Steps, Strategies & Challenges of Creating Specialty Pharmacy in a Hospital/Health System Setting*
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1 Steps, Strategies & Challenges of Creating Specialty Pharmacy in a Hospital/Health System Setting* *Session co-supported by educational grants from Diplomat Specialty Pharmacy & Monarch Specialty Group Tuesday, October 15th 1:30pm-3:00pm
2 Session Information This program will highlight the unique challenges, strategies and steps involved in implementing hospital/health system based infrastructure changes to incorporate specialty pharmacy. Attendees will gain a first-hand knowledge account of how a hospital/health system based pharmacy program identifies & addresses systematic requirements to support specialty pharmacy. Universal Activity# L04-P 1.5 contact hours; Knowledge-based activity Faculty: Kyle Skiermont, PharmD Director Specialty/Infusion Operations, Fairview Pharmacy Services Jody Miller, MBA Partner, Monarch Specialty Group, LLC Mary Van Hoozer, MS National Account Director Hospital/Health Systems, Diplomat Specialty Pharmacy
3 DISCLAIMER The information within this CME/CE activity is for continuing education purposes only, and is not intended to substitute for the medical judgment of the healthcare provider. Recommendations for use of any particular therapeutic agents or methods are based upon the best available scientific evidence and clinical guidelines. Reference in this activity to any specific commercial products, process, service, manufacturer, or company does not constitute its endorsement or recommendation.
4 Kyle Skiermont Director of Specialty/Infusion Operations Fairview Pharmacy Services Minneapolis, MN As Operations Director, Kyle is responsible for strategy and overall operations of Fairview Pharmacy's specialty pharmacy, mail order, long term care, compounding, home infusion and community infusion business units. He interfaces with providers, the health system, payers and manufacturers to create innovative, patient focused solutions for specialty pharmacy.
5 DISCLOSURES I do not intend to discuss an off-label use of a product during this activity. I have not had any relevant financial relations during the past 12 months to disclose
6 OBJECTIVES 1. Describe barriers for hospital/health system entry into specialty pharmacy 2. Describe services customers expect from their specialty pharmacy 3. List key steps for successfully implementing a specialty pharmacy program for the hospital/health system
7 Fairview Health Services provides a full continuum of health and medical services. Not-for-profit organization established in 1906 Partner with the University of Minnesota since ,000+ employees 2,050 aligned physicians 7 hospitals/medical centers (1,627 staffed beds) 44 primary care clinics 55-plus specialty clinics 47 senior housing locations Home care, home medical and hospice 30+ retail pharmacies Urgent care and retail clinics 2012 data 74,649 inpatient admissions 1.16 million clinic visits $514 million community contributions Total assets of $2.77 billion $3.22 billion total revenue
8 9 Comprehensive Set Of Pharmacy Services Retail Pharmacies (34) Medical office buildings and clinics, University of MN hospital Hospital Pharmacies (8) Infusion Therapy (home and ambulatory service) Licensed pharmacy and home health agency w/regional coverage Clinical team: IV nurses, clinical pharmacists, dietitians Antibiotic therapy, TPN, oncology, pain management On-site Infusion Pharmacies (4) Specialty Pharmacy Nationwide coverage, all drug classes, case-managed approach Mail Service Pharmacy Long Term Care/Assisted Living Pharmacy Compounding Pharmacy Central Packaging Medication Therapy Management (MTM) 20 clinics, multiple direct-to-employer and payer contracts Fairview Clinical Trials Services Anti-coagulation clinics (30) Wholesale pharmacy Advanced Drug Therapy Program ClearScript SM pharmacy benefit management Management oversight of UMMC Hemophilia Clinic Health system consulting
9 Why is specialty pharmacy important for a hospital/ health system? Fragmentation of care impacts costs and quality Hospital Readmissions Result From Medication Therapy Fragmentation NEHI Research Shows Patient Medication Nonadherence Costs Health Care System $290 Billion Annually Global Payment Models will put health systems at risk for the cost of care and those with health plans must increase value to their employer customers
10 Why is specialty pharmacy important for a hospital/ health system? Specialty medications represent about $75.8 billion in 2010 Wall Street pharmacy companies will control 87% of market Fastest growing employee benefit expense Specialty Pharmacy is concentrated with a small number of patients ~1% of the population High-cost and/or high-risk medications Complex regimens used for complex conditions
11 Barriers for hospital/ health system specialty pharmacy Established specialty pharmacies in the market Three companies generate about two-thirds of revenues from pharmacy-dispensed specialty drugs 1 PBMs directing to owned specialty pharmacy 1 Drug Channels: 2011 Pharmacy Market Share for Specialty Drugs
12 Barriers for hospital/ health system specialty pharmacy Limited number of hospital/health system based specialty pharmacies Competing priorities in the health system Lack of specialty pharmacy experience
13 Services stakeholders expect from their specialty pharmacy Distribution Billing Clinical Services Data reporting Customer Service
14 Most valuable services provided by specialty pharmacies Ensure dose accuracy Manage drug waste and abuse Adherence measurement Limited distribution drug access EMD Serono Specialty Digest, 9 th Edition
15 Most valuable services provided by specialty pharmacies Adherence programs Savings measurement Track type of patient interventions Track patient intervention outcomes EMD Serono Specialty Digest, 9 th Edition
16 Strategies to get started Maintain current environment Partner with an existing specialty pharmacy On site model Central model Start a specialty pharmacy Joint venture Consultants Join with other health systems
17 Strategies to get started Develop project plan and assign leader Size the opportunity Develop business plan Obtain appropriate licensure Dedicate staff Dedicate space
18 Strategies to get started Provide service to patients with any willing provider payers Government plans Some commercial Discharge Non-specialty specialty Transplant, HIV Hospital/health system owned health plan
19 Strategies to open larger opportunities HUB relationships Leverage hospital/health system payer agreements Care for own patients Explore exclusive payer relationships Accreditation Explore limited distribution drugs Center of excellence Care for own patients
20 Summary/ Lessons Learned First step is to develop the services expected by a specialty pharmacy Start small open access medications or a few disease states Once established, utilize the expertise and leverage of the hospital/health system to expand
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