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Hospitals get some needed help with challenges in Rx.

CHESTERBROOK, Pa. -- Helping hospital pharmacies add value to their institutions is a top priority for AmerisourceBergen Corp.

With prescriptions being one of the biggest expenses for hospitals, the company wants to provide economically competitive access to products, says Emily Lightfoot, AmerisourceBergen's senior vice president of health systems. But beyond that core competency, the company has developed initiatives to help pharmacists provide services to elevate outcomes and potentially boost hospital revenues.

"Something we strive for with pharmacists is to clear their plate so they can engage in patient care," says Lightfoot. Providing unit-dose packaging and compounding, for example, frees pharmacists to consult with patients about post-discharge care, or to work with ambulatory care patients.

For large, integrated health systems that have multiple points of care, the company wants to ensure optimal pharmaceutical care for patients leaving the acute setting. Those points of care can include an in-house retail pharmacy, which sometimes may be a Good Neighbor Pharmacy, notes Lightfoot. Such pharmacies often serve the systems' employees, and many of the systems are the largest employers in their community, she adds.


With the implementation of the Affordable Care Act have come not only more insured patients but changes in reimbursement. "Depending on where they are with their patient mix and how their payer mix has changed, hospitals may be moving more toward outcome-based reimbursement models," comments Lightfoot.

A key emerging trend at hospitals is being able to provide specialty pharmacy services. AmerisourceBergen has fostered that capability through consulting and helping customers get access to the right products and accreditation as specialty pharmacies. "Essentially what hospitals are trying to do is support a patient along the entire continuum of care, from admission through treatment to release and outpatient follow-up," says Lightfoot. "Having access to specialty pharmacy solutions is important to them."

Specialty pharmacy has its own set of demands revolving around special handling of drugs, as well as utilization and adherence data requirements, and integration with payers to ensure appropriate reimbursement.

"We help hospital customers understand what make sense for them, given the patients that they serve and where they are in their reimbursement transition," Lightfoot remarks.

On the logistical level, AmerisourceBergen supports specialty pharmacy needs with daily deliveries through AmerisourceBergen Drug Corp. or its specialty delivery function, she adds. "Whether via full-line or limited distribution, hospitals are treating the sickest patients that need the most specialized medicines, and we're giving them access. We want to be able to provide access to product regardless of how the manufacturer chooses to take it to market."

Another opportunity for Lightfoot's team is helping customers comply with the 340B government pricing program for indigent care. Only certain hospitals are eligible, she says. "The inventory management, pricing and the way they order is complex, so we help them through that model."

For pharmacists, AmerisourceBergen is involved with American Society of Health-System Pharmacists (ASHP) and continuing education programs. It likewise offers supply chain consulting around ambulatory pharmacy, in some cases even providing staffing.

Hospital pharmacy generally is evolving from a focus on cost containment and efficiency to transitional care and population health management. Hospitals are being paid in a bundle around "events" such as joint replacements or cardiac care. Flat rates cover surgery, medical devices and drugs, with penalties for readmission.

"Pharmacists are becoming more and more engaged with outcome management and ensuring that upon discharge, patients are taking their meds and reducing their probability of readmission," said Lightfoot. "Studies across the board have found that a lot of readmissions are related to nonadherence and negative drug interactions."

AmerisourceBergen's response has been to take a "pharmacy-centric" approach, she says. It recognizes that patients at the greatest risk of readmission tend to be elderly, or lacking cell phones or access to the Internet. "A technical solution isn't always necessarily the best solution," she says. Instead, pharmacists should focus on the "patient connection" to prevent readmissions and drive hospital profits.

Through "Meds to Beds" programs, for example, hospitals are ensuring that patients are connecting with a community pharmacy, with follow-up promoting adherence.

With the consolidation of the hospital industry, says Lightfoot, pharmacies are increasingly becoming part of the "supply chain portfolio." That includes everything from medical devices to food and uniforms. "There's this interesting dichotomy where you have pharmacists who are very clinical in their view looking at outcome-based health care management, and then you have supply chain professionals who are focused on contracts and efficiency. It's an interesting time."

The rising price of branded and specialty drugs poses a significant cost control challenge, particularly for hospitals, she adds. The tendency of hospitals to treat people for acute conditions means they use fewer generics than retail pharmacies, which tend to dispense maintenance medications for chronic conditions. But beyond looking for savings, hospitals are seeking out new sources of revenue, which reinforces the importance of transitional care, says Lightfoot.

"We really want to help our pharmacy partners be a value added service within hospitals, where a lot of dynamic change is unfolding. Our focus is on giving them full product access across a broad array of services including distribution, unit dosing and sterile compounding, as well as specialty pharmacy. When they win, we win."
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Title Annotation:AmerisourceBergen[R]: SHAPING HEALTH CARE DELIVERY
Publication:Chain Drug Review
Date:Jun 6, 2016
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