Blog, The Hospital Finance Podcast®

How Integrated Specialty Pharmacy Improves Health System Economics & Patient Outcomes [PODCAST]

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In this episode, we’re pleased to welcome David Filstein, Senior Director of Corporate Strategy at Shields Health Solutions, to discuss how integrated specialty pharmacy improves health system economics and patient outcomes.

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Highlights of this episode include:

  • About Shields Health Solutions  
  • The benefits of the integrated specialty pharmacy model
  • How integrated specialty pharmacies can create new revenue streams for health systems
  • Where health systems are investing in new services
  • how an integrated model can help to mitigate labor shortages

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome David Filstein. David is a Senior Director of Corporate Strategy at Shields Health Solutions. At Shields, David and his team oversee corporate initiatives, including new service launches, strategic partnerships, integrations, and M&A. David is passionate about improving patient care, especially for patients who are dealing with some of the most challenging and acute diseases. Prior to Shields, David spent several years working in investment banking at RBC Capital Markets. David graduated with master’s and bachelor’s degrees from NYU Stern. In this episode, we’re discussing how integrated specialty pharmacy improves health system economics and patient outcomes. Thank you for joining us today, David.

David Filstein: Hi, Kelly. Happy to be here.

Kelly: Well, great. Well, let’s go ahead and jump in. Can you provide some information on Shields Health Solutions and the benefits of the integrated specialty pharmacy model?

David: Absolutely. So, Shields Health Solutions partners with around 80 health systems nationwide, representing over 1,200 hospitals to help manage their specialty in retail pharmacy programs. We do this via our clinical model proven to lower total cost of care for specialty patients by 13% and by elevating payer and drug access at these programs. So, Shields’ expertise is in health system specialty pharmacy, which are pharmacies that have the ability to dispense specialty medications. Specialty drugs are more complex than most prescription medications and are used to treat patients with serious and often life-threatening conditions, including cancer, hepatitis C, rheumatoid arthritis, multiple sclerosis, and many other acute or chronic conditions.

To provide some context, specialty medications represent 1% of patients, but 50% of drug spend. So, specialty prescriptions medications cannot be routinely dispensed at a typical retail community pharmacy because the therapy typically requires special handling as well as significant patient education regarding appropriate utilization. The consequences of inappropriate handling or issues with treatment with specialty medications are much more severe, both from a patient health and financial standpoint. As a result, a lot of attention is given to the specialty pharmacy care model. Shields is built on the benefits of an integrated specialty pharmacy model, which means a specialty pharmacy that is embedded in the health system and often actually on site at the hospital. With an integrated specialty pharmacy model, healthcare providers and in-clinic staff are able to play a much more active role in the patient’s pharmaceutical journey. This means the patients have active support in getting on service and staying on service. Any necessary adjustments to the patient’s care, such as dosage changes, treatment changes, or any concerns the patient may have about their drugs, are addressed much faster and more effectively.

Kelly: Great, thank you for that background on Shields. Against the backdrop of harsh economic conditions for health systems over the past 18 months or so, how can integrated specialty pharmacies create new revenue streams for health systems?

David: Yeah, Kelly, so specialty pharmacy represents the largest untapped financial opportunity for every health system in the country. For some of our mature programs, their specialty pharmacy programs represent 50, 60, and for some, even close to 100% of their bottom line. Beyond improving patient outcomes, this is a key value driver that Shields provides. When we accelerate health system specialty pharmacy programs, we bring tremendous profitability to the health system. When health systems are able to dispense specialty medications at their integrated pharmacies, they’re able to capture some of that financial opportunity, which would otherwise be realized at external, non-health system pharmacies. Shields helps our partners gain access to over 80% of all limited distribution drugs, LDDs, and most health insurances in the nation. We also help partners ensure all clinics within a health system, which prescribes specialty opportunity, have the right workflows set up with the integrated pharmacy, which means that health system pharmacies are able to service almost the entirety of their specialty patient population. For many health systems, the on-site specialty pharmacy in the past used to be effectively a cost center, as limited specialty volume meant limited financial opportunity. We’ve helped turn specialty pharmacy programs into some of the strongest profit drivers at our health system partner sites.

Kelly: Wow, very interesting. In the same vein, where are you seeing health systems invest in new services given the financial constraints of the economic climate?

David: Yeah, it’s an interesting question, Kelly. So, health systems are looking to invest in tools that can help them boost efficiency and reduce waste, while simultaneously improving the quality of care, delivery, and boosting clinical outcomes. Given financial constraints in today’s climate, they’re trending to digital and tech-driven solutions, often via third-party technology, to help drive that efficiency. Hospital labor shortages have also led to increased investment in telehealth programs, which have provided flexibility to existing staff and allows for the hiring of remote workers.

Kelly: Great, thank you. And how can an integrated model help to mitigate the labor shortages that have plagued health systems?

David: Totally. So excited to provide some context here. So, for a hospital clinic, supporting the care of a patient on a specialty medication represents a significant administrative burden. Prior to the dispense of that medication, a benefits investigation needs to be completed to better understand the patient’s coverage. Most specialty medications are very, very high cost. And therefore, the insurance companies require a prior-authorization or a PA to be completed. The patient’s financial responsibility for specialty care is often very large as well. Financial assistance or FA workflows are also needed to understand if copay cards are available for the patient or maybe foundational assistance to help bring the patient’s copay to a more tenable figure. And when the drug is finally dispensed, the patient’s care needs should constantly be monitored via refill touchpoints and clinical pharmacist check-ins. All of this means a lot of work. And this burden usually falls on in-clinic staff, providers, nurses, and clinic administrators. Setbacks in getting this done means delays in patients getting on therapy and staying on therapy, which means worse health outcomes for the patients and worse financial outcomes for the Health System Specialty Pharmacy program. Shields’ in-clinic pharmacy liaisons, supported by a team of decentralized, licensed pharmacy technicians, help manage these efforts by completing BIs, PAs, FAs, and refill calls. Our patients get on therapy in less than two days with co-pays of less than $10 and have adherence rates in the mid-90s.

All of these results are possible because of the integrated care model, which allows Shields’ patient support advocates to have access to patient records within the EMR, driving high levels of efficiency and patient satisfaction. And when we take this administrative burden off of clinical staff, this enables them to practice at the top of their license by focusing on other patient-focused activities instead. Clinical staff, which aren’t as bogged down with administrative responsibilities, means much happier individuals.

Kelly: That makes a lot of sense, David. Can you share how the integrated model improves results in specific disease states?

David: Absolutely. So, we’re very, very proud of the results we’ve been able to drive at our health system partners and reinforce our reputation as the nation’s leading specialty pharmacy partner. I’ll walk through some highlights for success stories we’ve had across a number of disease states. So, for HIV, 93% of Shields’ HIV patients reach viral suppression compared to the national average of 65% with an average copay of $3 monthly. For context, for people who don’t know what that means, for 93% of patients that work with Shields, their virus is undetectable. If you have 100 patients within your clinics with HIV, 1 to 2 percentage points means that you are changing the lives of several people. For Rheumatoid Arthritis, we’ve achieved incredible adherence metrics with 91% proportion of days covered in that adherence metric compared to 30 to 80% as reported in various RA studies. We also have 52% of our RA patients improving their RAPID3 score. That’s a questionnaire that scores RA disease activity, which results in positive treatment outcomes and indicating low disease state activity or near remission. For Multiple Sclerosis, Shields’ patients’ annualized release rate, or ARR, is 0.18, a key metric in reducing the number of flares over time that can delay the progression of disability and neurologic dysfunction. The national average copay for MS treatments is over $3,000, which is nuts, while Shields’ patients pay an average of $5 per month. And then, finally, we also do work with Diabetes. And we’ve achieved great results in the Diabetes space, where our patients had average reduction in hemoglobin A1c levels from 0.8% from up to 60 days before their onboarding date through six months after enrollment in the program.

Kelly: Wow, those are outstanding results. Thank you so much for joining us today, David, and for sharing your insights on how integrated specialty pharmacy improves health system economics and patient outcomes. Thank you again.

David: My pleasure. I enjoyed talking to you, Kelly.

Kelly: Yes, me too. And if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?

David: Yeah. So, I would direct folks to our website, shieldshealthsolutions.com. There are some great points there to learn more about what we do and also to contact the company. And you can find me on LinkedIn if you have any specific questions too.

Kelly: Thank you for sharing that. And thank you, all, for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of the Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.

 

If you have a topic that you’d like us to discuss on the Hospital Finance podcast or if you’d like to be a guest, drop us a line at update@besler.com.

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