Insights Brief: The Role of Specialty Pharmacy in Accountable Care

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1 Insights Brief: The Role of Specialty Pharmacy in Accountable Care

2 ACOs and Specialty Pharmacy As healthcare in the United States continues to evolve, greater focus is placed on reducing costs while improving the quality of care delivered. In response to these goals, Accountable Care Organizations (ACOs) and similar risk-bearing care delivery models are proliferating. An ACO is an entity consisting of a related set of providers that agree jointly to be held accountable for the quality and cost of care delivered to a defined patient population. As of 2014, the number of ACOs (Medicare and Commercial) has surpassed Woven into this equation are prescription drugs - they continue to play an important role in achieving quality healthcare. In recent years, specialty pharmaceutical spend has increased nearly 20 percent. 2 However, less than 25 percent of ACOs have reported high levels of readiness regarding medication management. 3 Recognizing these significant shifts in ACO growth and specialty pharmacy spend,, Armada Health Care and Specialty Pharmacy Association of America (SPAARx) started a series in January 2014 to spur dialogue about the intersection of specialty pharmacy and ACOs. The series, The Role of Specialty Pharmacy in Accountable Care, brought together diverse and influential healthcare stakeholders to initiate discussion on this largely unexplored topic. The series consisted of four webinars and two live forums at the annual Armada Specialty Pharmacy Summit in May A list of contributing organizations appears at the end of this brief. Specialty Pharmacy Providers Can Work Across ACO Entities to Advance Patient Care Hospital Primary Care Group SPP Multi-Speciality Group Home Health Post-Acute Care Facility 1 (Growth and Dispersion of Accountable Care Organizations: June 2014 Update) 2 ESI Drug Trend Report, Dubois, RW. and Feldman, M. et al. Are ACOs Ready to Be Accountable for Medication Use? Journal of Managed Care Pharmacy. 2014; 20(1):17-21.

3 The stakeholders participating in the series identified six key capabilities that specialty pharmacies can offer ACOs to help achieve cost and quality goals. These six capabilities are listed below along with potential questions an ACO (or ACO-like entity) should consider. SPP Capabilities That Can Help ACOs Achieve Their Goals Medication Adherence Programs Does SPP offer best in class adherence programs? Outcomes Programs Does SPP offer interventions that result in a measurable impact on patient outcomes? Data Sharing Does SPP share data points that are valuable to an ACO? How timely and transparently can the SPP and ACO share data? Care Coordination Can SPP foster collaboration across organizations and demonstrate outcomes improvements? Integration Does SPP have visibility across medical and pharmacy benefits? Across sites of service? Whole Patient Health Can SPP identify other patient health issues that may impact their outcomes (i.e., depression risk, comorbid diabetes) and offer care resources?

4 During the series, participants also identified those capabilities that specialty pharmacies are most and least prepared to contribute to an ACO. These latter areas represent opportunities for specialty pharmacies to differentiate themselves in the market. Specialty Pharmacy Degree of Preparedness to Contribute Competencies to an ACO (February 2014) Medication Adherence Programs Outcomes Programs Data Sharing Care Coordination Integration Whole Patient Health Least Prepared Most Prepared Source: Avalere Expert Webinar, How Can Specialty Pharmacy Competencies Help Achieve ACO Goals?, February 19, 2014; n= 85 ( Least Prepared ), n= 75 ( Most Prepared); survey respondents cross-section of specialty pharmacies, specialty drug manufacturers, health plans, providers and other stakeholders. Summary Participants felt that as ACO entities assume more financial risk, specialty pharmacy partners will be expected to take on risk as well. That said, ACOs are still an emerging delivery model where performance measures and risk sharing models vary from entity to entity. As such, SPPs may want to take a measured approach toward partnering with ACOs. Early experience gained with these models may allow SPPs to differentiate themselves in the market and capture additional patient volume.

5 Take Aways In all, series participants anticipate that specialty pharmacies will leverage their traditional areas of focus (i.e.,medication adherence) while expanding their priorities on additional interventions that seek to improve health outcomes such as care coordination, transitions of care and a focus on whole patient health. Several important considerations were highlighted regarding future collaborations between specialty pharmacies and ACOs (or ACO-like entities): Specialty pharmacy services How will the ACO identify patients that most need specialty pharmacy services? Will the specialty pharmacy partnership be exclusive or many? How will the ACO share information and data about patients with the specialty pharmacy? How will the specialty pharmacy and the ACO ensure coordination of patient touch points? Data sharing What questions do specialty pharmacies need to ask potential ACO partners to ensure data sharing is feasible, accurate and timely? What additional data can specialty pharmacies share with payers, providers, drug manufacturers and patients beyond medication adherence data/medication possession ratio? (e.g., adherence to guidelines/ pathways, data/information to pinpoint opportunities for cost savings and improved patient outcomes) Risk sharing Who will pay for additional specialty pharmacy touch points and services? Is it better to not take on risk and just serve patients that are referred to the specialty pharmacy from the ACO (with possibly a fee-for service contract for any services that are deemed above and beyond )? If specialty pharmacies assume risk, what is the best way to take on risk? (i.e., calibrate level of risk to degree of data visibility, be at risk only for those items specialty pharmacy can control/observe via data) Can cost savings be maintained after low hanging fruit opportunities are addressed in the first year so that performance targets are realistic year over year?

6 Key Stakeholder Participants Janice Anderson, RPh Director of Pharmacy Programs URAC Gary Freeman, RPh., MBA Vice President, Pharmacy Amerinet John Baker, RPh Vice President, Managed Care Orchard Specialty Pharmacy Brett Furchner, MBA President Acro Pharmaceutical Services Duane H. Barnes, MBA, MS Senior Vice President, Enterprise Operations Prime Therapeutics LLC Kylanne Green President & CEO URAC Mark Brown CEO and Founder Priority Health Rx Dana Heschmeyer Pharmacy Program Manager Amerinet Christopher Benz Business Development Director Armada Health Care Amvrosios Ioannidis Chief Brand & Marketing Officer Onco360 Oncology Pharmacy Leigh Ann Bruhn, MBA Director William Johnson, MPA Director Business Development Patient Access Network Foundation Thomas Cohn, MS Chief Strategy Officer Armada Health Care Derek Lundsten VP Business Development Academy for Healthcare Learning Carmine DeNardo, RPh President and CEO ReCept Pharmacy, LP Chronis Manolis, RPh Vice President, Pharmacy UPMC Randy Falkenrath, MBA SVP, Specialty Pharmacy Services CVS Caremark Carrie Morton, PharmD, MBA Director of Pharmacy Deaconess Health System Raulo S. Frear, PharmD Director, Business and Product Development OmedaRx Patrick Moss, PharmD Account Manager Incyte

7 Lois Ann Murray, RPh Chief Strategy Officer Orchard Specialty Pharmacy John D. Musil, PharmD Chairman and Founder Avella Specialty Pharmacy Raymond Rede Vice President, Payer Relations Community Specialty Pharmacy Network Elan Rubinstein, PharmD, MPH Principal EB Rubinstein Associates Jeremy Schafer Senior Director, Specialty Solutions Prime Therapeutics LLC Rob Snyder, PharmD, MBA Director of Pharmacy Operations Panther Specialty SuAnn Stone, RPh Director of Pharmacy Services Regence Blue Cross Blue Shield Sajid Syed, MS, RPh President/Founder Acro Pharmaceutical Services John Witkowski, CPCO Senior Vice President CareMed Pharmaceutical Services

8 For additional information: Leigh Ann Bruhn