Analyzing the costs of developing and operating an integrated health-system specialty pharmacy: The case of a centralized insurance navigation process for specialty clinic patients

2021 ◽  
Author(s):  
Matthew H Rim ◽  
Karen C Thomas ◽  
Stephanie A Barrus ◽  
Ashley M K Ryther ◽  
Antoine Clawson ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Clinical Care ◽  
Care Center ◽  
Fiscal Year ◽  
Full Time ◽  
Specialty Clinic ◽  
Clinic Staff ◽  
Financial Strength ◽  
Specialty Pharmacy

Abstract Purpose Direct and indirect costs related to the growth of specialty pharmacy services and the insurance navigation process for specialty clinic patients are discussed, and development and implementation of a pharmacy-driven and system-wide prior authorization (PA) processing center within a health system are described. Summary Expensive specialty drugs require PA. Due to the concentration of specialists, health systems with multiple specialties experience higher PA burden and resulting care delays. Although clinic staff typically handle PA requests, health-system specialty pharmacies are well positioned to support patients, clinic staff, and physicians by assuming responsibility for the PA process entirely. University of Utah Health established its Pharmacy Ambulatory Clinical Care Center (PAC3) to centralize PA processing for selected specialty and primary care clinics within the health system. In fiscal year 2019, the PAC3 team (10 pharmacy technician and 1.5 pharmacist full-time equivalents) completed over 13,000 PAs. The pharmacy labor cost increase was significant; however, the benefits gained from increased services, quality, and financial strength surpassed all costs associated with the implementation and maintenance of the pharmacy operation. Other tangible benefits included decreased delays in therapy initiation, increased patient satisfaction, increased clinic visits, and increased staff and provider satisfaction and engagement. Conclusion Increased PA requests associated with specialty drugs have placed considerable stress and staff burden on specialty clinics within health systems. However, development and implementation of an efficient PA processing infrastructure within a health-system specialty pharmacy may reduce the burden, increase financial strength, and improve the patient experience.

Measurement of Individual Clinical Productivity in an Academic Anesthesiology Department

2000 ◽  
Vol 93 (6) ◽  
pp. 1509-1516 ◽  
Author(s):  
Amr E. Abouleish ◽  
Mark H. Zornow ◽  
Ronald S. Levy ◽  
James Abate ◽  
Donald S. Prough
Keyword(s):  
Medical Center ◽  
Clinical Care ◽  
Obstetric Anesthesia ◽  
Fiscal Year ◽  
Full Time ◽  
Full Time Equivalent ◽  
High Productivity ◽  
Academic Settings ◽  
Individual Productivity ◽  
American Society

Background The ability to measure productivity, work performed, or contributions toward the clinical mission has become an important issue facing anesthesiology departments in private practice and academic settings. Unfortunately, the practice and billing of anesthesia services makes it difficult to quantify individual productivity. This study examines the following methods of measuring individual productivity: normalized clinical days per year (nCD/yr); time units per operating-room day worked (TU/OR day); normalized time units per year (nTU/yr); total American Society of Anesthesiologists (ASA) units per OR day (tASA/OR day); and normalized total ASA units per year (ntASA/yr). Methods Billing and scheduling data for clinical activities of faculty members of an anesthesiology department at a university medical center were collected and analyzed for the 1998 fiscal year. All clinical sites and all clinical faculty anesthesiologists were included unless they spent less than 20% of their time during the fiscal year providing clinical care, i.e., less than 0.2 clinical full-time equivalent. Outliers, defined as faculty who had productivity greater or less than 1 SD from the mean, were examined in detail. Results Mean and median values were reported for each measurement, and different groups of outliers were identified. nCD/yr identified faculty who worked more than their clinical full-time equivalent would have predicted. TU/OR day and tASA/OR day identified apparently low-productivity faculty as those who worked a large portion of their time in obstetric anesthesia or an ambulatory surgicenter. tASA/OR day identified specialty anesthesiologists as apparently high-productivity faculty. nTU/yr and ntASA/yr were products of the per-OR day measurement and nCD/yr. Conclusion Each of the measurements studied values certain types of productivity more than others. By defining what type of service is most important to reward, the most appropriate measure or combination of measures of productivity can be chosen. In the authors' department, nCD/yr is the most useful measure of individual productivity because it measures an individual anesthesiologist's contribution to daily staffing, includes all clinical sites, is independent of nonanesthesia factors, and is easy to collect and determine.

Development of quality measures for use of self-injectable biologic therapy in inflammatory bowel disease: An integrated specialty pharmacy initiative

2019 ◽  
Vol 76 (17) ◽  
pp. 1296-1304 ◽  
Author(s):  
Nisha B Shah ◽  
Jacob A Jolly ◽  
Sara N Horst ◽  
Megan Peter ◽  
Heather Limper ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Health System ◽  
Bowel Disease ◽  
Biologic Therapy ◽  
Clinical Care ◽  
Disease Status ◽  
Quality Measures ◽  
Pharmacy Benefit Manager ◽  
Inflammatory Bowel ◽  
Specialty Pharmacy

Abstract Purpose The development of a tool to measure medication safety, therapeutic efficacy, and other quality outcomes in patients receiving self-injectable biologic therapy for the management of inflammatory bowel disease (IBD) at a health-system specialty pharmacy is described. Summary Through a collaborative initiative by pharmacists, gastro-enterologists, and representatives of a pharmacy benefit manager and a pharmaceutical company, a set of clinical and specialty pharmacy quality measures was developed. The clinical measures are intended for use in assessing patient safety, disease status, treatment efficacy, and healthcare resource utilization during 3 assessments (pre-treatment, on-treatment, and longitudinal). The specialty pharmacy measures can be used to assess medication adherence, medication persistence, specialty pharmacy accreditation, and patient satisfaction. The proposed quality measures provide a foundation for evaluating the quality of IBD care and improving patient outcomes within a health-system specialty pharmacy. Future efforts to validate and implement the tool in clinical practice are planned. Conclusion The proposed quality measures provide a foundation for future inquiry regarding the appropriateness and feasibility of integrating the measures into clinical care. Further work is needed to implement and validate these quality measures and determine their impact in optimizing health outcomes.

Multidisciplinary practice advancement: Role of a clinical pharmacy specialist in a pediatric specialty clinic

2020 ◽  
Vol 77 (21) ◽  
pp. 1771-1777
Author(s):  
Jessica J Lynton ◽  
Alex Mersch ◽  
Polly J Ferguson
Keyword(s):  
Clinical Pharmacy ◽  
Outpatient Setting ◽  
Relative Increase ◽  
Multidisciplinary Teams ◽  
Full Time ◽  
Hospital Organization ◽  
University Of Iowa ◽  
Specialty Clinic ◽  
Multidisciplinary Practice ◽  
Specialty Pharmacy

Abstract Purpose To describe clinical pharmacy specialists’ role in improving the use of specialty medications within a pediatric outpatient setting. Summary The outpatient pediatric specialty clinic (PSC) at the University of Iowa added a clinical pharmacy specialist to multidisciplinary teams within the PSC to focus on patient education, providing clinical recommendations, coordinating insurance approval, addressing barriers to adherence, and performing follow-up monitoring. Supplemental activities include coordinating between the electronic health record–integrated on-site specialty pharmacy and the PSC, assisting with quality improvement projects, developing policy revisions, negotiating access to specialty products, and answering medication information questions. Benefits in workflow efficiency, documentation, and revenue generation resulting from implementation of the pharmacist within the PSC have been identified by the clinic and the specialty pharmacy. The specialty pharmacy identified an increase in the rate of specialty prescription capture from 14% to 50%, leading to an increase in revenue for the health system. Within 12 months of the addition of the pharmacist to the team, an improvement in the rate of 13-valent pneumococcal conjugate vaccine administration to pediatric patients of 25.7 percentage points, medication adherence of >90%, and a 75% relative increase in appropriate hydroxychloroquine dosing were recognized. Due to the pharmacist’s impact on the PSC, a full-time pharmacist was added to the pediatric team to cover additional clinics, and 2 benefits investigation technicians were hired and funded by the PSC. Conclusion An interdisciplinary team with an integrated pharmacist has facilitated sustainable improvements in medication access and adherence and clinical and quality measures, benefiting patients, the pediatric clinic, the specialty pharmacy, and the hospital organization.

Decoding gene therapy: Current impact and future considerations for health-system and specialty pharmacy practice

2021 ◽  
Author(s):  
Scott L Canfield
Keyword(s):  
Gene Therapy ◽  
Health System ◽  
Health Systems ◽  
Pharmacy Practice ◽  
The United States ◽  
Gene Therapies ◽  
Novel Treatments ◽  
Engagement Strategies ◽  
Clinical Benefits ◽  
Specialty Pharmacy

Abstract Purpose To provide health systems with baseline knowledge on existing and pipeline gene therapy treatments, including considerations that health-system pharmacies and specialty pharmacy programs may reference when evaluating and implementing services around gene therapies. Summary Advancements in research and biotechnology have recently led to the development and launch of the first commercially available gene therapy treatments in the United States. These treatments have the ability to significantly alter and even effectively cure diseases. Alongside these significant advances and clinical benefits, these therapies present unique challenges due to their cost and complexity. Given the large number of additional gene therapy treatments that are currently in late-stage clinical development, stakeholders across the healthcare industry must increasingly adapt and ready themselves to meet these challenges. The diagnosis and treatment of patients with diseases being targeted by gene therapies largely occurs within health systems, and judging by the gene therapy pipeline, this trend is likely to continue. To prepare for these novel treatments, health systems must understand and consider the methods in which gene therapies are developed, procured, reimbursed, administered, and monitored. Conclusion The future of health-system pharmacy practice must include comprehensive gene therapy services and stakeholder engagement strategies to ensure patients have access to these life-changing treatments.

scholarly journals The good, the bad, and the disruptive of performance- based financing on the Mozambican health system: results from a process evaluation

2018 ◽  
Vol 21 (2) ◽  
Author(s):  
Jessica Gergen ◽  
Yogesh Rajkotia ◽  
Nirmala Ravishankar
Keyword(s):  
Health System ◽  
Work Environment ◽  
Health Systems ◽  
Health Workers ◽  
Clinical Care ◽  
Health Systems Strengthening ◽  
Positive Effects ◽  
Financial Autonomy ◽  
Performance Based Financing ◽  
Systems Transformation

A significant debate is unfolding around whether performance basedfinancing (PBF) is a mechanism of achieving broader health systems transformation. This study aims to contribute to this dialogue by assessing how PBF fostered positive, perverse and disruptive effects on the health system in two provinces of Mozambique. The study used qualitative methods to collect data in 24 PBF health facilities from 60+ health workers and facility administrators. PBF improved the facility’s work environment through improved local financial capacity and autonomy, resulting in greater planning. Health workers perceived incentives as a source of motivation, however the allocation of incentives among staff as unfair and lacking transparency. Major improvements in data qualityand completeness was observed in facility registers, verified quarterly. However, a heavier workload and enhanced focus on information systems were disruptive to time spent on clinical care. PBF remains a health systems strengthening intervention that results in targeted and program-driven changes that are not yet institutionalized or uniformly applied. Sustaining positive effects will requires greater focus on institutionalizing changes to governance, management structures, and financial autonomy, while enhancing inclusiveness of the  demand-side.

Developing tools to enhance the use of systematic reviews for clinical care in health systems

2018 ◽  
Vol 23 (6) ◽  
pp. 206-209 ◽  
Author(s):  
Allison S Morrow ◽  
Stephen P Whiteside ◽  
Leslie A Sim ◽  
Juan P Brito ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Health Systems ◽  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Decision Aids ◽  
Clinical Care ◽  
Clinical Decision ◽  
Clinical Encounter ◽  
Additional Information

We aimed to develop tools that can facilitate uptake of evidence summarised in systematic reviews by clinical decision makers in health systems. After conducting a systematic review on the management of anxiety in children, we interviewed health system representatives, clinicians and patients to ask about additional information needed for decision-making. Using stakeholders’ feedback and literature searches for contextual and implementation information, we developed two tools (decision aids (DAs)), one for the health system and the second for the clinical encounter. This information mapped to factors of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) Evidence to Decision Framework. The health system DAs provided information on which patients are candidate for treatment, values and preferences, costs and resources, acceptability, impact on health equity, feasibility, drug dosing, alternative therapies, remission rates and prognosis. Health system stakeholders found the DA useful for clinical decision-making and generalisable to other conditions. The encounter DA was produced as cards containing information on issues that drive treatment decisions (effect on symptoms, effect on function, treatment burden, side effects and cost). Patients and parents prioritised the cards and chose the order in which these issues were discussed with clinician. The encounter DA was found to be helpful by patients, parents and clinicians. We conclude that the uptake of evidence summaries by health systems can be enhanced by developing tools that provide contextual and implementation information about clinical care. A dual approach addressing health system stakeholders as well as clinicians and patients is likely feasible and helpful.

scholarly journals 1069. Implementation and Results of a Health-System Antimicrobial Stewardship (AMS) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S379-S379
Author(s):  
Dayla Boldt ◽  
Jennifer Anthone ◽  
Bryan Alexander ◽  
Sumaya J Ased ◽  
Cassara Carroll ◽  
...  
Keyword(s):  
Health System ◽  
Program Effectiveness ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Medicine ◽  
Acceptance Rate ◽  
Fiscal Year ◽  
Full Time ◽  
Full Time Equivalent ◽  
Targeting Therapy

Abstract Background AMS expansion initiative was implemented in fiscal year 18 (FY18) across a 14-member health system (~1,000 average daily census combined) consisting of 8 community hospitals, 5 rural critical access hospitals and 1 academic medical center. Methods The expansion initiative included a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician and 2.5 FTE ID-trained clinical pharmacists to support daily AMS activities. Clinical decision support software (Theradoc) had previously been implemented across the health system. Here we report our continuation results for the first 9 months of year 2 (FYTD19) of the expansion initiative. Results AMS personnel documented an average of 319.8 and 313.2 interventions per month in FY18 vs. FYTD19, respectively. Mean acceptance rate of AMS interventions by providers was 87.9% and 89.4% in FY18 vs. FYTD19. Provider groups with the highest acceptance rate were Hospital Medicine, Pulmonary/Critical Care and Infectious Disease. Highest interventions in FYTD19 included recommending other diagnostic testing (17%) followed by de-escalating/targeting therapy based on culture results and recommending alternative therapy (both at 11%). Most common ID disease states AMS intervened included bacteremias (29%), pneumonias (ventilator-associated or community-acquired) 13% each, and UTIs 13%. AMS interventions generated 168 ID consults in FYTD19. The financial impact of AMS across the health system was a cumulative saving in antimicrobial expenditures of $1.29 million and $1.27 million in FY18 and FYTD19, respectively. Conclusion The ability to review offsite electronic medical records daily for antimicrobial optimization with ID pharmacist and physician support, identify facility-specific needs and opportunities, and collect available data endpoints to determine program effectiveness has helped to ensure program success. Disclosures All authors: No reported disclosures.

scholarly journals Building the Clinical Bridge to Advance Education, Research, and Practice Excellence

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Marilyn Svejda ◽  
Janet Goldberg ◽  
Maureen Belden ◽  
Kathleen Potempa ◽  
Margaret Calarco
Keyword(s):  
Health System ◽  
Clinical Education ◽  
Clinical Care ◽  
Full Time ◽  
University Of Michigan ◽  
Clinical Model ◽  
Education Practice ◽  
School Of Nursing ◽  
One Year ◽  
The University

The University of Michigan School of Nursing and the Health System partnered to develop an undergraduate clinical education model as part of a larger project to advance clinical education, practice, and scholarship with education serving as the clinical bridge that anchors all three areas. The clinical model includes clusters of clinical units as the clinical home for four years of a student's education, clinical instruction through team mentorship, clinical immersion, special skills preparation, and student portfolio. The model was examined during a one-year pilot with junior students. Stakeholders were largely positive. Findings showed that Clinical Faculty engaged in more role modeling of teaching strategies as Mentors assumed more direct teaching used more clinical reasoning strategies. Students reported increased confidence and competence in clinical care by being integrated into the team and the Mentor's assignment. Two new full time faculty roles in the Health System support education, practice, and research.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

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