a new one study published in Managed Care Journal + Specialty Pharmacy A correlation was found between health system specialty pharmacies and reduced cost of care for Medicare Advantage patients compared to costs of care associated with mail-order or retail pharmacies.
The study defines health system specialty pharmacies as those that operate within the health system itself. Such pharmacies assist with care coordination so that the care team can oversee all aspects of patient care.
Health system specialty pharmacies are also associated with improved patient outcomes, according to the study.The study looked at data from the following specialty pharmacy patients Shield Health Solutions, a specialty pharmacy accelerator designed to increase drug access in specialty pharmacies. Shields Health Solutions in Stoughton, Massachusetts, funded the study.
“This study is specific to Shields partners and the impact of their care model on total cost of care,” Stephen West, Shields’ chief strategy officer, said in an email. “Shields partners have staffed in specialty clinics ( work in the same EMR and often in the clinic).”
“[Shields has] Dale Fasching, regional director of clinical operations at Shields, said in an email:
Specifically, the retrospective cohort study leveraged pharmacy and medical claims data from Medicare Advantage beneficiaries in 2018 and 2019. The study looked at information from 9,780 members, of whom 208 (2.1%) used the services of a health system specialty pharmacy to see if one party had a monetary advantage over the other.
Notably, health system specialty pharmacies were comparable in cost to retail and mail order pharmacies in 2018, according to the study. However, in 2019, health system specialty pharmacies were associated with lower costs of care for Medicare Advantage patients, the study said. For example, healthcare plans pay close to $7,000 per month for health system specialty pharmacy users, while healthcare plans pay $7,600-$8,100 per month for each member of the provider benchmark group and network benchmark group; this figure reflects The total cost of health care – including medical and pharmacy costs – per member per month of the health plan.
The study attributed the cost difference to two factors: savings in pharmacy costs and costs associated with independent physicians.
“We believe this research will help understand how integrated health system specialty programs are taking risks with payers to expand the patients they serve. These studies have helped our partners at UMASS expand their Medicare Advantage plans, and we believe This type of evidence can help inform how other health system partners can venture into specialty pharmacy patient populations in a similar fashion,” West said.
West and Fasching also see an opportunity to expand on their findings.
“[Next steps needed include demonstrating] more patients with the same results, and [diving] Gain a deeper understanding of specific patient types (by treatment or special condition). Patient engagement is often achieved through technology and people embedded in the healthcare system, allowing the quality of care to influence the clinical intervention of the pharmacy team,” Fasching said. “The source of value for different patient subgroups and how patient engagement/intervention in the health system achieves that There are rich connections between values. We have looked into many of these connections and will continue to publish and share them. “
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