Today, if you are diagnosed with a chronic condition in the United States, you’re likely to face a rollercoaster of frustrations with a specialty pharmacy. If you’re unfamiliar with what a specialty pharmacy is, these organizations fill prescriptions for specialty therapies: drugs that are expensive, likely to have side-effects and require more extensive clinical touch-points (we covered this in more detail in a previous blog post).
Today’s Specialty Pharmacy Problem
The specialty pharmacy experience today is known to be disjointed, inefficient, financially burdensome, opaque and energy-draining for patients. And it’s equally burdensome for prescribers who typically spend dozens of hours each week dealing with paperwork and obtaining approvals for their patients to start medication.
At House Rx, we believe the current inefficiencies and fragmented care associated with specialty pharmacy can be solved through better technology. To that end, we’ve developed a technology platform with a clear purpose: to serve patients through better collaboration between clinical practice staff, pharmacists, and insurance companies.
Right now, these stakeholders operate in separate systems with little interoperability. This means, for example, that it’s impossible for a physician to send a patient’s medical record from their EHR system to the Pharmacy Management System for a holistic pharmacist review. Messages cannot be transmitted between systems and tasks cannot be assigned across clinical teams.
The status quo is rough, and frankly not viable when we think about the variety and increasing popularity of self-administered therapies (medications taken at home, typically by mouth or by self injection) which require the clinical care of both physicians and pharmacists. Systemic inefficiencies often lead to delays in patients getting access to their therapies, and fragmented data and incomplete patient charts are a breeding ground for patient safety issues. For example, lack of access to real-time lab results could lead a pharmacist to approve and dispense a therapy that’s not safe for a patient based on their latest blood tests.
Current systems also lack automation and streamlining of insurance investigation and financial affordability screening. Since healthcare providers are increasingly strapped for time, they may not have the ability to manually provide detailed financial counseling, which can pose financial hurdles to getting or keeping a patient on therapy. And a lack of patient monitoring and side-effects counseling leads to a more painful chronic illness experience for the patient, not to mention avoidable adherence issues (such as skipping your dosage because it makes you nauseous).
Using Technology to Center Care on the Patient
At House Rx, we are re-imagining how to manage therapies for patients with chronic illnesses using technology. A fundamental belief that we’ve applied to our technology is that patient care is most effective when it’s provided by an integrated care team - meaning care providers along a patient’s specialty care journey work together in lockstep. Tactically, this means prescribers and pharmacists can easily communicate and have access to the same set of information about each patient. And they are supported by technology that’s designed to make the care team more efficient and effective by automating repeated tasks and fostering transparency.
So what do we mean by more effective and efficient? Let’s dig in a little bit to understand a few different scenarios where technology plays an important role in the medically integrated dispensing process.
Improving Coverage By Automating Benefits Investigation
When patients are prescribed medication, a script is typically sent digitally from the EHR to a pharmacy management system where the script will be filled. Once the script is received, especially in the case of specialty medications, a process ensues to investigate and verify the patient’s insurance coverage. This process often involves clinic staff chasing information that isn’t always easy to find but is crucial to determining the patient’s benefits. With sophisticated technology, this process can be predominantly automated — triggers can be put in place to begin automated eligibility checks to validate a patient’s insurance coverage once a script is received, and also help to identify any missing or outdated information on file about a patient’s insurance plan. While this supplants most of the manual work of the insurance check, it also helps to flag where human intervention is required to validate missing insurance details.
Reducing the Time it Takes to Start a New Therapy and Improving Therapy Affordability By Automating Prior Authorization (PA) and Financial Assistance (FA) Workflows
Insurance plans often require prior authorizations before a patient starts on a specialty medication. Imagine a system in which data from multiple sources is automatically consolidated and pre-populated into prior authorization forms. Most clinics are accustomed to having to manually enter this data which culminates in dozens of hours of paperwork each week. Further, imagine a system that allows the care team to submit prior authorization requests directly from their own platform where they can seamlessly track prior authorization submissions and stay abreast of status changes (as opposed to the status quo of having to call insurance plans to request an update, only to find out the form has been sitting idle due to additional information being requested). And what about a platform that reminds care coordinators to submit a prior authorization renewal before the expiration date? This type of technological capability can help avoid gaps in a patient’s treatment plan by ensuring medication refills are filled on time.
Functionality focused on facilitating efficiencies among integrated care teams is a core focus for how we are developing the House Rx technology platform. And it goes beyond the prior authorization process of course. For many patients, even those who have insurance coverage, specialty medication is incredibly expensive. Fortunately, our platform also applies automation to financial assistance workflows by helping patients enroll in financial support programs after determining how much their insurance will cover. Between automating eligibility data capture from the patient around income and household, as well as proactively notifying our care coordinators when grants and foundations are open for enrollment, we are designing a system that enables more efficient financial toxicity remediation for patients.
Ensuring Proper Therapy Management by Empowering Pharmacists With the Right Data
Shifting to patient safety, a focus for House Rx’s technology is to ensure care team members have access to accurate, up-to-date data to safely and effectively support patients. As a key member of the integrated care team, pharmacists play an important role in determining therapy appropriateness and monitoring patient adherence once a patient has started therapy. To help pharmacists perform these tasks in a scalable way, technology is needed to augment manual work and provide visibility to accurate and current patient chart data. For example, to conduct a drug utilization or therapy appropriateness review, technology can support by consolidating relevant patient chart data, as well as provide system-generated reviews for the pharmacist to reference. In the case of a drug utilization review, a system-generated review can automatically check whether a drug has any contraindication with a patient’s allergies, other medications, diagnoses, age, pregnancy status, etc and then flag exceptions for a pharmacist to review. This process removes manual data entry and streamlines work for the pharmacist, allowing them to focus & maximize their time while ensuring the appropriate safety checks are performed. All of this is made possible due to the fact that we’ve set up a technology platform that integrates with EHR data and unlocks full visibility of the patient chart.
When it comes to patient adherence monitoring, imagine you’re a practice with a number of patients who just started on new therapy. These patients are due to be reassessed as part of a follow-up and are automatically queued up in the system for outreach based on when they initiated therapy. Each patient is prompted to answer questions digitally about side-effects they are experiencing and adherence challenges to their medication. Using this information, pharmacists are able to target their follow-up to patients who either requested a callback or indicated they may need more assistance from their check-in questions. This means pharmacists can focus their time on the patients who need additional support, like therapy counseling and side-effect management education, while still supporting and staying connected with the entire patient population. And on top of that, the care team is able to cater to each patient’s communication preferences to maximize patient engagement. This scenario is another example of something technology is uniquely positioned to facilitate and is the type of functionality we focus on developing at House Rx.
The above examples illuminate just a fraction of the promise House Rx’s technology holds. It will deliver more collaboration, better interoperability, and improved transparency in parallel to less red tape and inefficiencies caused by repetitive workflows. But the real promise lies in the integrated care teams taking care of patients — by empowering them with better technology, we’re creating a more accessible, efficient and effective care experience for patients.