specialty pharmacy patient care program

How a Specialty Pharmacy Group Redefined Its Patient Care Program

specialty pharmacy patient care program
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AgileThought Develops Smart Assessment Patient Services Process and Supporting Architecture

Specialty Pharmacy Patient Services

Patient advocacy and medication therapy management are a central component of specialty pharmacy, which treats people with complex diseases. These high-touch services involve:

  • Helping patients understand their medication
  • Scheduling prescription dosage and refills
  • Supporting patients who experience side-effects
  • Educating patients on what medicines they can and cannot take while being treated

Certain drugs have a risk evaluation and mitigation strategy (REMS) program. Such regulations require pharmacists to be trained in specific dispensing methods and follow-up treatment with patients. Patient care advocates (PCAs) are the first point of contact and drive follow-up conversations. They reach out to patients to guide and monitor their therapies.

Challenge: Develop a Unified Process and Supporting Architecture that can Handle the Unique Variables of Patient Care

Ten years ago, the patient care at the world’s largest PBM relied on manual processes to look up patient information, determine treatment status, and assess care. It was difficult to capture and organize patient information into something that could drive real-time decisions, map patient progress, or identify important issues.

A PCA would call patients to discuss treatment and the medication they were using. The conversation would follow a script based on patient responses.

A specialist might ask, for example: “Do you feel dizzy when taking your medication?”

If the patient answered, “yes,” then the PCA would jump to an answer page, which was either contained in a physical notebook, or within the notes section of their application.

PCAs would rely on the same methods, handwritten notes, to capture and retrieve patient history information (PHI).

The call would often be routed to a nurse or pharmacist, who would have to decipher notes, leading to inconsistent records.

The system was based on the knowledge and experience of individuals, and not on a defined process. There was a clear knowledge gap between ten-year veterans and new hires. New hires might not know what questions to ask based on patient responses, or skip important prompts.

The PBM specialty group hired AgileThought to come up with a unified process to capture and report patient assessments, and develop supporting architecture.

Choosing the Digital Strong Path: Develop a Smart Assessment

Process as a Service
AgileThought helped the specialty team develop a process and application, called the Smart Assessment, to drive patient advocacy in real time. The application is dynamic and configurable, which is important due to the many variables of patient therapies.

The Smart Assessment consists of a process nicknamed “FQE” (Fast Quick Entry), supporting architecture and system integration. It would prompt PCAs as they drove calls to success. Each script was based on a patient’s unique history, and the therapy they received, relying on trigger points to drive action. They include how to take each dosage (i.e. with food or at night), making sure patients do not combine certain medications, and scheduling refills.

The new system also enabled pharmacists to react quickly to events; real-time occurrences that require an immediate response. An example is when a patient is experiencing side effects while on the phone.

The FQE process became the go-forward standard for managing patient assessments.

Dynamic and Connected
All PCA’s could drive calls to success with the new system, regardless of their experience. The Smart Assessment would prompt the next action, reducing PCA training while increasing the quality and speed at which specialty services were delivered.

System automation was built in, further expediting the process. If, for example, a question was gender-based, and the patient was a male, the assessment would skip any female-specific questions such as questions about pregnancy.

The system was also built to connect patient calls to a single system of record. Patient health information (PHI) captured in the assessment would automatically update the PHI file, and tie into an application that schedules prescription refills and invoicing.

The Smart Assessment model opened the door to population group information while keeping individual patient information safe. The added insight would be used to improve therapy treatment plans and service.

There were universal questions that needed to be asked across population groups. If, for example, patients were losing weight because of their medication, it could be documented and reported. Such information was not accessible in in the prior system without extensive manual analysis.

Similarly, if a patient population was responding positively to a treatment update, that information could be reported to enhance future therapies.

How Knowledge of Specialty Pharmacy Business Drives Innovation

AgileThought’s knowledge of specialty pharmacy business processes enabled the team to roll out a process and support architecture within six months.

AgileThought has over a decade of specialty pharmacy experience. The team can quickly assess core processes and systems, those that touch so many aspects of the business, and drive them from manual to automatic. The Smart Assessment was developed ten years ago (having been updated regularly to keep up with technology advancements), and is still used today as the preferred patient-screening and point of care system.

Smart Assessment is 100% configurable. It can be applied to any business model as an administration module, process, and architecture.

Download The Success Story!

specialty pharmacy patient care program

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