Specialty Pharmacy Automation Part I – Opportunities and BPI

The promise is real, folks. The stakes are too high; the investments too…invested. It’s time. If you are evolving (digitally speaking) then you are automating.

In this blog series, we are going to discuss automation as it pertains to specialty pharmacy digital transformation and beyond. Topics will include how to get started, the state of automation, risks and rewards, and we will tie in success stories from QA to revenue cycle management to robotic process validation.

If you are interested in the potential of tens of millions of dollars in cost benefits, or in aligning IT with business operations, read on.

Automation in Perspective

Let’s take a step back for a minute – way back to 1996. It just so happened to be Father’s Day. I was driving and I needed to make an important call. Here’s how that process played out:

1. Pull off of the highway
2. Locate a safe place for a payphone – in this case it was a McDonald’s
3. Park
4. Go into the McDonald’s to get change
5. Make my way to said phone
6. Insert change
7. Call dad

Luckily, my dad was home and answered his phone. If he wasn’t available, tough. I’d have to leave a message. If there was someone already using the payphone, I’d wait. Today, all you have to do is access your built-in Bluetooth connection, say who you want to call, and you’re good to go.

You don’t even have to think about the logistics of calling someone. Your environment is setup to do it for you. Instead, you can focus on the tasks at hand. You can get to your destination faster while accomplishing more.

Opportunities for Specialty Pharmacy Automation

There’s no shortage of off-the-shelf IT solutions promising greater efficiency, lower operating costs, fewer errors, and better patient care. And specialty pharmacies are lining up; looking to automate their operations to achieve those ends.

But what about the automation process itself—from planning and design to implementation—and its potential impact on ROI?

This is a crucial question that isn’t asked often enough. Traditionally, IT initiatives have been limited in focus and executed in silos. But business and IT leaders are coming to understand the importance of aligning IT initiatives with business processes and goals. Whereas instituting or upgrading tech tools was once an end in itself, it’s now a means of ensuring all business functions and processes work better together for the good of the enterprise.

Specialty pharmacies that develop IT solutions in context, beginning each project with business goals in mind, yield more ROI from automation.

According to CSI Group’s 2018 State of Specialty Pharmacy Report, pharmacies continue to look for ways to increase efficiency, lower operating and healthcare costs, expand industry networks and patient access, and improve service quality.

Survey respondents, which included manufacturers, health system specialty pharmacies, and independent specialty pharmacies, offered the following as some of their chief ongoing concerns.

Access to payors is the #1 criterion for manufacturers when choosing pharmacy partners. But among specialty pharmacies surveyed, 40% believe their patients have challenges coming onto service 20% of the time. Any resulting changes or delays in treatment can incur significant revenue losses.

Among independent specialty pharmacies surveyed, 41% indicated they could service no more than 40–60% of patients referred to them.

Manufacturers cite consistency of patient service (25%) and access to accurate data (25%) as their leading challenges when working with pharmacy partners. Manufacturers also reported they would like to see pharmacies increase transparency and speed up reporting and time to fill.

When asked to name their first- and second-biggest challenges to growth, 24.1% of independent specialty pharmacies cited technology and staffing. Between 2016 and 2017, 13.8% of pharmacies surveyed had increasing difficulty managing and balancing growth with staffing needs and quality, technology, and other resources.

A majority of specialty pharmacies (60.7%) consider personalized and efficient customer service to be their primary differentiator in the marketplace, followed by communication, turnaround, and delivery (32.1%). In contrast, only 12.5% cited clinical expertise and adherence programs.

With over fifteen years of specialty pharmacy digital transformation projects under our belts, we’d be remiss if we did not mention compliance as an essential component to any healthcare IT initiative. Anything that touches prescription data or a patient profile information will likely require review and approval by a compliance department.

Compliance involves A) handling data from a HIPAA standpoint, and B) adhering to client internal control standards. Many of our clients have a robust testing and certification processes to ensure our teams are compliant to be working on their network.

If you do not have a program in place, we have our own track to make sure that, at the very least, our teams are HIPAA-compliant – protecting patients and personally identifiable information.

Linking Automation to Your Business through BPI

Automating various aspects of specialty pharmacy operations can have a transformative impact on the patient experience, the business’s operating costs, and its future prospects.

By making light work of most routine tasks and improving reliability and transparency, business process improvement (BPI) automation frees and empowers specialty pharmacies to become more responsive providers and lowers the cost of care. Pharmacy teams can also manage patient relationships at scale without draining resources or sacrificing service levels.

BPI hedges against future risk because, when done right, it takes change into account. Over time your business will be affected by:

• New technologies
• Mergers and acquisitions
• Shifting customer demand

The idea is simple, but powerful: an experienced team looks under the hood of existing processes for opportunities to improve efficiencies and drive out costs.

Here’s an example.

A large specialty pharmacy customer of ours recently acquired another organization. This naturally led to an examination of two disparate systems that support processing. In an effort to position themselves for a digital transformation, the company was measuring their system costs, and wanted to find out two things:

1. What a transformation would mean from a cost-reduction perspective.
2. How much they could lower costs by adjusting existing environments.

Increasing automation was a focal point of cost reduction. AgileThought was able to nurture growth through automation without a reduction in staff (more about this in the next post).

The team, with an understanding of the customer’s business, identified system changes and used data to measure gains. Once the team executed the projects, they used the same data to demonstrate improvements. As a result, system automation increased to 50% in multiple functions.

Imagine, as a customer, getting a real person on the phone faster, and having your issue resolved in less time. Sounds good, right? Most people agree. In fact, 86% of buyers are willing to pay more for a great customer experience.

We start with BPI because its where gains from automation are fundamentally impacted. In the next post, we’ll look at common barriers and discuss when automation fails to pull through.