By Philip Carroll, AVP of Sales
Earlier this month, I attended the InformaConnect IDN BioPharma Summit 2020 where I was interested in several sessions on value-based contracting, the value of health system data to improve capture rates and how health system specialty pharmacies can identify opportunities to grow their business. My key takeaways were exactly aligned with services that Excelera currently offers health systems who are interested in optimizing their owned specialty pharmacy!
HSSP should identify opportunities by provider, plan type and drug
It is important for health systems to align internal and external relationships. For example, ensuring access to your own health plan covered lives and groups just makes sense. Since Medicare contracts are the some of the easiest to obtain and represent the largest populations, it is important to maximize access to these patients. Also, generate new business by identifying and contacting local organizations that don’t use your specialty pharmacy and bid on these blocks of business. Pull through business from existing relationships – if a payer is giving you 30%, that means 70% not using your specialty pharmacy. So, aim for fifty percent or more from your payers. Lastly, evaluate how access to a specific medication or therapy might impact patients served by the specialty pharmacy, and watch the drug pipeline for trends such as categories that are strong and growing such as oncology, RA and Inflammatory.
Value-based contracting (VBC)
Value-based contracting is essentially a risk-sharing arrangement between stakeholders that should benefit both payers and manufacturers when done correctly. These arrangements are attractive to payers in that they reduce the risk associated with the uncertain performance of new therapies. These arrangements are attractive to manufacturers in that they can differentiate their product performance by providing greater discounts based on drug efficacy.
Currently, some barriers to value-based agreements include:
- Anti-kick-back laws which create reluctancy to incentivize adherence between payers and manufacturers.
- In order to demonstrate outcomes, manufacturers and health plans need access to large quantities of consistent data which would also need to be exchanged with stakeholders for the HSSPs
- Drug-specific data elements would require significant effort and cost to develop and maintain
Value-based agreements offers advantages as well as challenges for manufacturers and payers. Health system specialty pharmacies, as a key constituent with more touch points throughout the patient journey than any other health care provider, have the opportunity to provide patient education, impact adherence, drive persistency, and collect data that can be used to demonstrate outcomes related to treatment with specialty drug therapies.
Health system specialty pharmacy data is valuable
The key to leveraging health system data is to unlock value by quantifying every component of your specialty pharmacy workflow. Health system-based specialty pharmacies, by the very nature of their integration into the overall health system, can tap into medical records to demonstrate outcomes such as total cost of care reductions, unlike using an external specialty pharmacy.
For more information about how Excelera’s data and insights can help your health system specialty pharmacy identify growth or contracting opportunities, contact us at info@excelerarx.com.
