Shared responsibility for implementing a specialty pharmacy
Testimonial
“We have had a very positive response from both providers and patients as we develop our specialty pharmacy program. Patients enjoy working with a local pharmacy directly affiliated with their providers. Our providers love the convenience and prior authorization assistance we offer.”
– Tracey Murrish, Manager Specialty Pharmacy
Executive Summary
This content was written by Excelera, a Shields company.
To expand services offered to their patients, Billings Clinic engaged Excelera to assist in the development of Billings Clinic’s Specialty Pharmacy service operation. The partnership included providing advisory support and project management expertise for the specialty pharmacy. In addition, Excelera provided guidance on the build-out and implementation of pharmacy support operations such as call center, revenue cycle and business office functions.
The goals of the engagement were:
- Development of a business model and proforma to demonstrate viable business
- Establishment of a program focused on positive patient outcomes
- Creation of partnerships to gain access to payers and drugs
- Mentoring during accreditation process and implementation of policies and procedures
Challenges
Billings Clinic entered the specialty pharmacy market at a time when the field was becoming increasingly competitive. Thus, it was imperative to develop a thoughtful business model that considered significant market factors including payer and drug lock-out, and the volatile and uncertain future of both specialty pharmacy and government programs such as the 340B drug discount program. In addition, Billings Clinic needed to ensure the business model was viable and poised for near-term as well as long-term success, while providing Billings Clinic patients with a superior level of care as compared to outside pharmacies.
Solution
The partnership included the coordination of planning, development and implementation support for:
- Overall Project Plan
- Specialty Pharmacy Build-Out
- Clinical Therapy Management
- Call Center/Pre-Authorization and Financial Assistance
- Human Resource Planning including staffing models and training process
- Information Systems decision support for case management software, phone and reporting systems
- Connectivity to Excelera data aggregation system
- Compliance, quality, regulatory, and support in policy and procedure development
Results
Billings Clinic Specialty Pharmacy has created and implemented a 5-year business proforma. Under the guidance of Excelera consultants, they also plan to seek URAC specialty pharmacy accreditation next year.
About Billings Clinic
Billings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, Billings Clinic is governed by a board of community members, nurses and physicians. At its core, Billings Clinic is a physician-led, integrated multi-specialty group practice with a 304-bed hospital and Level II trauma center. Billings Clinic has more than 4,100 employees, including 450 physicians and advanced practitioners offering more than 50 specialties. More information can be found at www.billingsclinic.com/.
