Through emerging options that create automated processes to address prevention and wellness and increase accountability by the patient, specialty pharmacy has the ability to deliver greater value, said Eric Sredzinski, executive vice-president of clinical affairs and quality assurance with Avella Specialty Pharmacy.
As Sredzinski told attendees at the recent 2017 Pharmacy Solutions in Drug Plan Management forum in Toronto, a value-based contracting approach — where a portion of the provider’s total payment is tied to cost-efficiency and quality measures — can help a specialty pharmacy identify patients who need interventions and thereby lead to improved adherence and outcomes.
The specialty pharmacy, for example, has a key role when it comes to collecting data on patients’ results and side-effects and with regards to patient outreach, education and support, said Sredzinski.
“Just leaving an office and getting education just really isn’t enough. So, from our perspective, education doesn’t start and stop at the first fill. It’s continuing for as long as you’re managing that patient,” said Sredzinski.
New technologies are helping improve patient outcomes, including apps for patients that support adherence as well as for providers that empower informed prescribing decisions.
As an example, Sredzinski discussed a patient mobile app, tested by 250 HIV patients, that allowed for medication reminders and other functionalities. Mobile patients showed a medication adherence rate of 80 per cent. That compared to 65 per cent for HIV patients not using the mobile tool.
Another program, in this case focused on HIV, oncology, hepatitis C and inflammatory disease patients, used text messages to improve medication adherence through medication and refill reminders. The study found a 29 per cent increase in adherence rates for the low-compliance cohort.
While those who opted in to the program were able to record whether or not they took their medication, it’s also critical to include a clinical program of targeted interventions as part of the technology, said Sredzinski.
“So, if we see three days of no activity, a pharmacist will call the patient and ask them what’s going on.”
In terms of the next technology, Sredzinski pointed to the smart pill bottle that includes programmed dose times. The bottom of the bottle will light up, followed by a chime and a text message, if the patient fails to open it within an hour.
With a clinical program built around the technology, pharmacists are only looking for patients who have missed doses, said Sredzinski.
Ultimately, Sredzinski said that success in value-based contracting comes down to resources to support it — the staff to manage it, the systems to drive it, willing partners and providers and engagement with pharmacists.
Specialty pharmacies, he noted, also have to be able to aggregate the data to tell the story of what they’re doing and continue to monitor and assess the potential savings for a health plan.