Illuminated Path: Shining a Light on Healthcare's Best Operational Practices

Illuminated Path: Episode 9: The State of Specialty Pharmacy

December 07, 2018 Intalere: Healthcare Supply Chain Management Season 2 Episode 4
Illuminated Path: Shining a Light on Healthcare's Best Operational Practices
Illuminated Path: Episode 9: The State of Specialty Pharmacy
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Illuminated Path: Shining a Light on Healthcare's Best Operational Practices
Illuminated Path: Episode 9: The State of Specialty Pharmacy
Dec 07, 2018 Season 2 Episode 4
Intalere: Healthcare Supply Chain Management

In this episode of Illuminated Path, host Evan Danis welcomes guest Suzette DiMascio, president and CEO of Intalere partner CSI Specialty Group. DiMascio is recognized internationally as a thought leader, industry expert, frequent media contributor, sought after speaker and educator of all things related to the specialty pharmacy and the rare and orphan disease arena. In this episode she to discusses her strategic insight on marketplace trends – specifically, what’s driving the explosive growth of specialty pharmacy. DiMascio passionately speaks about her unwavering commitment to help every healthcare provider, regardless of size, understand specialty pharmacy and the financial ROI it can make to an organization. 

Show Notes Transcript

In this episode of Illuminated Path, host Evan Danis welcomes guest Suzette DiMascio, president and CEO of Intalere partner CSI Specialty Group. DiMascio is recognized internationally as a thought leader, industry expert, frequent media contributor, sought after speaker and educator of all things related to the specialty pharmacy and the rare and orphan disease arena. In this episode she to discusses her strategic insight on marketplace trends – specifically, what’s driving the explosive growth of specialty pharmacy. DiMascio passionately speaks about her unwavering commitment to help every healthcare provider, regardless of size, understand specialty pharmacy and the financial ROI it can make to an organization. 

Evan:

You are listening to Illuminated Path, shining a light on healthcare's best operational practices brought to you by Intalere. I'm your host Evan Danis, senior director of corporate communications at Intalere. Joining us in the studio today is Suzette DiMascio, president and CEO of Intalere partner, CSI Specialty Group. Recognized internationally as a thought leader, industry expert, frequent media contributor, sought after speaker and educator of all things related to specialty pharmacy and the rare and orphan disease arena. Suzette's strategic insight on marketplace trends help align and enlighten this continually pivoting industry. Under Suzette's leadership, CSI Specialty Group has become the industry's preeminent leadership consulting firm, offering strategic solutions to all healthcare market channels across the spectrum. Recent honors include being named one of Consulting Magazine's Fastest Growing Firms, Goldman Sachs, Top Growing Businesses, and Top 50 Women Owned Businesses by Commonwealth Institute. Suzette, welcome and thanks for joining us today. I'm hoping today we can educate our listeners on specialty pharmacy some, specifically what it entails, maybe break down what's driving the explosive growth of this industry and why every healthcare provider, regardless of size, needs to understand it and explore how they might be able to leverage specialty pharmacy to reach corporate goals and make a real impact on organizational ROI. So with that, let's get started. A couple of questions for you to start...briefly define for us what specialty pharmacy entails for our listeners from your perspective.

Suzette:

Thanks for having me on the show, Evan. Specialty pharmacy is a growing part of a solution to take care of very chronically ill patients. It's estimated by 2020 that over 50% of the outpatient drug spend in general will be on specialty molecules. And if you think of specialty pharmacy, think of a patient that is suffering from a chronic illness, whether it be Hepatitis, Multiple Sclerosis, Crohn's Disease, or potentially something very rare in the sense of Duchenne's Muscular Dystrophy, or hereditary angio edema. So it's a very chronically ill patient that needs a life sustaining medication, in order to have any quality of life. Oncology products also fall into this category as well, and they're usually very high touch, need, a lot of integration with the caregiver as well as a high cost as we all know.

Evan:

So based on that, I think you've kind of explained specifically what's driving its growth it seems like. But tell me a little bit more about that and why it's grown so exponentially over the last several years.

Suzette:

Well, in my opinion, it's very simple. Once we broke the genetic code, scientists were able to come up with different molecules to address a lot of genetic disorders that they never were able to. You take to Shane's dystrophy, for many years traditionally strikes a twin boys, uh, doesn't strike women as much. The genome doesn't hold in the female cycle per se. I'm not a geneticist, but I play one on TV. And subsequently since they were able to find the marker for this catastrophic illness, they are now able to treat these kids. And in the studies that when one twin could take the drug and one twin couldn't, they were able actually to slow down the progression of what typically is a death sentence. So it's really revolutionary now with high technology and high R&D to develop these drugs comes a high cost, and that's kind of where specialty has really become the forefront of consideration for employers, insurance companies to take a look at how do we mitigate the risk of taking care of these chronically ill patients when these drugs are so expensive.

Evan:

That's a little bit about, you know, again, how important it has become. So tell me a little bit then about how it's important to integrated care of the patient. I think what you explained really tells a little bit about that, a little bit more about how it's so important to integrated care. And there's a specific example that we've talked about before that I'd love for you to share with our audience as well.

Suzette:

In the past five to six years, health systems have been on a mission to look at ways that they can integrate specialty pharmacy into their outpatient offering. As we all know that outpatient pharmacy traditionally has looked at, been looked upon as a cost center, but now there's an opportunity for them to really take a look at the Triple Aim and have a 360 view of that patient. And that's by offering specialty pharmacy services. And what we like to say in our firm is that not everybody needs to be a specialty pharmacy, but they need to have a specialty pharmacy strategy. And I'll give you a case in point. It's a very poignant story. I was at a conference, and a health system pharmacy director came to me and asked me if I could talk to them about what steps do they need to take to open a specialty pharmacy. And of course, I asked some typical questions and then my main question was, what made you look at this now? And she shared a story with me about a little girl that had had a liver transplant. And as you can imagine as a parent; I have a son and I know you have children as well...when you get the diagnosis that your child needs a liver transplant-- it just changes your life, your life stops right at that moment. And so this health system was able to take this 14-year-old child from the brink of death to a successful transplant to discharge and at the time of discharge, as you can imagine, there's a myriad of drugs that she needs to take Because they didn't have a specialty pharmacy, they were locked out of the network and they weren't able to dispense the drugs that this child needed to sustain her life for the rest of her life. She's on all these medicines. There were a certain amount of meds that they could, and they left with those drugs. And then the rest of the drugs were called in by their pharmacists to another pharmacy that was going to dispense it. The drugs never got there, and she went into liver rejection. She entered the hospital, and within a short period of time they lost her. And first of all, as a parent, every time I tell the story, I get a chill because a mother lost her child, you know, and being a mom, there's no greater fear than something happening to your child. And it didn't need to happen. It didn't need to happen because if the health system was allowed to dispense that drug and take complete care of that patient at that moment, she wouldn't have passed away, but they weren't allowed that privilege because of our crazy systems and PBM lockouts, and that could be a subject for a whole other podcast. But the bottom line is health systems now not only want to have a specialty pharmacy strategy, in many cases, they want to have a specialty pharmacy as well so that they can have a 360 view of that patient and stop situations like this from happening.

Evan:

It's a very powerful and poignant story and it really speaks to the importance of integrated care and where specialty works into that. So thank you very much for sharing that. It really, really brings it home. We talked a little bit when you started talking about that we talked a little bit about how we say not every system or every facility needs a specialty pharmacy, but they do need some sort of specialty pharmacy strategy, and I think a lot of facilities, a lot of organizations are deciding where do we go, how do we start, what are some of the things to consider maybe when they're trying to formulate that strategy of whether they want to install a specialty pharmacy partner by builder, how they want to do that.

Suzette:

That's a great. You actually almost answered it for me. By builder partner is always the first discussion. What we're finding now is that most health systems will want to take a look at what that ROI means to them. For example, a 340B facility that's got 300 more beds, it might financially make sense for them to do a specialty pharmacy, but for a rural clinic that maybe has 10 specialty pharmacy patients a month, it doesn't make financial sense for them at that point, so they'd look to partner. I know that Intalere is coming up with some great solutions to help the plight of the rural health system as well as individuals that want to just expand their realm in specialty, and we're honored to be a partner in that.

Evan:

We talked a little bit, Suzette, about your passion for specialty pharmacy and your company's overall success. So tell me a little bit about how you see yourself in the marketplace, why you're so passionate. Obviously, we heard a story that tells us why you're so passionate about specialty pharmacy, but tell us a little bit about that in terms of building your business, and how you've been able to help some systems, large and small, figure out their way around the specialty pharmacy business.

Suzette:

Well, I guess for me it's been something since a child that I've always loved healthcare and you know, I figured at one point in my life I wanted to be a doctor and find a cure for cancer. So I like to think that maybe I'm not able to find a cure myself, but our clients and our partners are. And an example of that would be the work that we did with Johns Hopkins, so they actually were really early adopters, in specialty pharmacy, and they came to us to help build out their solution, and we basically did everything from designing the site, bringing in an architect, doing job aids, helping them with a call center, all the way to getting them ready for accreditation. So it was a complete build out. Now that the market's evolved a little bit, we'll get called in for different things. But the reason that I think we're able to be so successful is my team is passionate, and they have an exceptional pedigree. I'll put my team up against anybody in the marketplace. They come from the industry. So they've come from those early innovators like Accredo and Curascript and at Aetna Specialty. And I think a lot of times what we tell them our clients to do is I'm not as important as we tell them not to do because my team's been through the pitfalls, they've seen what's worked and what's not worked and they've adapted. So their ability to get to market quicker can happen because they're dealing with industry experts, and we're not like a top five consulting firm where we'll bring one subject matter expertise in and then they bring a couple of Ivy League students in to do all the work. We actually rotate our team based on their expertise. So in the beginning you might be working with someone that knows how to create an operational strategy, and design a site, and on the end work with another one of our consultants as an accreditation expert. So we'll bring people in based on their expertise, but they have a long lineage and a long pedigree in specialty. And every day they look at ways to not only make our clients lives easier and more effective, they want to make sure that whatever they're doing makes a difference in the patients that our clients are ultimately treating.

Evan:

Well, that's the most important thing is, is that patient care and making sure the outcomes are the best that they can be.

Suzette:

Absolutely.

Evan:

So one of other question I have is some organizations are thinking is now the time for specialty pharmacy, am I too big, am I too small? How does it work? What would you say to them in terms of why is the time now, why is now the best time to really consider a specialty pharmacy, and how it fits into their organization?

Suzette:

If anyone is taking a look at the pipeline of the drugs that are coming out in the next 10 to 15 years, they're either oral or injectable products, and most likely 50-60% of them will be a specialty product. So they're going to have to make a determination if they want to be held hostage to the situation that the early example is and wait for someone to take care of their patients for them, or if they want to be proactive and have a complete approach to that care. I also think that you have to take a look at the changes in our reimbursement system. You know our health system is fragmented right now, and it's not getting any better. And so there has to be an alignment with the payers of the world and value-based reimbursement is coming out...is something happens like in the incident that we talked about before, the little girl that passed away, what people don't understand is the ripple effect of that health system. So now that that little girl passed away because the transplant was rejected, that event caused the health system to pay back all the money that they gave that insurer, whoever the payer was, whoever was that planned sponsor. So all that money goes back to them regardless that they had nothing to do with the adverse event. And as a center of excellence, if they have more adverse events, they could lose their center of excellence in transplantation. And you know, what that'll do to a health system, that could just be a death sentence.

Evan:

Sure. It can be very devastating. So, I'm a health system. Tell me how I can get started down the path of exploring specialty pharmacy.

Suzette:

Well, the first thing is to call CSI, and we will talk to them and get to understand what are they trying to accomplish? Because we like to say in our office, if you've seen one health system or hospital, you've seen one health system or hospital, their missions may be different, their patient population, their geographic location, and they may have an outpatient pharmacy or not. They may have started in specialty for their employees or not. We go through a whole list of questions so that we can ascertain where they're at and where they want to be. From that, we usually like to go out and visit them again, kind of doing a day in the life. What are they doing today, what do they want to do tomorrow? And from there we'll come up with the statement of work to basically help them go through what they want to develop. Some organizations don't have a lot of hands, and they'll want us to be more hands on. We have projects that can last three months or three years. Again, it really depends on how heavy a lift they can do and how heavy of lift they want us to do. One of the things that they can also start out with, as any of our listeners today, we do run the only industry podcast dedicated to specialty pharmacy and it's a CSI Specialty Group, specialty pharmacy podcasts. Little bit of a mouthful, but I started that several years ago because there really isn't any informational site, tool, resource for people in the industry to hear what's happening. So every other week we do a podcast that's either based around something happening in the industry. For example, the beginning of this year, we had a whole podcast on copay accumulators. It was something new that was coming out that would affect patients, or we'll bring a vendor on or someone that is in specialty pharmacy that has a story to share that has value to the listeners. I think we've got about 46,000 listeners today that are on it, and it's funny when I go to conferences, it's very rewarding for me to have people tell me, thank you for doing that because nobody wants to educate us on this industry. They all want us to pay hundreds of thousands of dollars to consultants when a lot of what you give me at least gets me going in the right direction to make the right informed decision.

Evan:

And I think that's an important point to make is in helping them get educated before they engage, whether it's with you or with anyone, is they need those resources, in many cases, as you're saying free resources to help get educated or at least close up the speed so then they know the questions to ask and the things to look for. So there's some other things that you do as well I think in that vein to, or that they should look forward to.

Suzette:

We do, we started, actually two years ago doing a State of Specialty Pharmacy Report that's put out annually and what we do is we survey stakeholders across both health systems, independent specialty pharmacy and manufacturers, and I believe this year we're going to also have a fourth area or channel of payers so that we can get the perspective from for all four channels on specialty pharmacy and what they're seeing as trends. It's been very interesting and very enlightening. And to me it's an honor when I see people quote us in other research, so I know we're doing something right and again, it's to give back, you know, we love this industry. It's very exciting. It's very fast paced, but at the end of the day, we're taking care of very, very sick patients. It's not patients that just need to take Lipitor to lower their cholesterol; it's people that need to take ??? so they can get up in the morning and enjoy the day with their children. We never lose sight of the fact that the people that are relying on us are taking care of patients that are very, very sick and need that extra touch.

Evan:

And I think that in all of this is the most important points to make specialty can be probably a little bit daunting to think about or to get into for any facility, but ultimately it's about establishing that continuum of care, and I think as one of your customers said, and one of our members, Virginia Mason, I remember saying it's the right thing to do. Getting into specialty, thinking about specialty, is the right thing to do in terms of the best way to treat their patients.

Suzette:

That that's absolutely right. And I think that there, for those that are late to the market and you know, to our listeners on this podcast, you know, really only 20-25% of health systems today have any type of specialty pharmacy offering. And of those 25%, maybe two percent are optimized. And what I mean by that is we have a lot of health systems coming to us now that are established, especially the academic IDNs that are established specialty pharmacies, they've only been able to capture 20-30% of their potential. The rest of it is going out to these varied organizations that were the reason that this little girl didn't get her medicine, so they need to think about that. They need to have a better or they need to have some sort of a strategy to increase their capture rate, and we can help with that as well. So our services aren't just for people that want to start a new specialty pharmacy, our services are for people that want to make their specialty pharmacy the best it could possibly be and handle more of their physician's needs, and that's a critical message to our listeners.

Evan:

And again, it goes to the continuum of care and making sure those patients like that little girl are taken care of in the best way possible.

Suzette:

And the one thing that I would also stress to your members as well is that, as we take a look at specialty, this is what health systems do best. They take care of chronically ill patients so this isn't new to them. What is new to them is getting access to the drugs, making sure they have the right systems to get reimbursed, figuring out ways to get that patient assistance, help so that they can get the financial burden maybe lowered for that particular patients that stay on therapy, and then also making sure that they're getting that product timely so the care is not unique, the delivery of the product and what that product needs to get to the patient is unique, so it's not a big leap of faith. It's just a new business line to add on to an existing successful one they have.

Evan:

It's really great information, so thanks very much Suzette for educating us on the importance of specialty pharmacy and understanding why healthcare organizations really need to have a strategy around it. It's really good information. Thank you.

Suzette:

Thank you for having me.

Evan:

This has been the Illuminated Path podcast, shining a light on healthcare's best operational practices. Thanks very much for listening, and we hope to talk and walk with you again along the illuminated path very soon. If you've enjoyed this episode, make sure you subscribe to the Illuminated Path podcast wherever you listen to podcasts. To learn more about Suzette, CSI Specialty Group, or Intalere, check out our show notes and visit our website at Intalere.com. Follow us on LinkedIn, Twitter, and Facebook to learn when the latest episodes will be available and to keep up with all things Intalere.