McKesson: Evolving pharmacy model to play integral role in mitigating healthcare cost
ANAHEIM, Calif. — The McKesson Pharmacy Optimization team, a group of advisors that partner with health system pharmacies to help elevate the value they can bring to the system, has identified the top five trends that will impact the healthcare system and health system pharmacies in 2015 in a release Thursday.
“Financial stability and excellent patient care will continue to be key motivators for health system pharmacies in 2015,” said Mark Eastham, SVP and general manager of McKesson Pharmacy Optimization. “Forward-looking health system pharmacies can provide best-in-class clinical services that drive better patient outcomes, while contributing to the overall financial health of health systems.”
The 2015 Health System Pharmacy Trends:
Specialty pharmacy offers opportunity for expanded revenue and improved patient care: The specialty pharmaceutical industry is on the verge of one of the largest growth periods in history. By 2018, specialty drugs are expected to make up 50% of overall drug costs for commercially insured individuals. The growth for medications treating cancer, rheumatoid arthritis, multiple sclerosis and HIV represents one of most significant revenue opportunities that health systems have seen in many years. In this changing competitive landscape, health system pharmacies have important and valuable advantages in further developing their specialty pharmacy capabilities, including clinical expertise, coordination of care, patient education and support, and contract and billing expertise. To take advantage of this opportunity, health system pharmacies must fully evaluate the competencies needed and determine whether to build them in-house or via a partnership;
Growing pharmacy revenue, controlling costs and doing more with less: Financial challenges and implications of the Affordable Care Act continue to be big concerns for health systems, but they also create opportunities. Continued financial pressures including government funding cuts of Medicare and Medicaid reimbursement, increasing cost of staff and supplies, and more will all continue into 2015. With increasing margin pressure, health system leaders are actively partnering with their pharmacy team to identify new ways to generate revenue, preserve or improve margins, reduce costs and improve quality. Health system leaders are also beginning to realize how much ambulatory pharmacy can do for them. Not only can it be an additional source of revenue, but it also can help assist discharged patients with medication adherence, a critical means of reducing avoidable readmissions. With the expansion of health system pharmacy services, streamlining operations is critical to be able to “do more with less” and will continue to gain importance as pharmacy is viewed less as a cost center and more as a profit generator;
Evolving payment models: The continued evolution of payment models from fee-for-service to performance-based reimbursement models comes with many challenges. As health systems move toward value-based reimbursement, the business model and the care model become increasingly intertwined; changes made to care processes can have a significant impact on financial performance. Health systems must evolve the pharmacy care model to be fully integrated between inpatient and outpatient as a part of the care team with the patient in the center. Health systems need tools that help them identify their revenue and cost drivers and provide insight regarding how cost, quality and care decisions impact the network as a whole. There is an increased focus on the provision of optimal medication therapy management in the ambulatory care setting to improve continuity of care and medication adherence and reduce readmissions;
340B — effectively managing safety net programs: There is a continued focus on program integrity and compliance with government regulations, particularly with the recent Health Resources and Services Administration and the Office of Pharmacy Affairs rulings. There is a need for 340B covered entities to ensure optimal processes and compliance for all split-billing and contract pharmacy scenarios. The 340B program is complex and requires cooperation among health system departments to help ensure results while maintaining program compliance requirements. Considering recent changes and anticipated OPA guidance, all health systems — even well-established, successful 340B health systems and pharmacies — should undertake a thoughtful “best practices” assessment that focuses on areas of risk and opportunities for improvement. This means health system pharmacies that operate 340B programs need to ensure continual preparedness for audits by using internal compliance programs and technologies; and
Big data: Data rules everything — patient safety, the continuum of care, payment models and reimbursement rates. Data exists, but the challenge is linking it all together and getting all the appropriate stakeholders to communicate. Pharmacy needs to be involved in the big data movement with an increasing organizational focus on pharmacy analytics. As health systems take on higher levels of financial risk, they can rely on a comprehensive analytics platform to track and monitor patient cost and quality. Big data will continue to play an increasingly important role within health systems.
McKesson will be discussing these trends with health systems pharmacy leaders at the American Society of Health-System Pharmacists Midyear Clinical Meeting 2014, which runs from Dec. 7 to Dec. 11 in Anaheim, Calif.