An Integrated Approach to Optimizing Specialty Pharmacy and Accelerating Performance

Specialty medications are estimated to comprise 65% of drug spending by 2025, and health systems are rapidly addressing new industry demands with in-house programs to support high-cost, high-touch drug dispensing. 

While entity-owned specialty pharmacies meet a clear need for patients requiring complex therapies, getting these programs up and running is only part of the battle. Without strategic optimization across integrated channels, a specialty pharmacy’s long-term success hangs in the balance, but determining how to approach this endeavor often leaves health systems stumped. 

Let’s explore the top challenges impacting specialty pharmacy outcomes, and how health systems may achieve efficiencies and enhance performance for optimal financial, operational, and clinical outcomes. 

Common pain points and pitfalls 

With prescription drug costs estimated to rise by 10% this year and pharmacy staffing shortages persisting, health systems must contend with widespread challenges impacting all areas of the healthcare ecosystem. These factors, combined with reliance on manual processes and out-of-date technology, have a particular impact on specialty pharmacy performance contributing to key pain points including: 

• Workflow inefficiency – Complex pharmacy processes such as drug distribution and patient outreach require streamlined workflows, but many pharmacies aren’t prepared to staff these facilities as they grow. Additionally, the complexity of care needs seen through specialty pharmacies offer the opportunity to offer wrap-around clinical services that enhance patient engagement. 
• Medication non-adherence – Limited staff to support patient education coupled with high prescription costs leave patients with scarce resources to follow complex medication regimens resulting in suboptimal adherence rates. 
• Hindered Patient Access – Without strong manufacturer relationships, health systems may struggle to gain access to Limited Distribution Drugs (LDDs), hindering patient access. With more advanced therapies coming to market, organizations must be able to stand up a program that can service these patients. In order to get into narrow networks, patient engagement and reporting on outcomes are key. 

Together, these issues undermine the efficiency and effectiveness of specialty pharmacy programs leading to ineffective care coordination, increased operational costs, and diminished overall performance. For pharmacy leaders eager to make a change, the first step to address the above challenges is identifying operational silos and opportunities for workflow automation. 

Enhancing operational efficiency

As communication with pharmacy staff and ease in obtaining prescription refills are two of the top three factors influencing specialty pharmacy patient satisfaction, health systems have much to gain by removing operational bottlenecks. The tight integration of an in-house specialty pharmacy reduces inefficiency by enabling direct communication between pharmacy and care teams, as patient information flows freely across a health system’s various departments. This also offers an opportunity to lean into patient engagement technology, with multiple care team members able to sustain engagement across touchpoints. 

Thinking about the platforms within a health system, specialty pharmacies must ensure seamless integration with health system EHRs for better access to patient data and collaboration across care teams. Organizations should also implement robust specialty pharmacy management software for enhanced tracking of patient data, reporting, and compliance. 

Implementing automated systems for routine, manual tasks such as reporting, patient communications, and dispensing empower pharmacy staff to improve operational accuracy and focus on high-impact work. These improvements can help further offload work for providers to support their operations, including prior authorization verification and the process of providing financial assistance to patients in need. 

Incorporating patient-centered approaches

As nearly 70% of specialty pharmacists support pre-prescribing treatment decisions, there is a unique opportunity to further cultivate care post-prescription, throughout the patient lifecycle. Given the concerning rates of nonadherence for complex therapies, this support is critical to addressing treatment gaps that hinder effective care and begins with regularly training staff on new medications, compliance protocols, and technology advancements to ensure they provide the best possible care.

For example, patient-centered approaches, such as personalized medication management plans are interventions that account for individual lifestyle considerations, such as whether a patient has access to reliable transportation or how far one lives from a healthcare facility, to develop treatment regimens that patients can confidently follow. Patient education programs augment this support with in-depth information about complex medications, and operational enhancements enable staff to automate this patient outreach where appropriate, while also making use of direct, face-to-face interactions. 

Organizations should prioritize fostering stronger relationships between specialty pharmacy, physicians, nurses, and care coordinators to ensure holistic care. Creating seamless pathways for referral management and improving communication between internal and external care teams also helps ensure patients don’t slip through logistical gaps, and organizations can establish patient outreach programs to address any challenges with specialty therapies and improve satisfaction. In total, by supporting patients’ ability to navigate complex conditions, patient-centered approaches increase engagement and boost overall outcomes. 

Leveraging advanced data analytics 

After implementing operational and clinical refinements, it is essential to leverage available data to identify performance gaps and drive improvements, creating a culture of constant improvement within the organization. Integral to this endeavor are advanced data analytics platforms that track key performance measures in real-time, such as provider adoption, drug access, and payor mix. 

It is critical that specialty pharmacies also have systems that tie activities to outcomes. Analytics programs should track the disposition of every prescription to report on prescription capture rates, identify inefficiencies in how quickly that medication reached the patient, and offer insight into provider prescribing habits to advance your program. Health systems can also negotiate favorable payer contracts and ensure accurate reimbursement for specialty medications, leveraging outcomes-based data.

For health systems struggling with provider adoption, data-driven dashboards can track each specialty prescription written across a health system to pinpoint opportunities for conversion, based on the percentage of providers filling scripts out-of-network. Similarly, intelligent reporting tools are adept at analyzing patient refill data to identify larger population-level trends impacting drug access and clinical outcomes. To minimize financial pressures due to limited payor networks, analysis tools are expertly equipped to locate opportunities for expansion within a health system’s payor market for more diversified contracting. 

Embracing technological innovation to remain agile 

The rapid emergence of specialty pharmacy programs across the nation represents health systems’ response to evolving care needs and newly emerging patient populations. While no single source can predict exactly how healthcare demands will change in the next ten or even five years, there’s no debate that a well-optimized specialty pharmacy program is a solid strategy for the uncertain future. 

By employing operational best practices, patient-centered approaches, and advanced data analytics, pharmacy leaders will have the tools at their disposal to deliver maximum value for their specialty pharmacy investment, and in turn, provide high quality patient care for improved outcomes. 

Looking ahead, digital health and AI are set to transform how specialty pharmacies operate. Imagine having smarter tools for predicting needs, managing patients more efficiently, and tailoring treatments just for them. As health systems dive into these new technologies, agility will be crucial to tackle any challenges that come up and make sure financial strategies match up with their goals. This alignment will be essential for keeping up with the pace of innovation and continuing to deliver great care as the landscape evolves.

Photo: megaflopp, Getty Images

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