Recently, we had the pleasure of hosting Shivani Patel, Executive Vice President of Patient Access Operations and Technology Solutions at Asembia, on "The Dish on Health IT" podcast. Our CEO, Tony Schueth, led an insightful discussion covering critical issues such as specialty prescribing, pharmacy interoperability, TEFCA, and consent management. 

This conversation inspired me to write this blog because I often see stakeholders focusing solely on their specific areas within the vast, complex healthcare ecosystem. They overlook how every policy change or trend, especially those related to interoperability, creates a domino effect. In this blog, I'll recap some of the key topics we discussed and highlight their impact on various stakeholders across the ecosystem. Be sure to listen to the podcast to hear the full discussion.  

Complexities of Specialty Prescribing 

Specialty prescribing is a complex and challenging area of healthcare, involving treatments that require meticulous management due to high costs, special storage needs, and adherence difficulties. In our discussion with Shivani, we explored the logistical gaps and barriers in this space, such as prior authorizations and communication challenges between stakeholders. One significant issue we highlighted is the absence of a standardized definition for specialty medications, which often leads to delays and confusion regarding where a specialty prescription can be filled, potentially delaying or even preventing a patient from obtaining their medication. 

Progress in addressing these issues would have a broader impact on the healthcare ecosystem. For instance, currently, specialty medications can be covered under either the pharmacy or medical benefit. To simplify specialty prescribing, payers might consider a consistent approach to how these therapies are covered, aiding in streamlining the process. 

Resolving barriers in specialty prescribing not only benefits patients by enabling quicker access to necessary therapies but also aids providers by reducing administrative burdens. Additionally, life sciences manufacturers would see improved uptake and adherence to their therapies, further enhancing patient outcomes and the overall efficiency of the healthcare system. 

The Power of Pharmacy Interoperability 

Interoperability, between all care settings including pharmacy, is a cornerstone of an efficient healthcare system, enabling seamless sharing of clinical data among pharmacists, providers, and other stakeholders. Through my engagements with clients and standards work with NCPDP and HL7, I have learned that it's not just about the quantity of data but the quality and relevance. Pharmacists need access to targeted, pertinent information to improve patient care and streamline processes. We discussed how overwhelming pharmacists with excessive data can hinder their ability to provide optimal care. Instead, the focus should be on delivering the right information at the right time. 

Enhanced pharmacy interoperability impacts other healthcare areas by facilitating better coordination of care. For instance, when pharmacists can easily access and share pertinent patient data, providers benefit from having a more complete picture of a patient’s medication history, leading to better treatment decisions. Payers, on the other hand, could design reimbursement models to incentivize patients to seek basic clinical services in the pharmacy setting at a lower rate than general practitioners. This would not only benefit pharmacies and patients but also general practitioners, who, given the shortage of general and family practitioners, could spend more time with their patients on more complex issues. A shift to achieve more seamless pharmacy interoperability would also create opportunities for health IT vendors to develop pharmacy technology solutions and perhaps break into a new market.  

The Crucial Role of Consent Management 

Consent management is essential for ensuring patient privacy and data security, particularly in the context of pharmacy interoperability. On the podcast, Shivani shared the challenges of improving consent management to make the sharing of patient information more seamless and secure. One key goal is to give patients an easier way to manage consent, avoiding the redundancy of signing the same forms repeatedly. 

I have been deeply involved in the industry’s efforts to improve consent management, and it is finally gaining traction. The work we’ve done is reflected in reports like "Modernizing Consent to Advance Health and Equity", which highlights the challenges and key considerations in advancing this work. 

Improving consent management has far-reaching implications. When patients have greater control over their data, they are more likely to engage in their healthcare, leading to better outcomes. Streamlined consent processes simplify obtaining and managing patient consent, reducing administrative burdens for providers. Additionally, these improvements can aid life sciences companies in recruiting for clinical trials, ultimately leading to innovations in treatment. Addressing these challenges not only benefits individual patient experiences but also enhances the overall efficiency and effectiveness of the healthcare system. 

Listen to the full podcast episode for more insights:

Our healthcare ecosystem is a complex, interconnected web where changes in one area, like pharmacy, have a domino effect on the rest. Whether it's creating opportunities for health IT vendors to develop new solutions, prompting payers to rethink reimbursement models, or encouraging health systems to leverage pharmacists in community health equity programs, understanding and addressing these interconnections is crucial. This is why it was so important to talk with Shivani Patel from Asembia to explore these timely issues. 

POCP lends our 360-degree view of the industry to our clients, offering an objective perspective on issues and a fresh look at potential opportunities. We understand how the complexities of the healthcare ecosystem connect and can help stakeholders create strategies based on this deep knowledge. 

If your organization is facing challenges or just needs a fresh look at your current strategy, reach out to me at pooja.babbrah@pocp.com. Whether your needs require in-depth landscape analysis, primary research or educating your organization to smooth the path for process changes, we are happy to help.