Two Hospital System
Improving Health System Performance Through a Comprehensive Pharmacy Solution
This case study represents a health system that operates two hospitals and multiple clinics/physician practices in the Southeastern part of the US. In addition, the health system owned and operated an outpatient pharmacy on each hospital campus prior to partnering with ProxsysRx.
In 2015, the system was experiencing significant economic demands driven mainly by a rapidly changing reimbursement environment and increasing expenses. In addition, CMS-mandated hospital performance programs had begun to create additional pressures. The management team quickly embarked on a strategic plan that focused on specific quality and economic measures. Understanding that pharmacy related initiatives can have an enormous impact on these hospital measures, the system sought to augment its pharmacy program with a Comprehensive Pharmacy Solution that would achieve the following:
- Reduce health system expenses. Reduce health system expenses such as the outpatient pharmacy operating expenses, cost of employee benefits, and more.
- Enhance revenue position. Improve health system revenues as well as eligible 340b prescriptions.
- Improve performance measures. Provide the health system with a pharmacy-levered capability to positively influence CMS performance indicators and improve patient/employee satisfaction.
ProxsysRx offered the health system a complementary market/situational assessment. From this effort, Proxsy Rx presented an action plan that attended to specific solutions that the health system sought. The partnership proposal offered a selection of services that included:
- Pharmacy operational support. ProxsysRx would assume the financial risk associated with operating outpatient pharmacy initiatives. This included capitalizing and updating pharmacy facilities and financing all pharmacy operating expenses such as salaries/benefits, cost of drugs, etc.
- Pharmacy benefit administration (for system employees). ProxsysRx would deliver a non-traditional, pass-through prescription benefit administration to all health system employees/family members. The program offered members several delivery options, lower co-pays, and other savings and value-added services.
- Comprehensive 340b management services. ProxsysRx would bring a full 340b management program that was coordinated and all health system programs. This program would deliver all the necessary capabilities that a compliant and effective 340b program demands. The effort was to deliver a fully automated system that manages the flow of inventory, information, and payments between healthcare organizations, contract pharmacies, wholesalers, and third-party payers. ProxsysRx staff would provide support from program design through implementation and ongoing operations.
- Discharge prescription delivery program. To target the issue of readmissions associated with discharge medications, ProxsysRx would offer a technology-enabled program to provide patients the choice to receive their discharge medications at the bedside before leaving the hospital as well as facilitates post-discharge patient engagement.
Through its partnership with ProxsysRx, the health system achieved multiple aspects of its strategic plan through the deployment and ongoing expansion of a comprehensive pharmacy solution. To date (15-month period) the initiative has achieved the following:
- Over $3,800,000 in pharmacy operating expenses (including the cost of drugs, salaries, and benefits, etc.) were assumed by ProxsysRx.
- ProxsysRx invested over $500,000 into updating the pharmacy facility operations and pays $75,000 in rent per year.
- After experiencing year over year of double-digit prescription drug program increases, the health system saved more than $1,305,000 or an average of 9.5% through the prescription benefit administration initiative. This was done while maintaining and improving the benefit structure (e.g. lower co-pays) for the employees of the system.
- The 340b Management initiative generated $2,010,000 in net savings for the system. The system has chosen to apply the funds to several areas of the operating expenses of the affiliated hospitals.
- In the first 15-month period, the total economic impact was more than $7,690,000 or an average of more than $512,000 per month.
- The discharge Rx delivery program has served nearly 60% of the discharging patients of the health system and conducted over 18,000 patient engagement sessions.
IN PROCESS/NEXT STEPS
- Specialty drug program. ProxsysRx recently incorporated a specialty drug program that will provide a full spectrum of capabilities and services that provides lower cost and patient access to specialty drugs. These items are normally high cost, complex pharmaceuticals that require unique clinical, administrative, distribution, or handling conditions that may not allow the dispensing in a local traditional retail setting. This program is to function seamlessly with the 340b Management Program, which can provide multiple patient and health system advantages.
- Rx risk management. ProxsysRx is in the process of deploying population health management services that enable hospitals and ACOs to enhance the health status of their patients/members and reduce health care costs by identifying and resolving drug therapy problems (DTPs).
- Transition of care (medication reconciliation). This transitions-of-care service focuses on engaging defined patients to change behaviors by enhancing communication and delivery of outpatient prescription drugs to improve post-discharge health status. The program delivers a combination of a robust claims-based medication reconciliation technology and outpatient pharmacy support services.
Proxsys Rx can provide a senior-level contact at this health system as a referral.