Proving the Value of Specialty Pharmacy Data Management
The importance of establishing effective clinical measures
by Russel Allinson, CEO and CCO, Therigy
As the growing specialty pharmacy niche is becoming a major force in the health care industry, the need to effectively manage ever more complex data has become a challenge. The ability to aggregate data and measure outcomes is key to all stakeholders — patients, pharmacies, prescribers, manufacturers and insurers.
Both manufacturers and insurers are interested in seeing measurable outcomes for the drugs prescribed to patients. Manufacturers want to say that their drug — if used correctly — will decrease the progression of disease, reduce visits to the emergency room and achieve positive outcomes. Manufacturers also want to compare their drug to others on the market to point out its effectiveness.
Insurers have a similar interest. They look for drugs that decrease cost, reduce hospital admissions, and improve patients’ quality of life by lessening their disability and reducing absences from work due to illness.
Both manufacturer and insurer stakeholders need access to comprehensive internal data and look to specialty pharmacies to provide that service. At present, few pharmacies can measure outcomes adequately. Being able to claim “This is the result of the drug the patient took” is hard to do.
The health care industry uses “outcome measures” as a general term that describes how well a drug can achieve what it was developed to do. Drug manufacturers and health care insurers rely on proxy measures to indicate that a patient’s condition is improving, not worsening, for example. Getting the results of more scientific outcome studies would provide valuable data.
The benefits of capturing data
Having hundreds of patient attributes in many different disease states enables a pharmacy to identify what course of treatment will generate the best results for the patient and provides valuable data to other stakeholders. In fact, the ability to capture and aggregate data is key to a pharmacy’s success. The level of data that specialty pharmacies must collect goes beyond the traditional model of transaction-based data required for typical chronic medications.
In current software systems, such as the one developed by Therigy, the data capture process is part and parcel of care. The system guides the clinician through the care process, assigning tasks, leading the user through a series of questions, and allowing the clinician to document every step he or she has taken. This gives a longitudinal history of a patient that, when aggregated with data from other patients, shows how patients responded to the care process. The integration of the care process with the data capture process is not disruptive to the pharmacy’s operations.
The Therigy system, which operates on servers that comply with strict requirements of the Health Insurance Portability and Accountability Act, allows pharmacies to go into the application and access patient information in a confidential environment that only the pharmacy can see. The Therigy system meets all requirements and regulations.
Developing metrics that determine which therapies work
Five different types of metrics must be developed to best analyze therapies: high-level metrics, performance indicators, operational metrics, clinical metrics and economic metrics.
- High-level metrics measure patient adherence — for example, if the patient took the medication on schedule and as prescribed.
- Performance indicators evaluate a pharmacy’s performance. How quickly was the pharmacist able to process orders and find financial help for the patient? What is the level of patient satisfaction with the pharmacy?
- Operational metrics are needed so that a pharmacy can qualify to sell a new drug or fulfill a new health plan. These metrics show how a pharmacy performs in comparison to its peers.
- Clinical metrics such as lab values indicate whether the drug is correctly prescribed and specify the genomic profile of the patient and how this relates to the drug’s effectiveness and patient progression.
- Economic measures reveal the impact on a patient’s quality of life —
for example, whether a pediatric patient missed fewer days of school and had fewer doctor visits. This data is difficult to capture, as it often relies on reports by the patient to the pharmacy.
Working down the list, the data become more difficult to measure, but in the future all systems will connect with one another, such as a pharmacy system connecting to a lab or to a doctor’s electronic medical records. Relying on patients’ self-reports will become obsolete. The health care industry is heading down a path to allow systems to connect to one another, to provide a much fuller picture on all sides. The connectivity of all these systems, in the end, will help pharmacies and caregivers share information in a confidential environment, understand where the costs are coming from and eventually decrease health care costs.
The aggregation of all these standardized data, which puts a definitive measure to every question, will tell a story over time. Today, not enough normalized data are available, so solving these challenges will be a huge step forward in the health care industry.
The increasing need for detailed information and reports on patient adherence, quality of care and outcomes measurements is changing the role of specialty pharmacies. This change in focus reflects the increased expectations of various stakeholders: patients, payers and health care organizations. In this environment, outcomes management and data reporting are an essential part of specialty pharmacy operations, and new tools will make pharmacies’ growing role in health care even more indispensable.
Russel Allinson, RPh, MS, CEO and CCO, has accumulated extensive knowledge throughout his career that has earned him a place among the industry’s most respected authorities on topics such as specialty pharmacy operations and biotech therapies. A co-founder of Therigy, Allinson serves as chief executive officer and chief clinical officer, steering the company’s clinical direction and leading the clinical research team to deliver thought leadership to Therigy clients through publications and hands-on engagement. Allinson’s extensive experience includes executive positions at a tertiary care health system; at two public specialty pharmacies, Priority Healthcare and Stadtlanders; and providing startup operations for a health plan specialty pharmacy joint venture, Aetna Specialty Pharmacy. He also gained startup experience at Ariba, the leading Internet-based supply-chain software company.