Specialty Success: Strengthening Care Across the Continuum with a Health System Specialty Pharmacy

An interview with Angela Ward, Vice President, Pharmacy Services for Memorial Hermann Health System

What are the leaders of health system pharmacies doing today to help lower costs and improve the quality of care? For Angela Ward, one answer has been to develop a specialty pharmacy dedicated to serving patients and specialty physicians across the healthcare continuum.

Angela Ward is the Vice President, Pharmacy Services for Memorial Hermann Health System - the
largest not-for-profit  health system in Southeast Texas, with 15 hospitals and numerous specialty programs and services. For nearly five years, she has led pharmacy, quality, infection control and risk management efforts across the organization and has been responsible for pharmacy management from purchasing to inventory.

Collaborating with AmerisourceBergen - including  the Pharmacy Healthcare Solutions (PHS)
team - Ms. Ward recently developed the health system’s own specialty pharmacy.

We asked what motivated her to lead the initiative and how it has enhanced revenue, cost savings and the quality of patient care. She also discusses her vision for continuing to expand the role of health system pharmacy organizations to further impact these goals.

As the pharmacy executive for a major health system, what are your top priorities today?

One of my most important goals is to support the Memorial  Hermann Accountable Care Organization, which we created to provide quality patient care across the healthcare continuum from end to end.

Because the pharmacy is a critical component of the healthcare continuum, we’re expanding
our footprint to support quality care to a broader patient population. Creating our own specialty pharmacy has been a foundation of this effort - improving speed-to-therapy and compliance
by helping to ensure patients receive the right medications and consultation in a timelier way than relying on a third party, such as a mail order pharmacy.

In addition to supporting quality outcomes, having our own specialty pharmacy has also strengthened our relationships with specialty- prescribing physicians. For example, we help physicians improve compliance and work directly with payers to resolve issues, freeing up office staff time for other responsibilities.

What was the first step in creating your specialty pharmacy?

Educating our senior leadership on the value of specialty pharmacy was job #1. We explained what specialty pharmacy is and its vital role in
a healthcare continuum  - promoting patient compliance, supporting quality outcomes and controlling costs.
At the same time, we made the financial case for having our own specialty pharmacy. In the absence of a specialty pharmacy, that revenue would go to a third party who wouldn’t know our patients as well or have the opportunity for continual personal contact.

Once you had executive support, what did you do?

Our next step was to identify the right consulting team to help us explore the opportunity.  Based on my experience, we wanted a consultant who had multiple success stories, not just one. Further, the right consultant would have experience starting from ground zero to standing up a full-fledged specialty pharmacy. And the consultant must have more than one expert on staff; there is so much movement of talent in the pharmacy industry that we didn’t want to risk losing the only expert once the project had begun.

We ultimately chose the AmerisourceBergen PHS team because of their depth of experience and bench strength. Then together, we began exploring the specialty opportunity more deeply for Memorial Hermann.

How did you explore the opportunity?

We started by creating a business plan. First, we wanted to get a sense of the market potential, including the number of specialty physicians throughout the health system, how many specialty prescriptions  are written and how easy they are
to fill.

With this information, we knew what our space requirements for the new pharmacy would be. So we began developing construction  and IT plans and costs - as well as a staffing plan. During this stage, we developed four cost and revenue modeling scenarios:
1.  Base case
2.  Best case without 340B business
3.  Best case with 340B
4.  Worst case

Vice President of Pharmacy Services, Angela Ward explains the process of space development to visitors at the opening of Memorial  Hermann’s Specialty Pharmacy.

We worked with our finance department to develop these scenarios in Memorial  Hermann’s preferred proforma  format, including  ROI. In each scenario, the aim was to understand when our health system would “break even” on the invest- ment - and then what the revenue potential would be after that.

Once we understood our capital requirements, we presented our business case to senior leadership and were approved for funding.

With funding in hand, how did you select a location?

Like the vetting process for our consultant, I had precise requirements for the structure and location of our specialty pharmacy. We scouted about 50 sites in the greater Houston area before finding the perfect fit, which had to include plenty of warehouse space and a loading dock in back.

We also needed an entrance area suitable for greeting and serving those patients and physicians who would want to visit us. Because we were creating a decentralized pharmacy model, we weren’t anticipating  a lot of in-person visits. But we wanted to be ready for them.

What is the decentralized model and why did you choose it?

In a decentralized model, our pharmacists don’t stand behind a counter and wait for patients to come to them. Instead, they’re embedded directly in specialty physician offices, where the patients are. Our pharmacists work directly with and
advise patients and physicians right onsite, where they will have the greatest impact on improving care. Prescribed medications  are then delivered either by FedEx or local courier.

In addition, our onsite pharmacists are able to work one-on-one with specialty physicians - hearing their pain points firsthand. As a result, we
can help minimize their time and effort to ensure patients receive the right medications.

Here’s a perfect example of the value: when a patient’s hepatitis C medication was stolen, our pharmacists worked directly with the insurance company to obtain patient assistance funds. The patient received a refill at no charge - without the involvement of the physician office staff. We handled it all.

In addition, our decentralized model strongly supports Memorial Hermann’s patient care strategy of delivering a quality experience across the continuum.  We didn’t want to create another “big box pharmacy”; instead, we’re building stronger and more personal relationships with both patients and specialty providers.

And we’re strengthening ties with payers as well - working directly with them to better serve our mutual customers, the patients.

What lessons have you learned through this process?

This process reinforced the importance of partnership, such as working with managed care colleagues to protect reimbursements and improve access and patient care. An example is our partner- ship with AmerisourceBergen’s US Bioservices subsidiary, to lower barriers to access. Before our own specialty pharmacy was open, US Bioservices dispensed all of our specialty medications. Today, we continue to rely on this key relationship  to
help obtain limited distribution  drugs, meet 340B requirements and navigate the complexities of payer contracts..

Now that you’ve established your specialty pharmacy, what’s next?

We’re pursuing  several additional  strategies to support our health system’s quality and cost containment goals:

• Offering specialty drugs to large, self-insured companies: Again, our pharmacy intervention improves care while reducing costs.
• Leadership training for emerging directors of pharmacy: DOPs are key to helping us manage population health, and there is a shortage of them.
• Managing the uninsured patient population: The Houston area has one of the nation’s largest; how do we better meet their needs across the healthcare continuum?
• Maximizing our 340B opportunity: Most Memorial Hermann hospitals are 340B eligible. We should optimize this savings opportunity while best serving our patient population.

What advice would you give other pharmacy executives who may be thinking about developing a specialty pharmacy?

As health systems face mounting  pressure to improve patient outcomes and satisfaction at a lower cost, I’m confident that pharmacy organi- zations like ours will play an even greater role in achieving success. By leveraging the specialty pharmacy and other strategies outlined here, we all can make a difference. And at Memorial Hermann, we’re just getting started.

To start a conversation regarding specialty care, email solutions@amerisourcebergen.com