Elevating Specialty Pharmacy
Analysis shows that integrated specialty pharmacy model is associated with lower total cost of care1
Shields Health Solutions (SHS) recently partnered with Optum Advisory Services to evaluate the impact of the SHS integrated specialty pharmacy model on total costs of care for Medicare Advantage patients.
SHS’s integrated specialty pharmacy (SP) model reduces total health care costs measured on a per member per month (PMPM) basis.
Optum proprietary de-identified Normative Health Information claims database was used to identify patients enrolled in Medicare Advantage and pharmacy insurance coverage in 2018 and 2019. To be included in the data set, patients had to fill at least one self-administered specialty prescription in 2018. Patients were assigned to groups (as seen in the table on next page.) Total health care costs (including medical and pharmacy spending) were then compared. The authors used Centers for Medicare & Medicaid Services Hierarchical Condition Categories risk scores to adjust for differences in disease states, comorbidities, and demographic factors between patient groups.
In 2019, risk-adjusted PMPM costs were 13% lower for the intervention group as compared to the control group ($7,061 vs. $8,149 respectively). Patients whose specialty prescriber participated in the SHS care model but did not fill their prescription at an SHS-aliated pharmacy had 6% lower risk-adjusted PMPM costs ($7,683 vs. $8,149 respectively)
“Integrated specialty pharmacy is one of the most critical drivers of improved quality and economic outcomes for patients and health systems. In partnership with Shields, we have developed a program that delivers market-leading medication adherence, which is critical for a specialty hospital and transplant center such as Tampa General. In addition, our program is now a new source of growth for our organization, enabling Tampa General to invest in new initiatives for patient care.” - John Couris, CEO of Tampa General
The Shields Care Continuum
Shields Health Solutions’ dedicated clinical team of pharmacists, liaisons and patient support advocates, engages patients and their families to help educate, coordinate care and ensure patients receive specialty medication without significant delays.
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