How Integrated Health Care Delivery Networks Collaborate to Optimize Specialty Pharmacy Care

As the number of specialty drugs has grown in the past decade, regional health systems and academic medical centers have stepped up to assert the power of integration and coordinated care by establishing and expanding their own specialty pharmacies.

The guiding premise of an integrated delivery network (IDN)–based specialty pharmacy is that the patient must be at the center of care. With an IDN infrastructure, all members of the care team are empowered to rally around the patient. They can coordinate information and decision making to balance 2 important objectives: delivering the best possible care and managing the cost of care.

At Banner Health, in Phoenix, Arizona, we recognized that we had all the ingredients to provide great care, but we needed to add a specialty pharmacy component to improve care for patients with complex needs. In 2014, we built an in-house specialty pharmacy in 6 months, launching in October of that year.

In addition to the typical features and capabilities, such as a call center, patient educational providers, data reporting, express shipping and tracking, and cold chain expertise, an IDN-based specialty pharmacy involves some not-so-typical capabilities. For example, pharmacy liaisons are embedded in specialty clinics to reduce the administrative burden on clinic staff and assist patients on the spot. Smoother workflows, shorter time to first fill, and greater patient satisfaction result from this operational model.

Another way we exceed minimum standards is by offering same-day order fulfillment and delivery in our service area. We also offer regional patients the flexibility to receive drug therapy at the right site, whether that is at home, at the clinic, or at an infusion center.

Building the Banner Health specialty pharmacy would not have happened so quickly without Excelera, a member-owned network of health systems that focuses on optimizing care for patients with complex needs through specialty pharmacy collaboration. Excelera’s assistance helped us build the specialty pharmacy to meet rigorous standards in the areas of compliance and accreditation, operational capabilities, benefits and assistance, clinical and adherence programs, performance metrics, and data reporting.

The notion of a specialty pharmacy net- work was simply an innovative idea in 2009 when Excelera was formed, a collaborative venture that would set operational standards, find ways to facilitate pharmacy data collection, and assist health systems in building their own specialty pharmacies. The network model was created in response to 3 major challenges: payer lockout, lack of access to some specialty drugs, and significant gaps in the ability of IDNs to address manufacturers’ complex data needs. Only by addressing these challenges and providing integrated, coordinated pharmacy care to patients with complex and chronic conditions can health systems achieve the Institute for Healthcare Improvement Triple Aim: improving population health, improving their patients’ care experience, and reducing the per capita cost of care.

PATIENT CARE AT THE CORE

Without specialty pharmacy access at the point of care, patients can face hurdles that range from inconvenient to dangerous. Two examples from Excelera members:

• A patient who had undergone a kidney transplant stopped taking medication for 1 month because his outside pharmacy failed to correctly handle a transition from Medicare to Medicaid. With the IDN model, a refill follow-up phone call might have caught the issue sooner, sparing the patient hospitalization for rejection and treatment with thymoglobulin.
• A patient with breast cancer had no choice but to obtain 2 different oral oncolytic drugs from 2 separate outside specialty pharmacies because of payer restrictions. She could have had a seamless transition from clinic to home if the Excelera member where she was a patient had been authorized by the payer to fill the prescriptions (as a National Cancer Institute–designated Cancer Center, the member had access to both drugs).
• Since the concept of the Excelera network took shape, the specialty pharmacy landscape has become only more complex and costly. This year, specialty drugs will likely account for half of overall drug spending.1



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