as achieving a 93% proportion of days covered in the first six months of 2021. Additionally, 94% of patients with HIV supported by the specialty pharmacy have achieved viral suppression, and patient and provider satisfaction scores were each 94% in a recent survey. Overall the pharmacy helped drive a 14% reduction in
drug cost for SummaCare, the health system’s employee health plan.
The DIY Model
At the University of Utah Health, Matthew Rim, PharmD was working on projects such as centralizing prior authorizations and establishing a pharmacy benefit manager for the employee health plan. This was around 2013, when specialty pharmacies were gaining traction. With challenges coordinating services for then-new hepatitis C therapies such as ledipasvir/sofosbuvir (Harvoni, Gilead), Dr. Rim and his colleagues realized they needed better infrastructure to support patients and process prescriptions. They, too, decided to enter the specialty pharmacy realm.
Dr. Rim’s team started with a gap analysis to see what resources they needed to add. They also reached out to other colleagues who had both retail and specialty pharmacies for advice about budgets and services. They visited some sites to observe, and took advantage of national forums such as ASHPs’ meetings to exchange ideas.
The group realized they needed to build a 24/7 call center. They also embedded a pharmacy contract manager in the managed care group to work on payor contracts, and assigned an administrative staff person to gain and maintain access to limited distribution drugs. They set up a management team, pursued accreditation and researched cold-chain packaging for temperaturesensitive products.
Overall, it took about two years to have everything ready, said Dr. Rim, who is now the associate director of specialty pharmacy services at The University of Illinois Chicago (which built its own specialty pharmacy in 2012). Then, within three years, they had maxed out their space due to all of the new specialty medications coming to market. The hospital built a new mail-order pharmacy center to keep up with demand.
At UIC, due to the success of the specialty pharmacy build-out, the organization was able to gain access to 17 limited distribution FDA-approved drugs in fiscal year 2021 alone, Dr. Rim said. UIC was one of the first academic medical centers to achieve and maintain dual specialty pharmacy accreditations (URAC and ACHC) since 2016. While maintaining a patient satisfaction rate of 95%, UIC’s specialty pharmacy services more than doubled their patient volume and annual revenue over the past five years, he said.
“One of the benefits of DIY is that it will allow you to leverage internal expertise,” Dr. Rim said. “Having a core group of pharmacy staff who can maintain and develop operations gives organizations flexibilities and expertise to expand their services.”
The Consultant Model
In 2016, Texas Children’s Hospital built a specialty pharmacy. The medical center already had a small retail pharmacy serving mainly Medicaid patients, said Jeffrey Wagner, PharmD, MPH, RPh, BCPS, the assistant vice president for pharmacy, respiratory care and ECMO services. Then, he and his colleagues saw some data cited in an Institute for Safe Medication Practices (ISMP) workbook demonstrating that the average outpatient pharmacy has a 15% to 35% error rate for pediatric medications (J Pediatr 2005;147[6]:761-767).
“That’s pretty alarming,” Dr. Wagner said. “We knew that if we could mimic what we do on the inpatient side, the safety and quality we provide would be that much better.”
The health system engaged a consultant firm, North Highland, to help prepare, starting with focus groups for families from each of the four planned pilot locations for the specialty pharmacy: rheumatology, hematology/oncology, endocrinology and pulmonary medicine. It was important to the pharmacy that prescriptions were filled in-house. In addition, there was a feeling among some staff that projected specialty pharmacy revenue was too good to be true, Dr. Wagner said. Having a consultant with experience helped staff feel more confident it could actually be true. The consultant also served as a sales team, pitching the service to providers and helping to place pharmacists in specialty clinics, Dr. Wagner said. While patients had a choice of specialty pharmacies to use, many opted for Texas Children’s. The consultant also helped with payor and market access and set the specialty pharmacy on a path to accreditation.
“The reason we engaged a consultant is if we were going to do it ourselves, we would probably roll out a clinic once every month or two,” Dr. Wagner said. “With our consultant engaged, we went live every two weeks and had 13 clinics established by the middle of 2017.”
The pharmacy now has a presence in every specialty clinic at the main campus and the health system’s two community hospitals, covering 15 specialty care service lines, Dr. Wagner said. The pharmacy processes more than 10,000 prescriptions per month, and the team has grown from none to 68 full-time employees. Internal metrics show that patients’ average time to start therapy after receiving a prescription is 0.21 day using their specialty pharmacy versus 4.05 days using external pharmacies.
“It was a significant investment for the system, but the quality and outcomes we’ve achieved through our process we’re very proud of,” Dr. Wagner said.
—Matthew Rim, PharmD
—Karen Blum
The sources reported no relevant fi nancial disclosures other than their stated employment.
