One key factor driving shifts in health systems’ patient care strategies is the change in patient volumes to non-hospital settings.
Vizient’s 2024 Forecast Report predicted a 17% increase in outpatient care volumes over the next decade.
With a higher volume of specialty medications prescribed, coupled with more patients interested in seeking care closer to home, outpatient pharmacies play a pivotal role in providing and improving access to high-quality health services.
Without an effective specialty pharmacy model, hospital patient care strategies are missing out on serving a broader population and increasing market share, while also improving their missions of care. Hospitals could be missing other benefits by serving their own employees, too.
Q: What benefits do specialty pharmacies provide?
Specialty pharmacy services can be an important source of revenue for health systems and also offer key benefits for patient care and outcomes.
From guiding patients’ specialty drug regimens and assisting those struggling with copays and costs through patient advocacy programs, a health system’s specialty pharmacy extends the care it provides to the community, helps improve medication adherence and provides insights into contributing factors for length of stay and outcomes.
Q: Why don’t all hospitals take advantage of opening or maximizing a specialty pharmacy?
First, smaller facilities may mistakenly assume that they do not have patient volumes to justify one, but in reality, when less than 10 prescriptions have proven to make a substantial cost savings for the facilities that Cardinal Health supports.
These pharmacy business models are complex and present unique challenges, such as labor, resources and expertise. From labor scarcity and pharmacy benefit billing resources to accreditation complexities, it’s common for these pharmacies to lack the tools and support needed to tailor operations for the optimal patient and payor mix.
Q: How can health systems get specialty pharmacy support and resources?
There are many resources to help health systems overcome these challenges. For example, health systems can choose to customize the level of support needed based on their specific needs, labor situation and service lines. Customized services range from traditional consultative assessments to outsourcing, accreditation support and payor access solutions.
There also are increasing choices for remote support to ensure these facilities remain compliant and best support patient needs while a providing new, sustainable revenue engine for the health system.
For example, specialty pharmacy hub services today include 24-hour clinical support--a requirement of specialty accreditation--as well as remote prior authorization services and remote order entry. These services help lean on-site teams focus on delivering direct patient care.
To learn more about how your health system can unlock the benefits of a custom outpatient specialty pharmacy strategy leveraging a hub model, click here.
Sometimes a client wants to see what you can do with one project before jumping in with both feet.
Such was the case with a Southeastern health system with 10 hospitals and almost 200 doctors’ offices and outpatient clinics.
Cardinal Health committed to save one of the system’s larger hospitals $1 million during the first year managing its pharmacy.After exceeding that goal, Cardinal Health began supporting additional facilities. System leadership noticed that managed facilities performed better and decided to leverage the pharmacy to achieve its strategic goals.
Today the health system relies on a three-pronged strategy for all its pharmacies: cost savings, system standardization and revenue growth.
Here are three questions to ask about how such an approach could work for your facility:
Q: How can a pharmacy deliver cost savings to hospitals?
To measure progress, one must start with baseline assessment of performances. For this system, Cardinal Health conducted evaluations to measure pharmacy performance against benchmarks and industry standards to identify opportunities and challenges.
Next, using a clinical consulting approach, the pharmacy collaborates with stakeholders to guide therapies for patients, providing them the safest, most effective drugs at the best cost.
Keeping the baseline assessment top of mind, an annual performance assessment is conducted for continuous improvement, identifying new and potential challenges, while resetting year-over-year savings goals.
Q: How does systems standardization improve quality and accountability?
When hospitals of different sizes use different processes and metrics to measure results, it’s hard to understand the full scope of success. Standardization ensures that all hospitals use the same procedures to make and measure improvements. The process includes operationalizing assessments, drug purchase processes, buyer training, formularies and policies.
Given that inpatient drug spend is approximately 58% of this system’s drug spend, standardization is vital to improve efficiency. This proved true after all 10 of the hospitals implemented these changes and recognized $800,000 in savings in a single year.
Q: How can a health system increase revenue?
Health systems can drive additional volume and revenue in outpatient settings like infusion centers. Some systems hesitate to do so, because rejected or denied regimen orders can be difficult to manage, complicated and time-consuming. However, Cardinal HealthTM AtrixTM Ally can prevent this from occurring and increase remittance team efficiencies.
AtrixTM Ally identifies patient advocacy opportunities to help patients with the cost of care. With this approach, hospitals can reduce bad debt and enhance the patient experience. For example, one health system saved $1.1 million in a single year, including $264,000 in denial avoidance and $836,000 in advocacy.
To learn more about how your health system can unlock the benefits of growth through pharmacy support and resources, read the full article here.
