Featuring Bill McElnea, Vice President of Population Health, Shields Health Solutions

My name is Bill McElnea. I serve as vice president of population health at Shields Health Solutions. I've been with the company for about 6 and a half years and came on board as director of ancillary services and diabetes management. 

Diabetes care opened the door for us to be involved in population health more broadly. Through diabetes we learned there is a tremendous demand for higher-touch pharmacy care. This also ended up opening doors in care areas like COPD and heart failure. This was the impetus for our whole portfolio now where we are working with health system specialty pharmacies to expand the scope of their work into more non-traditional spaces. I think many health system specialty pharmacies serve as a co-morbidity to specialty, but it's a newer thing for them to service those diseases when a patient has it as a leading business. 

How can we reduce the total cost of patient care and what role can specialty pharmacy play in achieving this goal? 

Yeah, I think there are a lot of ways that specialty pharmacies can help to reduce the total cost of care. We are big fans of health systems standing up their own specialty pharmacy programs just because of the integrated way in which those specialty pharmacies can serve patients.

We have observed that when you can deliver an integrated care model, medication adherence increases well into the 90th percentile and higher from a PDC standpoint. Medication adherence is a very powerful thing. If you can get that right, it's going to have a horizontal effect on other clinical outcomes such as viral load suppression in HIV or SVR rates in HEPC. 

Adherence has an enhancing effect on different outcomes which in turn impact medical expenditure. If you can get the adherence piece right, a lot of times that will minimize the complications that patients are having. This means they don't have to seek care from a physician or go to the hospital and ER as often, all of which can be high-cost events. So that is one way I would say that the HSSP model is particularly well suited to focus on medication adherence. 

What specific efforts within health system specialty pharmacies are combating this high cost of care? 

First and foremost, just the presence of a pharmacy liaison in a clinic where patients are receiving care is a very powerful thing. If these pharmacy liaisons that we work with health systems to deploy in clinics are removing pharmacy-related administrative burden from patients and clinics. On the patient side, that means not having to worry about the status of prior authorization and not having to worry about affordability as much because our liaisons are trained to get co-pays down as close to zero as possible. Oftentimes those co-pays may be $10 or under, which can be a major game changer for patients. Liaisons administer refills month over month and are in touch with patients monthly. The presence of the pharmacy liaison is still a relatively new thing in health care but is a very powerful role that is helping clinics to focus more on care. 

I'd say another key element is the clinical pharmacist team. They're particularly well suited to educate patients on the medications they're taking since patients tend to have many questions about high-cost, intensive medications. They want to make sure they have a full understanding of what they're taking. The clinical pharmacists are there to talk through potential side effects and warn patients of any potential barriers to adherence. These strategies come together to provide a higher touch, more integrated experience that has a big impact on medical and pharmacy expenditures. 

Are there any key highlights from your session at Asembia that you would like to share with our audience who couldn't attend?

We discussed that there is a growing body of research around how health systems’ specialty pharmacies can reduce the total cost of care. Just last year there was a study that came out in the Journal of Oncology Pharmacy Practice that studied oncology patients across about 25 different health systems. They found that oncology patients filling prescriptions through an HSSP had 32% lower medical expenses than patients who filled with different types of pharmacies. And it was interesting that they were also associated with pharmacy expenditures that were 14% more than patients who were filling elsewhere.

We also worked on a study with Optum Advisory Services back in 2022 that evaluated about 20 different health systems. The study found a 13% reduction in the total cost of care for patients across 6 different specialty disease states that were filling prescriptions through an HSSP. 

Continual research is solidifying the case for health systems to leverage HSSP in order to enhance their value-based care and population health efforts. In conversations about value-based care, it’s important to bring up what kind of tool health system specialty pharmacies can be. It is exciting to see how when you connect all these dots, you can provide a better experience for the patient and health systems.  

What changes can the value-based care space anticipate as health system specialty pharmacies are increasingly utilized aside from cost considerations? 

Health systems are increasingly better positioned to perform on outcomes-based contracts because that's what HSSP is all about, trying to improve outcomes across the board. And not just medication adherence but in several different areas. Another focus in my Asembia presentation was trying to expand people's viewpoint on all the different quality measures under a value-based care arrangement that HSSP can impact. Much of this comes down to the broadness of that pharmacist's skill set and if outside of MTM lane they're also addressing nutrition and lifestyle. We're screening for things like tobacco use, depression, A1C control, and blood pressure then making referrals when necessary. More and more pharmacists can help patients with these comorbidities. And health systems are financially incentivized to do better on these measures, not to mention it's the right thing to do. 

A major area for expansion in value-based care arrangements is social determinants of health. Are you screening for SDOH barriers, making the appropriate referrals, and bringing those challenges to resolution? Increasingly, our pharmacists are doing that. I hope to see HSSP be more included in the national conversation around care management. The more that we learn about the dividends that a good health system specialty pharmacy can have, the more we hope it will take a central role in the population health and value-based care movement.