Hospital Executives: How Specialty Pharmacy Can be a Lever for Health System Mission-Centric Change
The Brooklyn Hospital Center’s Specialty Pharmacy Journey
The Brooklyn Hospital Center began their outpatient pharmacy journey in 2017 when they opened their first retail pharmacy. Executives knew that expanding their retail pharmacy to include a specialty pharmacy program was important to the long-term sustainability of the health system because as a disproportionate share hospital, all patients are cared for, regardless of financial or insurance status. Making a difference in the healthcare of diverse communities is at the core of the hospital’s mission, however, they needed to find a way to help compensate for the financial strain the hospital was experiencing.
Opening a Specialty Pharmacy, Acquiring a Specialty Pharmacy Designation and Earning Accreditation
For The Brooklyn Hospital Center to gain access to lifesaving therapeutic options, deliver optimal care to their patients and begin realizing a return on their investment to expand a specialty pharmacy service line, they chose to find a partner to help them navigate the highly complex and variable specialty pharmacy landscape. Specialty medications are typically more high-cost and high-touch than traditional medications and may require extra special handling and patient monitoring. There is also an extra layer of complication with prior authorizations (PAs) and patient clinical and education support. As well as hurdles to navigate with compliance and regulatory requirements to maximize the value of the 340B program, achieve specialty pharmacy accreditation and grow the program through expanded access to limited distribution drugs for patients.
To assist with these efforts, The Brooklyn Hospital Center began their partnership with Clearway Health in June of 2023 to improve their clinical and operational excellence while taking the next steps to launch a specialty pharmacy program.
Highlights from the Becker’s Healthcare Webinar
In a live webinar with Becker’s Healthcare, The Brooklyn Hospitals Center’s Robert DiGregorio, PharmD, FNAP, chief pharmacotherapy officer, pharmacotherapy services and Leonard Berkowitz, MD, chief infectious disease division medical director, HIV/AIDS services joined Amanuel Kehasse, PharmD, PhD, director, clinical programs and drug information, Clearway Health, to discuss how specialty pharmacy became a lever for mission-centric change.
Embedded Specialty Pharmacy Teams
Clearway Health began to build and strengthen The Brooklyn Hospital Center’s infrastructure for their specialty pharmacy program by hiring and embedding skilled clinical pharmacists and specialty pharmacy patient liaisons directly into the hospital's clinical team and improving the operational performance of the hospital.
“Providers do not always have the time to see patients for all the necessary follow-up visits after beginning a new specialty therapy. Clearway Health’s clinical pharmacists fill this gap in care by offering consistent and timely monitoring with the opportunity to make clinical interventions. Ensuring patients stay adherent to therapy improves clinical outcomes, in many cases, even before they see their provider. Along with this service, pharmacists help patients gain access to vital medications through obtaining financial support and taking on the peer-to-peer discussion and appeal process when a prior authorization is denied,”explained Kehasse. “These services improve provider and staff bandwidth significantly – making it possible for them to focus more time on patient care. A specialty pharmacy program such as this creates a clinical excellence that can be translated into a revenue stream to justify the return on investment for starting a hospital program.”
Dr. Berkowitz expanded on his experience with the Clearway Health partnership.
“Developing the specialty pharmacy service is quite a daunting task. The need for a specialty pharmacy service [partner] is not debatable because of the revenue and care excellence it delivers,” said Berkowitz. "We have learned ways to proactively identify barriers and put a solution to those barriers so the clinical and financial benefits could be realized within a matter of weeks or months. It's a matter of how and when you should [find a partner], in my opinion.”
Berkowitz noted, “A major problem has always been getting prior authorizations approved, which are not only difficult but also a time waster for our staff or the physicians. The specialty pharmacy staff have completed all the prior authorizations for us, which relieves us of that possibility.”
Implementing Clinical Programs
There is often a significant gap in the early diagnosis of disease states such as hepatitis C (HCV) and diabetes and linkage to care. Clearway Health helps health systems implement clinical programs to better screen patients for these types of therapeutic conditions through a test to treat model, primarily led by the pharmacy team.
“Clearway Health is able to monitor through a technology-supported dashboard, the complete patient journey from initial diagnosis lab result to linkage to care to achieve viral load suppression,” explained Kehasse. “In a value-based care environment, ensuring patients are getting access to the clinical or therapeutic treatments can help prevent flare-ups and emergency department or hospital admissions. Proactively addressing the challenges these patients face that is leading them to have high healthcare utilization and making sure they maintain their health while reducing the cost of therapy has an enormous financial value for the health system.”
Dr. Berkowitz emphasized how this has helped The Brooklyn Hospital Center improve their HCV patient treatment and outcomes.
“We've had a lot of success with our HCV program. Before we had this integrated program, we would have a report from the lab whenever someone had a positive HCV antibody test, but then there was no process for acting upon it and making sure those patients were pursued for follow up. With the process we have now with the specialty pharmacy program, they were able to change the way HCV testing is done, which should be done nationwide.”
The Brooklyn Hospital Center’s HIV patients have also benefitted from the clinical program. “We have about 190 patients on injectable treatments for HIV. It is crucial for us to be able to get these drugs in a prompt, reliable way and to have them ready for the patients on the dates that they are expected to be here,” said Berkowitz. “Partnering with a specialty pharmacy group has allowed us to have tight control over all the distribution of the medication.”
“Since this program has started, we've not had a single person miss an injectable dose," said Berkowitz. “There've been zero missed doses in well over a year now. And of those patients who are on the injectables for HIV, 100% of them have maintained viral suppression, which is the bottom line for us.”
Stakeholder Buy-in
Having pharmacy leaders in the C-suite and at the executive table within a healthcare system to help lead the specialty pharmacy strategies is important to the success of the program like the one at The Brooklyn Hospital Center. “Everyone from your information technology people, finance, your operations experts as well as your pharmacy and medical and nursing staff should be involved,” said DiGregorio. “There's a lot of overlap, relationship building and justification to make that leap into what is a very costly investment but with an incredibly good return on that investment.”
“Key factors in starting a program like this is getting buy-in from your physicians because they're going to be a key cog in this process,” said Berkowitz. “There are clearly better clinical outcomes associated with the process. That, along with not having to do prior authorizations, will get your physicians interested in participating, and they should be from the beginning, to help outline the programs that you're going to be designing for screening processes or making changes to your EMR.”
Data Considerations
Planning for a specialty pharmacy program also requires data and analytics to drive the decisions on what specialty areas to target and where to build clinical programs.
“We leverage the data to validate the opportunity before we even start building the program,” explained Kehasse.
“The information technology team and pharmacy informatics professionals can pull data from the EMR and figure out where prescriptions are going. It was quite eye-opening as we started building out our retail pharmacy and then even more eye-opening as we got into the specialty realm to see what our prescribers were writing for and where those prescriptions were going,” said DiGregorio. “I was surprised by the scope of how many specialty prescriptions were being written by our providers and going outside The Brooklyn Hospital Center to other specialty pharmacies.”
“We determined a strategy to ensure the health system has a financially viable program for delivering care to all patients that are eligible for care. We complete several payor mix margin reimbursement assessments before we design and pitch the idea to the executive leaders to demonstrate the value of the clinical program and to get buy-in for the outcomes,” said Kehasse. “For every clinical program we develop, we have success metrics to show clinical outcomes and financial outcomes. For example, for HIV and HCV, we constantly monitor their viral load level. We need to make sure that patients are achieving their viral load suppression.”
Specialty Pharmacy Program Partner Selection
When it comes to beginning the specialty pharmacy journey and making a specialty pharmacy partner selection, “It's a bit of a heavy lift in the beginning. Using an accelerator like Clearway Health really was immensely helpful for us. It was an effective way of instilling confidence in our senior administration that we would be successful,” said DiGregorio. “Building a specialty pharmacy program is an investment of resources and an investment of inventory. Giving a level of confidence to your CEO that the investment will pay off is a challenge. And being able to partner with an accelerator that has some record of accomplishment and can pull data and compare data to other institutions and give you that sense that you will be successful is very important.”
Impactful Results and Return on Investment
Because of the partnership with Clearway Health and the specialty pharmacy program that resulted and grew at The Brooklyn Hospital Center, "Not only can we keep the lights on, but now we can justify additional resources we need, including a patient assistance program. Even with insurance coverage for specialty medications, there is still often a high copay or deductible that patients may have to meet,” said DiGregorio. “Being able to offer a patient assistance program as a charity fund is something that historically we wouldn't have been able to do, but because we're having such a good return on this investment, we can invest back into our patients and make sure that financial constraints are not the reason they're not taking their medications.”