BACKGROUND
– An Integrated Health System Dedicated to Treating the Whole Patient
Union Health is an integrated health system serving communities throughout western Indiana and eastern Illinois. The main campus, Union Hospital, is a 350-bed not-for-profit community hospital in Terre Haute, Indiana. The health system also includes Union Medical Group, which is comprised of over 130 providers in 20 specialties practicing
at locations throughout the region — making it Wabash Valley’s largest multi-specialty provider group.
Union Health strives to provide patient-centered care using a collaborative, multidisciplinary approach. An essential part of that care is helping patients get affordable access to the medications they need. That’s why Union Health had
long operated two outpatient retail pharmacies — one in the main hospital serving discharged patients and employees and another for the general public in their medical office building. However, at that time, the health system did not have its own specialty pharmacy, which left a gap in its ability to provide exceptional patient care for those prescribed complex, expensive therapies to manage cancer, rheumatoid arthritis, HIV, multiple sclerosis, and other chronic conditions.
THE CHALLENGE
– Navigating the Complexities of Specialty Medication Access
According to System Director of Pharmacy Services, Dan Cleveland, PharmD, BCPS, for Union Health, without a specialty pharmacy — patients and providers were left to navigate an often confusing process on their own.
“The trouble is that process is not always straightforward,” explains Cleveland. That’s because specialty medications require pre-authorizations, so there can be a lot of back and forth and follow-up required. “We were hearing from providers, especially those in the oncology and rheumatology space, that patients were waiting weeks before they started therapy.”
Plus, since specialty medications are often very expensive, most patients need financial assistance above and beyond insurance coverage. “That’s just another process to be managed and can be a barrier to treatment,” says Cleveland. “And while our providers did what they could — they simply didn’t have the dedicated staff necessary to handle all the administration that comes along with specialty medications.” That’s why he decided to explore how Union Health could establish an onsite specialty pharmacy to elevate patient care.
THE SOLUTION
– A Partnership That Paved the Way for Patient-Centered Specialty Pharmacy Services
After conversations with a number of potential partners, Union Health ultimately chose CPS Solutions, LLC (CPS), one of the nation’s largest pharmacy and hospital services providers, to build out and manage their specialty pharmacy. “One of the things that stood out about CPS was their expertise and relationships with payors and manufacturers,” Cleveland says. Most payors require dual accreditation for specialty pharmacies to gain access to their specialty networks and limited distribution drugs — and CPS’ team of experts helps systems like Union Health earn those accreditations rapidly. “I just knew my team and I would not have the time to navigate that piece of the puzzle, so it was important for me.”
While payor access is one of the keys to a successful specialty pharmacy — having the people and processes in place to help patients is also critical. That’s why CPS hires and integrates pharmacists and liaisons in clinics to work directly with staff and providers under Union Health’s brand. The benefit of CPS’ locally-focused approach is that when one of the specialty pharmacy team reaches out to patients — they know they are talking to someone from their community. “We’ve found that having a local Terre Haute patient talking to a Terre Haute-based pharmacist or liaison has made a difference in building trust and helping them understand we have a specialty pharmacy right here onsite,” says Senior Vice President, Zel Skrtic, PharmD, of Onsite Operations for CPS.
Clinical Operations Manager, Kathy Canup, PharmD, who grew up in Wabash County and has been with the health system for 13 years, oversees the specialty pharmacy operations. She and her team take the time to work with patients to get medications into their hands as quickly as possible. “We get prior authorizations and do what we can to make the medication affordable through insurance, copay cards, financial assistance programs, or grants,” Canup says. Beyond that, specialty pharmacists and liaisons support patient needs — walking them through treatment plans, helping them manage refills, and more.
THE RESULTS
– Fast, Affordable Access to Critical Specialty Medications
Union Health Specialty Pharmacy opened its doors in February of 2021. “Once we signed the contract — it was pretty much plug and play from our standpoint,” says Cleveland. CPS handled everything, including absorbing the upfront risk from a capital and operational staffing perspective. “Hospitals our size don’t often have an onsite specialty pharmacy,” he explains. “Being able to help our patients access and manage these complex medications improves their experience and outcomes — and that’s something we couldn’t have done without the help of CPS.”
Today, the specialty pharmacy supports Union Health’s patients who are dealing with various cancers, rheumatoid arthritis, neurological disorders, infectious diseases, and respiratory conditions. Canup says having pharmacists and liaisons onsite is a big win for clinic staff. “I didn’t realize the workload nurses were taking on trying to obtain prior authorizations and help patients research and apply for financial assistance.” Now, with dedicated staff to manage the process, provider satisfaction has improved. Moreover, patients are better able to access and afford their therapies. “The specialty pharmacy maintains a 96.7% prior authorization approval rate and has saved patients over $2.6M in financial assistance,” says Canup.
As a result, patient satisfaction has increased, too. Union Health earned a Net Promoter Score (NPS) of 97.7, placing it as the 2024 winner and top performer for patient loyalty in Managed Markets Insight & Technology’s (MMIT) 9th Annual Specialty Pharmacy Patient Choice Awards. This is a significant honor as the MMIT awards recognize health system specialty pharmacies nationwide that provide exemplary patient satisfaction.
ADDING VALUE
– Uncovering New Opportunities
Working with CPS provides Union Health with opportunities to serve that community that would not otherwise have been possible. This includes focusing on programs and initiatives to improve patient adherence and outcomes.
In 2023, the specialty pharmacy team began working with a group of local neurologists to follow their migraine patients closely. “Starting with a patient’s baseline migraines, we track their progress once they’ve started therapies to confirm treatment is effective and migraine days are decreasing each month,” explains Canup. If there isn’t improvement after three months, the pharmacist works closely with the neurologist to adjust and optimize therapy. “And when an office visit is required for further evaluation, we can typically get patients seen faster so they are able to adjust therapies as needed in a more timely fashion.”
Working with the rheumatology clinic, the specialty pharmacy team also conducted a study to determine if self-administered subcutaneous injections could be a more affordable and convenient option for patients with autoimmune diseases being treated with intravenous (IV) therapies. The catalyst for the study was related to the cost of IV therapies, which were becoming unaffordable for many patients, even with financial assistance, as well as the time and expense spent traveling to a medical facility for treatment. Self-administered medications were delivered to the homes of patients who agreed to participate. Union Health specialty pharmacists then interviewed participants using a standardized six-question survey to measure patient satisfaction, ease and convenience of use, and confidence in the self-administered medication. Overall, 87% of participants said the self-administered medication was either extremely convenient or very convenient. With this, the specialty pharmacy team began working with rheumatology patients to educate them on at-home treatments — helping them transition from IV therapies and secure financial assistance to cover more of the medication costs.
THE BOTTOM LINE — FOR PATIENTS, PROVIDERS, AND UNION HEALTH
“What we do on a daily basis is very rewarding,” says Canup. “Patients are constantly thanking us for making a complex and scary situation more manageable.” That includes helping them get access to the specialty medications they need, as well as the financial assistance to make treatment more affordable. She also notes that being in the clinics helps doctors and nurses understand exactly what the specialty pharmacy team can
do for them. “The CPS team frees clinicians up to do what they are trained to do — build relationships with and care for their patients,” says Skrtic. “That’s why we’ll continue looking for more opportunities to help other specialty providers increase patient satisfaction.”
From Cleveland’s perspective, he believes many directors of pharmacy in smaller hospitals might not think they can embed a specialty pharmacy. “That’s just not the case. I had
no idea what opportunity was waiting for us until we decided to establish a specialty pharmacy.” As a result of adding specialty pharmacy services, Union Health’s pharmacy department continues to exceed its operational margin goal. “I think any hospital with 340B access that offers specialty services should explore what is possible working with a partner like CPS.”
For more information on Union Health, please visit their website at www.union.health.
