With the upcoming election, 2020 promises to be a year of major shifts for the healthcare industry as a whole. In particular, your hospital or health system pharmacy should take note of specific trends that could impact you operationally, fiscally and clinically.

Healthcare will be a major theme of the upcoming election cycle, resulting in uncertainty and instability. Areas you should watch include potential drug pricing legislation, changes to or elimination of the 340B Drug Pricing Program, the potential repeal or modification of the Affordable Care Act and the continued expansion or contraction of government programs. The McKesson RxO® team, a group of trusted advisors helping hospital and health system pharmacy operations, addresses and analyzes challenges expected to impact hospital and health system pharmacies in the year ahead.

“Regardless of election outcomes, hospital and health systems must proactively move from transactional relationships to insulate themselves from volatility,” reveals Tom Perry, MBA, vice president and general manager, McKesson RxO. “Pharmacy leaders need to solidify partnerships with their suppliers, distributors and vendors who help diminish complexity in advance of the 2020 election to support their goals and maintain quality patient outcomes along the continuum of care, regardless of which political party is in office.”

According to Perry and the McKesson RxO team, these are the challenges faced in election year 2020:

1. Increasing complexity and growth in integrated delivery networks

The lines between care settings are blurring as hospitals integrate with medical practices, infusion centers and home care, to form sophisticated networks delivering comprehensive patient care. While the number of hospital mergers declined in 2018, mega mergers are the new standard.1 This inevitable evolution is also presenting challenges around patient education, clinical workflow, systems integration, standards across care settings, contractual obligations with group purchasing organizations, payers, suppliers and various other vendors. The need for business partners to help networks diminish complexity and streamline operations across the continuum of care has become increasingly important as leaders work diligently to do what is right for the patient.

2. Hospitals expanding specialty pharmacy footprint

Specialty pharmacy has been a top trend for the past several years as utilization and drug spend have dramatically increased across healthcare. As hospital and health systems experienced nearly 20% growth in the specialty drug market in 2018,2 health systems continue to establish their own specialty pharmacies or expand their existing capabilities. While this may benefit your health systems’ quality and continuity of care initiatives, administration of specialty drugs is challenging and highly complex given the number of new therapies and payer requirements. Speed to therapy and ongoing patient support are still critical.

3. 340B delivering clinical and economic benefits

While the ongoing debate over the 340B Drug Pricing Program continues, thoughtful business planning, attention to access requirements and diligent compliance tracking will ensure successful participation in the program, resulting in diminished complexity, enhanced patient care and significant benefits to your health system. 340B savings have grown to become a material contributor to financial health, and participating pharmacies have a renewed focus on quantifying, optimizing and reporting impact. This requires continued investments in 340B tools to better track and manage program savings, which ultimately translate into resource funding necessary to appropriately care for patients in underserved communities.

4. Out-of-pocket costs impacting patients and revenue

Specialty drugs have emerged as important treatment options for cancer and other complex diseases, but there can be significant access and affordability issues with specialty drugs. The cost of specialty medications and the increased adoption of high-deductible health plans (HDHP) have placed a higher financial burden on patients. As out-of-pocket costs increase—from higher costs or insurance denials—patients are more likely to abandon their treatment plans. Due to this trend, your health system pharmacy is more involved with the revenue cycle than ever before, ensuring providers are reimbursed for purchased drugs. Embedding financial support and patient assistance programs, along with various other charitable programs in the revenue cycle, are key to improving patient adherence and health outcomes.

5. Finance and pharmacy leadership relying on data-informed decisions

Pharmacy directors face increasing pressure from performance-based reimbursement and diminishing resources. To alleviate these pressures, you can leverage data and analytics at your pharmacy to reduce costs, help maintain a healthy bottom line and support quality patient care. However, not all health systems have the tools and resources to aggregate and sift through data in order to apply comprehensive, real-time analytics to deliver better care effectively while maintaining a healthy balance sheet. Your pharmacy leadership will need to work with their business partners, specifically distributors, to adopt proactive strategies in multiple care environments, helping health systems become the preferred provider for a patient’s continuum of care.

“Operating in a complex environment is nothing new for health systems. However, this coming year is likely to bring even more change and potentially unexpected challenges. In order to maintain quality care and outcomes, as well as strong business operations, pharmacy leadership must proactively leverage actionable insights to help manage costs, drive revenue recovery and expand capabilities,” shares Barbara Giacomelli, PharmD, MBA, FASHP, vice president, advisory services, McKesson RxO.

Being aware of expected shifts in the industry can help you stay one step ahead and plan accordingly. By doing so, you can see continued success at your hospital or health system pharmacy—and continue delivering quality care to your patients.

Related: Learn more about McKesson’s RxO pharmacy technology and consulting services

Sources:

1 KaufmanHall’s “2018 M&A in Review”
2 IQVIA’s “Medicine Use and Spending in the U.S.”

McKesson

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McKesson editorial staff is committed to sharing innovative approaches and insights so our customers can get the most out of their business solutions and identify areas for operational improvement and revenue growth.

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