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Why Specialty Pharmacies Need Analytics to Thrive in 2025

Specialty pharmacies are becoming an essential component of the healthcare system, and their growth is driven by several key factors.

The Rise of Specialty Pharmacies

A Shift in Business Model

The shift towards specialty pharmacies is driven by the need for healthcare providers to strengthen the continuity of care they deliver to patients.

This lack of visibility can lead to gaps in care coordination and patient experience.

The Impact of Connectivity Gaps on Patient Experience and Care Coordination

Pharmacies with connectivity gaps are often plagued by inconsistent or nonexistent claims review processes. This lack of visibility into the percentage of specialty pharmacy prescriptions filled outside of the health system can have far-reaching consequences for patient experience and care coordination.

The Consequences of Inconsistent Claims Review

  • Inconsistent claims review processes can lead to:
      • Gaps in care coordination: Without visibility into the percentage of specialty pharmacy prescriptions filled outside of the health system, health systems may struggle to coordinate care effectively. Poor patient experience: Patients may receive inconsistent or incomplete information about their medications, leading to frustration and mistrust. Increased costs: Inconsistent claims review processes can result in unnecessary costs associated with duplicate prescriptions, incorrect medication administration, and other errors. ## The Benefits of Connectivity and Claims Review

        • The Benefits of Connectivity and Claims Review

  • Improved care coordination: With visibility into the percentage of specialty pharmacy prescriptions filled outside of the health system, health systems can coordinate care more effectively. Enhanced patient experience: Patients receive consistent and accurate information about their medications, leading to improved satisfaction and trust.

    Identifying Pain Points

    Health systems can leverage claims and 340B-related data to pinpoint areas of inefficiency and optimize their specialty pharmacy programs. By examining top drug volumes and value, health systems can identify manufacturers that are not adhering to the 340B program’s pricing guidelines, resulting in unnecessary expenses.

    With the right data-driven approach, healthcare providers can identify and address these gaps, ultimately leading to better patient outcomes and more efficient use of resources.

    Understanding the Importance of Data-Driven Decision Making

    In today’s healthcare landscape, data-driven decision making has become an essential component of program improvement. With the increasing complexity of healthcare systems, it’s no longer possible to rely solely on anecdotal evidence or intuition when making decisions. Instead, healthcare providers must rely on data to inform their decisions and drive improvement.

    This information can be used to tailor the program to the physician’s preferences, increasing the likelihood of in-network fulfillment and reducing the likelihood of out-of-network claims.

    Optimizing Specialty Pharmacy Programs with Key Data Assets

    Understanding the Benefits

    Utilizing key data assets for specialty pharmacy program optimization can have a significant impact on business, clinical, and patient outcomes. By leveraging data insights, programs can be tailored to meet the unique needs of physicians, patients, and payers, ultimately driving better health outcomes and reducing costs.

    The Role of Claims Data

    Claims data plays a critical role in identifying opportunities for program optimization. By analyzing claims data, program managers can identify trends, patterns, and anomalies that can inform strategic decisions. For example, during the intervention process to drive in-network fulfillment, analysis of claims data may reveal individual physician propensities to send prescriptions to specific out-of-network pharmacies. Key insights from claims data:

      • Physician preferences for specific pharmacies
      • Trends in prescription filling and payment patterns
      • Opportunities for in-network fulfillment and cost savings

        • Tailoring Programs to Physician Preferences

        By leveraging claims data, programs can be tailored to meet the unique needs of physicians. This can include:

  • Personalized communication: Tailoring communication with physicians to their individual preferences, such as language, format, and content. Pharmacy selection: Offering a range of in-network pharmacies that meet the physician’s specific needs and preferences. Payment and reimbursement: Offering flexible payment and reimbursement options that align with the physician’s business model.

    The Rise of AI in Healthcare

    The integration of Artificial Intelligence (AI) in healthcare has been gaining momentum in recent years, with various applications across the industry. From automating manual processes to augmenting decision-making and predicting outcomes, AI is revolutionizing the way healthcare is delivered.

    Operational pain points include:

    Operational Pain Points

  • Medication management complexity: Managing multiple medications, dosages, and refill schedules can be overwhelming for patients and staff. Inventory management: Ensuring adequate stock levels of high-demand medications can be a challenge, particularly in smaller health systems. Pharmacy staff training: Providing adequate training to pharmacy staff on complex medications and patient needs is crucial.

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