Specialty pharmacies are high-touch organizations whose many interactions with patients allow them to collect valuable data from patient-reported measures (PRMs) to improve care and share with partners. Health plans can use these data in a variety of ways, including supporting value-based contracts (VBCs) with life sciences companies. Innovative tools and processes would help improve pharmacies’ ability to collect PRMs and enhance the value of the data to health plans, but investment is required to support innovation and implementation.
An Oct. 21 panel at the Academy of Managed Care Pharmacy (AMCP) Nexus 2020 explored the tension between PRM funding and innovation and highlighted published research by the National Pharmaceutical Council (NPC) and Discern Health on PRMs and patient-reported performance measures (PR-PMs). The panel was moderated by Discern Vice President Theresa Schmidt, MA and featured expert panelists C. Bernie Good, MD (UPMC Health Plan) and Ann Fish-Steagall, BSN, RN, OCN (TwoLabs), who represented the payer and specialty pharmacy perspectives.
The following five key take-aways emerged from the panel discussion:
- Pharmacies can collect PRMs and make data actionable.
PRMs are tools (such as surveys) that capture patients’ perceptions of their care experiences and outcomes. Pharmacists can use these tools to understand aspects of patient care such as medication compliance, need for dose modifications, refills, and medication knowledge. Introducing the panel, Schmidt noted, “pharmacists can play a key role in collecting PRMs and intervening as needed to address symptoms and help prevent ER visits or rehospitalizations, but they need the financial support to do so.”
Steagall explained that pharmacists can collect PRM data through in-person or telephonic interactions and ultimately amass large amounts of information on issues such as finances or physical symptoms through their close relationship with patients. PRM data can prompt pharmacists to take action by adjusting drug regimens or working with patients to seek additional needed care. Pharmacists also relay PRM data to manufacturers or health plans to help them understand patient experiences and outcomes related to specific medications.
- Health plans can use PRM data to support programming and value-based contracts, but the return on investment (ROI) for pharmacies is not always direct.
PR-PMs translate PRM responses into metrics that may be used to assess healthcare performance, compare entities, and measure changes over time. PR-PMs can also tie performance to payment when they are used in VBCs. According to Schmidt, the literature has shown benefits for health plans to use PRMs, such as identifying effective interventions, supporting population management, and driving outcomes in health plan accountability programs.
In 2019, UPMC worked to establish a VBC with Biogen for multiple sclerosis therapies. As Good described, this contract involved UPMC working with specialty pharmacy providers to collect a PRM for disease progression. Because the pharmacies used an already established process to collect PRM data, UPMC was able to capture needed measures for 85%-90% of patients.
UPMC has not included PRMs or PR-PMs in VBCs directly with pharmacies, but some pharmacies do participate in VBCs. Pharmacists often see patients more than physicians do, prompting Good to ask, “How can we use this access to demonstrate the value of community pharmacy, medication, or both?”
Pharmacies may not see an immediate ROI for collecting PRMs to support VBCs between health plans and manufacturers. Steagall, however, emphasized that pharmacists are providers and have the same responsibility as prescribers do to improve patient outcomes, often via increasing medication adherence. “If the patient is more adherent to their treatment, it results in more scripts going out the door, and the pharmacy and manufacturer will be happy with that at the end of the day.”
- Barriers undermine PRM administration and use.
Despite the utility of PRMs in care and contracting, several barriers impede their implementation in the specialty pharmacy setting. Schmidt discussed NPC/Discern research findings on implementation barriers and recommendations for addressing them, also outlined in a recent Journal of Managed Care & Specialty Pharmacy article, “Improving patient-reported measures in oncology: a payer call to action.”
Building on these barriers, Stegall indicated that specialty pharmacists must balance the time they spend on the phone with patients capturing PRMs with the time to get the other information they need to deliver care. Another challenge is finding the right tool, like an app, that is easy for patients to access and may allow them to complete PRMs independently.
“Selecting PRMs for value-based programs is also challenging,” said Good. “We spent a lot of time reading, doing research, having conversations, and identifying outcomes that might be relevant for patients and other stakeholders.” Choosing outcomes that are clinically meaningful and validated is critical for engaging provider and manufacturer partners.
- Innovation in PRM technology and contracting could promote PRM implementation and use.
The panelists discussed technological innovations that could increase the use of PRMs in specialty pharmacy. An app or online system may offer one innovative solution that would allow patients to report their symptoms in real time, or at key points in the therapy cycle, without necessitating an extra phone call. The difficulty, however, would be making an app customizable to specific therapies. Health plans and/or manufacturers should also consider incentives to motivate patients to download apps and use new technologies.
Additionally, the panelists discussed the potential for innovation in payment models, such as a per-member-per-month (PMPM) payment to support PRM implementation and administration. According to Good, health plans have discussed ways to engage community pharmacies to compensate them for their time but may not have considered using a PMPM model. However, this approach has been used in telephonic case management and could therefore also be applied with technology.
- Funding for innovation should go hand in hand with innovation itself.
The panelists agreed that funding and innovation are tied together and suggested that some innovations could be covered by a health plan or manufacturer. Ultimately, patients should not have to pay for PRM innovations.
Specialty pharmacies are collecting a large amount of data, but sharing and analyzing it requires funding. As Steagall stated, “In a sense, it’s a little bit like a clinical trial. We know there is data there, we have a hunch that what we’re doing is going to be meaningful, but we need some backing to prove it.”
The debate between prioritization of funding and innovation may present a chicken/egg scenario, but collaboration and risk-sharing between stakeholders can help ensure that PRMs can be used effectively to advance the continuous improvement of patient care.
For additional information, check out NPC’s research with Discern: Improving patient-reported measures in oncology: a payer call to action (2020, JMCP) and Improving Patient-Reported Measures in Oncology (2019, white paper).