1. Data Management and Analytics
To effectively manage cost and outcomes, specialty pharmacies will need a more complete picture of patient pharmacy and medical utilization and associated outcomes. Specialty pharmacies who can integrate, manage, and analyze data effectively to coordinate care, increase adherence, and improve outcomes will be seen as adaptable and forward-looking partners who are able to manage cohorts of patients based on data-driven insights.
2. Access to Medical Claims Data
Both manufacturers and specialty pharmacy providers indicate access to medical claims data is one of their most pressing needs. This access allows both parties to quantify the relationship between specialty drug utilization and medical outcomes, which is often central to the design of value-based contracts.
3. Legal & Compliance
Manufacturers and specialty pharmacy providers are eager to better understand how to navigate and properly address legal and compliance requirements within value based contracts. Such considerations include the anti-kickback statute and the Medicaid program best price implications.
These recommendations are derived from a session focused on uncovering actionable insights—both what works and what does not—into how health plans are managing costs and quality in the rapidly evolving specialty pharmaceutical space.
Session moderator, Leigh Ann Bruhn, vice president at Avalere, moderated the discussion and added, “Value-based healthcare is a dynamic area that holds strong potential to achieve market advantage. The elements that make a specialty pharmacy an attractive partner in a value-based arrangement include a focus on population health, strong data management and analytics capabilities, and a commitment to a trust-based relationship. These capabilities will enable specialty pharmacies to navigate what is ahead.”
The session, ‘DIMENSIONS of Value-Based Healthcare through Optimized Data Integration & Analytic Capabilities,’ was co-hosted by Avalere and Janssen Pharmaceuticals, Inc., as part of the DIMENSIONS program, which explores areas of interest to stakeholders across the healthcare landscape, covering topics such as specialty pharmacy provider channel management, site-of-care optimization, biosimilars, clinical pathways, and others. The panel drew more than 200 summit attendees and featured industry perspectives from panelists Jason Lynn, PharmD, vice president, Clinical and Trade Services, ReCept Pharmacy, and Kelly Pokuta, PharmD, vice president, Specialty and Industry Relations, OptumRx.
To learn more about DIMENSIONS, please visit: https://www.specialtydimensions.com.