Expanding specialty pharmacy services could help health systems improve outcomes and manage chronic disease costs | Asembia AXS26 Summit

Earlier this week at the Asembia Specialty Pharmacy Summit in Las Vegas, speakers highlighted how health system specialty pharmacy programs can go beyond dispensing medications to improve outcomes and lower costs for patients with chronic conditions.

Samir Malkani, M.D., clinical chief of the division of diabetes, endocrinology and metabolism at UMass Memorial Health, and Bill McElnea, vice president of population health at Shields Health Solutions, presented findings from a UMass specialty pharmacy program during a session focused on value-based care. The session was held on April 27 and titled “Health System Specialty Pharmacy as a Care Management Platform to Support Value-Based Care.”

The model supports high-utilization patients by expanding services beyond traditional specialty pharmacy. These services include lifestyle counseling, support for social determinants of health and mental health referrals. They shared that these combined efforts aim to reduce hospital admissions, improve outcomes and create shared savings under value-based care arrangements.

Malkani said the approach isn’t limited to diabetes care. He pointed to broader applications across chronic diseases, which tend to drive higher costs and worse outcomes.

“Chronic care disease management is more similar than different,” Malkani said. “We've shown that this works for diabetes. This same model could work for heart failure patients. It could work for chronic kidney disease. Patients with chronic disease have a higher, higher expense. They have a higher rate of hospital admissions, poor outcomes, and there is (even) a big push from CMS to offer chronic care management remotely.”

McElnea said payers and managed care leaders should take a closer look at the full value of specialty pharmacy programs rather than focusing only on upfront costs.

He added that sometimes when people hear specialty pharmacy, the first reaction is about cost, but it’s important to look deeper at the full value. For instance, he noted that specialty pharmacy can be a strong driver of cost-effective chronic disease management when a program offers comprehensive, 360-degree care and “marries” it with value-based care arrangements.

Both speakers suggested one takeaway for managed care leaders is to more fully incorporate specialty pharmacy into care management efforts, as this approach can help improve patient outcomes while also supporting more sustainable costs.