In an article published today in the Journal of the American Medical Association (JAMA) Network Open (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771388), a three-year study (2016-2018) revealed that patients living with chronic illnesses such as cancer, transplants, rheumatoid arthritis, and other diseases were associated with significantly lower total medical expenditure when filling their prescriptions at the hospital’s own specialty pharmacy, rather than using an outside specialty pharmacy.
Specifically, the article illuminates the financial impact of a clinic and specialty pharmacy closely coordinating care compared to when clinics and pharmacies are separate entities. According to the JAMA Network Open article, integrated hospital clinic/hospital specialty pharmacy care resulted in an average net medical cost savings of $1,274 for every Medicare patient, every month.
With its focus on patient medication adherence, clinical pharmacist support, patient convenience, and active coordination with the physician/care team, the specialty pharmacy care model at UMass Memorial Medical Center has proven to deliver landmark results for at-risk patient populations. The specialty pharmacy at UMass Memorial Medical Center has been operated for the past nine years in partnership with Shields Health Solutions, the nation’s leading specialty pharmacy integrator for non-profit health systems.About the Study
The study reported in JAMA Network Open, a peer-reviewed, open access, general medical journal, was performed at the UMass Memorial Medicare Accountable Care Organization (UMMACO). Services provided by UMMACO include transitions of care from skilled nursing facilities, social work, housing assistance, and medication reconciliation, among many others. The goal of coordinated care through an Accountable Care Organization (ACO) specialty pharmacy program is to ensure patients get the right care at the right time, while promoting medication adherence and addressing medication-related concerns in collaboration with the prescriber and ACO team.
UMass Memorial is the largest ACO in central Massachusetts and provides care to more than 47,000 Medicare patients. The ACO consists of seven hospitals, four federally qualified health centers, 60 medical practices, and 24 independent physicians. Since its inception in 2015, Shields Health Solutions has collaborated with UMMACO to provide specialty pharmacy care services, helping the organization to realize $8.1 million in total savings in 2018 and $27 million in 2017.
Study analysis focused on approximately 300 UMMACO patients receiving care from a specialty department (e.g., a cancer clinic, transplant clinic, or other specialty clinics) and receiving oral or self-injected specialty medication. Patients filling their prescriptions with the UMass Memorial Specialty Pharmacy were matched to, and compared with, patients filling at a pharmacy not connected to the health system or its clinics.
Total Medical Expense (TME) was assessed as per-member-per-month (PMPM) cost in U.S. dollars and did not include pharmacy benefit costs. After adjusting for comorbidities (patients’ additional health conditions), patients in both groups had similar PMPM costs in 2016. While PMPM cost decreased in 2018 by $267 for patients filling with UMass Memorial Specialty Pharmacy, PMPM cost increased by $1,007 for UMMACO patients filling at an outside pharmacy.