The specialty pharmacy industry is booming and as many pharmacies opt for moving down the specialty pharmacy accreditation path, many hospitals and healthcare systems are starting to realize opening their own specialty pharmacies (or partnership with one) could be a good idea. The jump to specialty pharmacy for a health system or hospital, isn’t only a revenue driver as it gives them access but could also help with re-admissions, quality of care, and data collection. And as specialty pharmacies crop up all over the country, with an estimated 250 to be accredited by Q1 2016, it is the perfect opportunity for health systems to take fate into their own hands. From driving revenue, to increasing quality of care here are three main areas a hospital or health system can benefit in an in-house specialty pharmacy.
Specialty drugs generally are defined as having one or more of the following characteristics:
- Complex to manufacture, requiring special handling
- Injectable or oral, self-administered or administered by a provider
- Costly taken by patients with complex medical conditions
- Difficult for patients to take without ongoing clinical support
Generating and Gathering Data
Specialty conditions rely on specialty drugs, which in turn rely on specialty pharmacies. It is this unique relationship that provides a great opportunity for hospital and health systems to collect additional data on specialty drug outcomes and patient care. The ASHP reported in 2014 that Kevin Colgan who is Corporate Director of Pharmacy for Rush University Medical Center in Chicago was hopeful that opening a specialty pharmacy gives a health system access to a “robust data” could help them “determine which of the expensive medications work best.”
In “Five Health System Pharmacy Trends to Watch in 2016” published by McKesson, the company reported that one very important pharmacy trend would actually go-hand in with a booming healthcare trend, big data. According to McKesson, “A top priority for health systems is using analytics to track and monitor drug spending and use, patient care and quality. This data can be used to make better clinical and financial decisions. Lack of connectivity or interoperability of health records between pharmacy and other providers can be a major safety issue for patients and has continued to be an overall problem in the industry.” This doesn’t just apply to hospital pharmacies but can be applied to the specialty pharmacy industry. By having specialty pharmacy data available in-house, health systems and hospitals can record and control data themselves.
The American Pharmacists Association reported on a specific case where The University of Wisconsin Hospital and Clinics opened a specialty pharmacy and completely enhanced their EHR system as to integrate with their pharmacy. By doing this they then were able to “see a patient’s visit history across health-system departments, the patient’s labs, and other medications among the abundant other information that pertains to a patient in a health-care system,” helping the pharmacy staff have a wider view of a patients’ medical history.
Generating revenue is constant for any hospital or health system. It’s staggering to think that by not having a specialty pharmacy, they could be missing out on a huge revenue driver. But just how much revenue are they missing out on? Billions, according to Jim Smeeding, the Executive Director of the National Association of Specialty Pharmacy. Pharmacy Practice News quoted Smeeding, who suggested that “a moderately sized health system with $2 billion to $3 billion in annual revenue stands to gain $20 million to $30 million annually by adding its own specialty pharmacy.”
This isn’t an outdated concept either. According the McKesson report (mentioned earlier) health systems can look toward specialty pharmacy no a “cost center” but as a revenue generator. Why? Well according McKesson “Whether still operating in a fee-for-service environment or shifting to a performance or value-based reimbursement model, the pharmacy can have significant impact on the overall P&L of a health system by focusing on incremental revenue opportunities such as ambulatory, specialty and mail-order pharmacy services1.”
Continuity of Care
It’s no secret that once a patient leaves the pharmacy, there are a wide variety of reasons why they may or may-not take their medication on time, or come in for a re-fill. Pharmacy medication management programs are crucial in situations of medication adherence. According the McKesson report pharmacies inside hospitals and health systems can actually help improve the continuity of care, medication adherence, and reduce readmission1. Still not convinced?
According to Jim Smeeding, in Considering Specialty Pharmacy, a major concern for hospitals and health systems is “fragmentation of care, which impacts both cost and quality.” Opening a specialty pharmacy inside a hospital or health system might be the answer to breaking that gap in care – which in turn will increase medication adherence and quality of care. If a patient doesn’t even need to leave the building to get a prescription filled and their provider can work with their specialty pharmacist, this can only mean better care for the patient.
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