Outpatient care is changing. Many factors are driving this such as innovations in medicine, rising costs of care, shifting demographics, an increase in home care, and more. These changes are creating opportunities for health systems to extend patient care, bringing more care within their four walls, while expanding reach by following patients in their communities and providing ongoing continuity of care.
Health systems that can integrate their inpatient and outpatient care can better manage outcomes and reduce the financial risk inherent in emerging value-based contracts. Providers have greater access and communication with their patients if a holistic team interacting with the client can provide documentation in a single electronic health record (EHR).
One of the best opportunities for health systems to extend patient care today is to add specialty pharmaceuticals to their ambulatory pharmacy. By centralizing the care and associated clinical data for these complex disease states into one shared EHR, providers are better able to focus on patient outcomes by seeing the entire picture created by the data. Without an integrated specialty pharmacy, patient care and the associated data becomes fragmented leading to suboptimal outcomes.
Where We Stand Today
Right now, some health systems are doing better than others when it comes to managing outpatient care. The health systems that are doing it right are focusing on all aspects of outpatient care, and maintaining the follow-up and collaboration needed to manage complications like side effects, adverse reactions, and positive or negative treatment effectiveness. They are focused on patient satisfaction as well as pursuing the best outcomes possible.
Health systems with an integrated specialty pharmacy are utilizing embedded pharmacists as part of the medical teams. This creates more communication channels between providers and patients, for both inpatient and outpatient settings.
For specific medications, payers may dictate where the treatment is to take place, and from whom it is dispensed. Health systems have to adhere to these restrictions from payers which may lead to fragmented care and fragmented data about the patient. As the specialty market grows, this fragmentation increasingly threatens optimal care for the patient.
Patients use the pharmacy benefit more than any other health-related benefit. While only 3% to 4% of patients use specialty medications, they are rapidly reaching 50% of total drug costs. Specialty medications also represent some of the most clinically complex therapies making their clinical management more important. Health systems and their clinical pharmacists are best positioned to manage these complex therapies as part of the integrated care team.
Integrating Inpatient and Outpatient Care Into Health Systems
A lack of integration across both inpatient and outpatient healthcare can lead to fragmentation, creating unnecessary gaps in care for the patient. This increases the risk of complications from undocumented side-effects, new symptoms, abandonment, or a lack of adherence to medication.
Payers don’t want to pay for patients not adhering to medication — or a failure by the pharmacy or health system — and in the new value-based reimbursement model a lack of integration can hurt health systems seeking the best outcomes.
In the end, health systems are uniquely equipped to manage the entirety of patient care due to their exposure to each step of their journey. It’s vital that they can integrate themselves into outpatient care and reach better outcomes and more valuable care.
It makes sense that health systems would lead the charge in care for the patient. When it comes to complicated disease states and specialty medication, integrating a specialty pharmacy helps reduce the amount of outsourced, fragmented care significantly. A bridge of communication between inpatient and outpatient care also ensures that no matter what happens, the most up-to-date and medically relevant data is present in the patient’s EHR.
While ambulatory specialty pharmacies may not have access to limited-distribution drugs for every disease state and some patients will have to go to an outside pharmacy, this is still a worthwhile investment for health systems with specialty practices looking to manage treatment effectiveness.
An Ideal Solution — A Network of Providers
Looking to the future, an ideal arrangement is a large network of providers, one that can adapt to the patient’s needs and ensure a better outcome. The goal of a network of providers is to provide care to local patients in your market, while also sharing the benefits of being part of a broader system that manages patients beyond the expertise or ability of their own health system, either due to an on-site pharmacy or lack of on-site specialists. This allows health systems to provide the best patient outcome, without creating large amounts of fragmentation or loss of control. Smaller markets (or one without a specialist) can get their patients to a partnered clinic or hospital, while still maintaining the data and context for future treatments.
A network of providers also helps deal with regulations on dispensing drugs across state lines. Patients may seek out specialists across the nation, and a network can then find them the right partner in their home state to make sure they are getting the outpatient care they need.
Ultimately, while this also protects the revenue of a health system, it is a way to provide better, more convenient care for a patient.
