Executive Summary
This content was written by Excelera, a Shields company.
Sentara Healthcare engaged Excelera to develop an in-house specialty pharmacy. Historically, the Norfolk, Virginia-based health system had contracted with a national specialty pharmacy provider. The engagement included advisory, project management and SME assistance for the specialty pharmacy and home delivery design, build-out and implementation, including related pharmacy support operations.
When it launched in July 2016, Proprium Pharmacy, as the in-house specialty pharmacy was branded, served only the self-funded Sentara Healthcare employee group of Optima, the health plan owned by Sentara. A few months later, the transition effort expanded to include all Optima members assigned to the national specialty pharmacy provider.
Proprium, from the Latin for “specialty,” is a subsidiary of Sentara. It is positioned with the intent to grow Sentara’s post-acute specialty pharmacy program among hospitals and community specialists in the service area, whether or not they are affiliated with Sentara.
Medication adherence and customer service both improved after the transition.
“Working with Excelera, we developed a strategic business plan and the operational strategies necessary to launch and be successful. Additional business development has been realized through LDD access, benchmarking, and clinical excellence, and we continue to learn and seek opportunities to use Excelera’s network for support.”
Challenges
Healthcare cost management is challenged by the growth of expenses due to specialty medications. The team at Sentara recognized a significant potential revenue opportunity, as well as a real opportunity to better manage patients and members in need of these specialized medications.
Solution
The engagement with Excelera 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
- Revenue Cycle: Licensing, credentialing, billing and revenue integrity, finance and accounting, audit defense, payer relations, 340B program
- Job Descriptions & Human Resource Planning: Staffing models and training process
- Related Pharmacy Operations
- Central Fill Robot/Mail Service/Automation: Planning and implementation
- MTM: CPAs, PBM services
- Retail Pharmacies: assessment, planning, ongoing SME support
- IT: Decision support for case management software, phone and reporting systems; connectivity to Excelera data aggregation system
- Compliance, Quality, Regulatory, P&P Plans: including URAC accreditation support
- Provider Integration: Targeting, measurement, best practices
Results
Proprium Pharmacy serves more than 2,600 patients each month, and annual savings are approximately $10.7 million. The team that developed the Proprium Pharmacy won an award in Sentara’s annual, internal business competition for their efforts in developing, constructing, and operationalizing the specialty pharmacy. The award was based in part on these impressive results from 2017:
- Customer Service: 97.7%
- Call Center Metrics: 98% of calls answered live within 30 seconds (of more than 14,000 inbound and outbound calls per month)
- Average Pickup Time to Answer: 5.3 seconds
- Delivery Accuracy: 99.93%
- Dispensing Accuracy: 99.99%
- Adherence Rate Improvement (same patients) over transitioned National Pharmacy program: 4.6%
- Adherence Rate: 93.7%
- Total Unique Patients Served: 3,835
- Total Rx Dispensed: 41,613
- Total Deliveries: 29,450
- Total Calls: 145,276