Health system specialty pharmacy programs expand into care management to support value-based care | Asembia AXS26 Summit

Health system specialty pharmacy programs are expanding beyond traditional roles to support value-based care, according to a presentation at the Asembia Specialty Pharmacy Summit in Las Vegas.

Speakers Samir Malkani, M.D., clinical chief in the division of diabetes, endocrinology and metabolism at UMass Memorial Health, and Bill McElnea, vice president of population health at Shields Health Solutions, who shared additional perspective on population health strategies, discussed how the program has grown from handling administrative pharmacy tasks to delivering hands-on care management for high-risk patients, including those with diabetes.

At UMass Memorial Health, specialty pharmacists have been a significant part of clinics for many years, originally helping with medication management and prior authorizations. Though, over time, the model shifted to focus more directly on patients with uncontrolled diabetes.

“About five years ago…. there was a suggestion that specialty pharmacists would help us manage people with difficult-to-manage diabetes,” Malkani said. “And we said, if someone's got an A1C over 9% all the time, in spite of seeing an endocrinologist and an educator and working with us over a few months, then we are going to have a special program called the Care Coach program.”

The program targets patients with complex needs who usually require more support than traditional care models provide. Pharmacists, many who are also certified diabetes care and education specialists, help guide patients on medication use as well as broader lifestyle changes.

McElnea said the shift reflects a larger change in how specialty pharmacy teams are used within health systems.

“I think while we started with pharmacy liaisons in the clinic to really, first and foremost, to handle the administrative burden of the pharmacy-related administrative burden for patients and providers, and that ended up being very valuable,” McElnea said. “It was clear that more needed to be done. That specialty pharmacy could do more.”

The initiative also aligns with value-based care goals while focusing on high-utilization patients and improving outcomes. McElnea added that the program has helped generate shared savings while supporting better patient care.

Both presenters said combining pharmacy revenue with value-based contracts is key to making these high-touch models sustainable, adding that health systems looking to improve outcomes could benefit from more fully integrating specialty pharmacy teams into care delivery.