5 Ways Health Systems Are Missing Out by Not Addressing Specialty Pharmacy

This article was originally published by Acentrus Specialty.

Specialty pharmacy remains a growth and patient care opportunity for large health systems (ie, academic medical centers, integrated delivery networks, and community-based hospitals). Not only can they improve care and enhance continuity of care to the patients they serve, but also increase revenue streams and satisfaction among patients and physicians while reducing the risk in a value-based reimbursement model.
Operating a specialty pharmacy is a great benefit to a health system that adopts it early, while those who wait are going to face higher risks and have a lower probability of success.
Here are 5 ways health systems can be affected by not opening an integrated specialty pharmacy:
1. Missing Out on Better Patient Care
While third-party pharmacies fulfill delivery of specialty medications to patients, they reduce the ability of physicians to easily monitor and track the patient’s health, making it harder to offer the highest possible quality of care. Where this becomes especially important is continuity of care and management of adverse effects or new symptoms.
Without the benefit of real-time transparency that a shared electronic health record (EHR) provides, it becomes more difficult to manage and intervene in patient care complications and prevent a readmission or visit to the emergency department.
Working through a health system specialty pharmacy may not always feel the most comfortable to patients, as many associate hospitals are critical care settings. Although it may feel more familiar to go to an offsite specialty pharmacy, it’s not always easier for patients.
With physicians and pharmacists working together through an on-site pharmacy, they can provide education and management of medication while proactively adjusting treatment based on adverse effects and focus on increasing adherence.
Integrated specialty pharmacies at health systems give physicians and the multidisciplinary care team of pharmacists and nurses better access to their patients’ records. This allows them to better manage and monitor their patients’ compliance and persistence of use for prescribed medication. The ability to impact adherence of patients saves health systems money and results in healthier patients with fewer medication-related complications.
2. Preparing for Value-Based Reimbursement
Health systems and hospitals are now seeing their profitability directly tied to patient outcomes due to the transition from fee-for-service to value-based reimbursement. Transferring the pharmaceutical care of patients to commercial specialty pharmacies gives up control over the total care of a patient, which increases the risk to the health system.
If a patient sent to an outside specialty pharmacy does not adhere to their medication regimen and is readmitted to the health system, then the cost for the interventional care comes without any additional reimbursement to the health system. This also results in reduced quality of care for the patient.
Health systems moving to a fee-for-value model and accountable care organizations (ACOs) are in alignment with payers around financial incentives. Outside specialty pharmacies, organizations incentivized to fill the most prescriptions possible, are not aligned with this system. Specifically, this makes the health system and ACOs responsible for any difference in allocated cost from capitation or reimbursements if the outside specialty pharmacy charges more than allocated for the medication.
Establishing an in-house specialty pharmacy is a win-win for health systems because it provides greater control over managing the patient. Adherence and the impact on readmission are vital to the health systems viability in a value-based care model.

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