Value-based care is the intersection of better clinical outcomes and lower utilization costs. As their role expands, clinical pharmacists are in a strong position to make the connection by creating new delivery models for health system and hospital pharmacies in the year ahead.
The Web2pro RxO team, a group of trusted advisors working to help health system and hospital pharmacy leaders track, manage and grow their pharmacy operations, has identified five trends that will impact health system and hospital pharmacies in 2018.
1. Renewed interest in 340B to address growing oversight and reimbursement changes
The ongoing policy debate over the 340B Drug Pricing Program has raised health system leadership interest in the 340B program to fund hospitals’ mission and support community benefit. While participation in 340B adds complexity to pharmacy operations, the cost savings and opportunities are significant. As a result, pharmacy and supply chain leaders have renewed their focus on 340B to address rising drug costs and to foster specialty and retail partnerships for expanded patient care access and support. With increasing Health Resources & Services Administration audits, health systems must be able to demonstrate accountability and best practice compliance. To help navigate the complexities of 340B and patient assistance programs, health systems can draw on the expertise of industry experts to develop actionable recommendations to optimize program participation and utilize a robust 340B management software package for audit preparations.
2. Access to data and analytics to drive outcomes and operational efficiency
Whether health systems grow organically or through acquisitions, it is not uncommon to have a dozen or more disparate databases housing critical clinical and operational data. Organizations can use this information to make better financial, clinical and operational decisions and drive improved outcomes. However, a health system’s or hospital pharmacy’s analytics will only be as effective as its source data, which is why it’s important that IT platforms throughout the system have electronic data exchange (EDI) functionality. If the data is not searchable or easily accessible, it cannot have a meaningful impact on patient care or help physicians make better decisions. With advanced analytics, users can track and monitor drug spend and utilization, optimize and reduce drug costs, explain drug usage and cost variances, and improve staff efficiency by reducing time spent gathering data.
3. Continued growth in specialty market will create new opportunities
The specialty pharmaceuticals market continues to grow dramatically and health systems are seeing the largest increase in specialty procurement. While 81 percent of health plans are covering at least one biosimilar product, according to research from Avalere Health1, limited networks and exclusive distribution channels for many specialty pharmaceuticals create barriers to access and reimbursement. Despite these barriers, specialty pharmacy can generate significant revenue and internal capabilities can support health systems’ quality and continuity of care initiatives. Whether health systems want to build, buy or partner, they can leverage resources to develop the required clinical and operational competencies and expertise.
4. Health system pharmacies as source for generating revenue
As a growing percentage of health systems’ revenue comes from outside the hospital, pharmacies are an increasingly important source of revenue. In addition to the obvious expansion into specialty pharmaceuticals, capturing discharged prescriptions, working with outpatient infusion clinics, optimizing 340B opportunities, maximizing patient assistance and recovery programs, and expanding retail and ambulatory pharmacy services are just a few ways pharmacies can generate revenue. The hospital pharmacy can be an overlooked piece of the revenue cycle, and given the complexities in reimbursement, many systems are leaving money on the table. Recovery solutions help hospitals ensure that the pharmacy revenue cycle is running efficiently.
5. Industry consolidation to drive centralized service centers
The industry continues to see tremendous consolidation in all areas, including providers, payors, and vendors. Ongoing mergers and consolidation drive the need for centralization of pharmacy operations designed to help large health systems utilize a centralized hub to manage costs, improve order entry and verification, and standardize policies and procedures. Health system pharmacies have the opportunity to centralize services such as order entry, compounding, packaging, and dispensing that allows clinicians to focus on patient care and drive costs down through improved inventory management and supply chain visibility. Creating one central formulary for the system is a complex issue but a must to ensure consistency of patient care and optimal patient outcomes. Standardizing drugs throughout a medical system reduces variation, which limits medication pick errors, increases patient safety and improves patient care.
Related: Read more about Web2pro’s RxO solutions and services for health system and hospital pharmacies