2014 armada presentation - specialty pharmacy at retail pharmacy
DESCRIPTION
Rebecca M. Shanahan, CEO of Avella Specialty Pharmacy presents on Specialty Pharmacy at Retail Pharmacy at the 2014 Armada Summit.TRANSCRIPT
SPECIALTY AT RETAILRebecca M. Shanahan, CEO
Avella Specialty Pharmacy
Agenda• Specialty Pharmacy Market Drivers
• Specialty at Retail Program Highlights
• Patient Engagement
• Integrated, Real-time Data Sharing
• Opportunities for Growth
State of Retail Pharmacy• 93% of Americans live within 5 miles of a
retail pharmacy
• Pharmacists ranked as the second most trusted profession for the third consecutive year (Gallup Poll, 2013)
• Pharmacists may soon to be given “provider status’
• Retail pharmacies becoming a healthcare destination (screenings, immunizations, first injections, flu shots, clinic)
• BUT the growth is in Specialty Rx
• 1,256,250 patients per year• Assumes conservative $2,000
per month, 8 scripts per year• Data & Other FFS
opportunities• Shared/Aligned Risk Upside
Specialty at Retail - OptionsTraditional SRx
Investigate Benefits
Hub & Spoke Triage
Limited Distribution Drugs
Dispensed by XX on Behalf of Retail YY
Specialized SRx
Lower $$; Higher Volume Drugs
Compounds, Infusions & Nutriceuticals Brand ExtensionsCo-Pay & Discount Cards
Persistence & Compliance
Payor Centric SRx
Disease Specific “Center of Excellence”
Geographically Dense Relationships
Clinical Program & Data
Orphan SRx
3PL Competencies
REMS Competencies
Roll Out Experience
Informatics Competencies
Clinical & Program Data
IDN/ACO SRx
Medical Home
Medications @ Discharge
340(b) Programs
IPA Relationships
Shared Risk
The Path of a Specialty Prescription
Retail Rx
Specialty Rx
Location, Location, Location - Patient Access and Empowerment• Patient Assistance Programs• Drug/Disease Education• Persistence & Compliance
What Specialty Stakeholders Want
Payer Hotbox - Predictable Costs• Value based health care• Bending the cost curve• Documented Comparative
Outcomes
Actionable Information is the Special Sauce - Quality Clinical Programs• Best Practices Clinical &
Formulary Management• Patient & Provider Network
Satisfaction
Not Your Grandmother’s Soda Fountain – Access to Clinical Pharmacist• Pharmacy & Medical Benefit• Engagement with Patients• Engagement with Physicians &
Offices• Real Time visibility to
Drug/Disease/Patient Variables
Food For Thought• Is Specialty Pharmacy a set of activities that drive patient access &
compliance, a “bricks and mortar” profile or both?• Are there discernable factors that drive Pharmaceutical Manufacturers to
select certain profiles of Pharmacy Providers?• Hep C, HIV, Infertility, RA have broad Retail dispensing presence• Oral Oncology, Injected and Infused Drugs have more Limited Distribution
Specialty Presence• How are site of service changes, e.g. Hospital acquired Medical Oncology
Practices, Physician Networks, etc. driving Class of Trade and Pharmacy network differences?
• Are there different factors driving Payer Network Selection• National/Affiliated Pharmacies• Fulfillment Pharmacies• Regional Retail &/or SRx Pharmacies• Provider Based Pharmacies
Specialty at Retail Program Highlights
HIV at Retail
Chronic Condition No Limited Distribution
Financial Assistance AAHIVM Credentials Adherence Tools
Community Focus
HIV at Retail• HIV – A Chronic Condition requiring individual regimens, treatment
plans and Pharmacist/Patient interactions– 90 to 95 % adherence to HAART achieves Optimal efficacy.– Viral load increases after only 2 days of missed dosing.– Some patients acquire drug-resistant mutations, requiring changes in medication regimen.
• Key Compliance Driver – Hands-on Coordinated Care• No increased level of adherence/virologic improvement with intensive telephone counseling as
the only approach to adherence (Collier and the ACTG Team, 2002 – HIV patients)• Patient is an active participant in therapy management with MD/RPh professional guidance
and regular intervals of review • Adherence is monitored through regular face-to-face interactions with Pharmacists who reach
out to Physicians when Patient encounters barriers to adherencePatientQuestionnaire
Build Meds Schedule Teach Patient
• Score Patient Adherence Likelihood
• Set Cadence of In person Follow ups
• Review of Meds Tracking
Measure MPR Review & Report
• Collect & Analyze Data
• Patient Compliance• Patient Safety• Comparative Outcomes• Share with MDs & RPhD
RPh Disease & Drug Education
• Standard Content & Scripts
• Standard Information & Intervals
• One Platform
• Sleep pattern• Work schedule• Eating schedule• Travel & weekend
schedule
• Standardized Meds Adherence Tracking
• Build Contingency Plans
• Build Pt. Coping Skills
• Patient Adherence • Side Effects• Patient Well-Being• Discharge Reasons
90% Compliance
Rheumatoid Arthritis at Retail
“Specialty Light” Program Patient Education Injection Training
Intervention Step Therapy CDAI Scores
Outcomes: Patient Counseling and Education
Infertility at Retail
STAT Medications Disease Management Hub and Spoke
Centers of Excellence Trained Pharmacist Provider Relations
Compounding Services Passion Patient Education
Hepatitis at Retail
High Revenue Growth Opportunity Not Limited Distribution
Short Duration CDC Testing Guidelines
Provider Relations National Testing Day Manage Viral Load
Patient Education
Patient Access & Empowerment
Mobile App
Bi-Directional Text Messaging Program
• Text messaging program– Daily reminders to take medication– Reminders for lab work – Educational tips, e.g. blood pressure
monitoring – Motivational messaging– Patient surveys
• Gather lab values
• Pharmacist intervention for any indication of non-compliance – Clinician notified– Weekly emails to clinical staff
• Refill Reminders
Bi-Directional Text Messaging ProgramIncrease in Refill Rates After Adoption
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
69.4%
89.4%
Pre-adoption rate
29%Growth in refill rate after adoption of text messaging program
Post-adoption rate
Study Results
The intervention group showed a 12.6% improvement in adherence rate (MPR)
over the course of the study.
Study Results
Intervention group was 78% more likely not to be hospitalized: Saving $27,852
per month in healthcare costs.
Integrated, Real-time Data Sharing
Integrated Real-time Close-Looped Solutions Will Drive the Future of
Healthcare© Copyright 2014, Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health.
SharedHIT
Solutions
Patient
Specialty PharmacyPhysician
Physician:Increasing complexity of
precision therapeutics requires decision support, virtual Clinical
Pharmacist Partner
Patient:Just-In-Time, 3 minute mobile health solutions to empower the patient &
maximize adherence and compliance
Specialty Pharmacy:Rapidly expanding arsenal of high-cost,
low-volume therapeutics demands personalized approach
Ongoing Benefits Management Complexities
Patient:Get the right informationGet the right drug & dose
Get it at the right time
Avella Frameworks SRx Integrator Platform
The New Specialty Pharmacy:Highly configurablePushing/Pulling Data Across dispersed yet shared healthcare continuum.Connecting Patients, Payors, Providers, Drug Manufactures, Specialty Pharmacy for better outcomes (Health/Financial)
Specialty Pharmacy Management
Patient & Payor
Physician/Hospital Management
Single Repository – User Specific Insights
Transactional
• Scripts• Authorizations• Fills• Claim Filing• POS/Medical
Data Capture• Providers• Pharmacy• Patient• Payor
Central Data Repository
and Analytics
• Contract • Patient Management• Claims Management• Audit Risk Mitigation• Better Outcomes
Patients
• Better Compliance• Better Management• Lower Cost• Predictable• Better Outcomes
Provider Portal
Opportunities for Growth
SRx Implemented Pathways Programs
• 96% cost savings between Payor-sponsored Formulary/Pathways Program vs. oncologists not utilizing pathways for breast, colon and lung cancers (1)
• Variance includes only the use of clinically equivalent, evidenced based protocols. Additional savings can be generated from anti-emetics, dose modulation, off-protocol prescribing, management of late stage metastatic disease, and care management
(1) Study included practice data for all Medicare HMO patients with a breast, colon, or lung cancer diagnosis at 3 non pathway practices and 1 pathway practice for 12 months.
Oncology Spend Comparison Pathway Physician Non-Pathway Physician
Avg. Drug Cost Per Person $5,160.6 $10,115.2Patient Sample Size 15 49# of Practices 1 3Avg # of Infusion's Per Month 3.00 3.23Cost Differential 96%
Medications at Discharge
CMS Star Rating
Re-Admission rates a Key Driver of CSM Star Ratings MPR/Adherence is a Key Driver of CSM Star Ratings
Coordinated Discharge and Prescription Follow upHospital & Pharmacy jointly participate
at the Discharge pointPatients leave with Rx, and a
Follow-up plan from the Pharmacy
Numerous Studies Demonstrate poor Rx management at DischargePoor Patient management of Discharge Rx leads to Re-Admission
Movement from Volume to Value
Fee for Service
Thank You
Stay Connected
Rebecca M. Shanahan, Esq.CEO of Avella
linkedin.com/pub/rebecca-shanahan/7/100/262