Hospice care focuses on ensuring patients’ comfort by addressing pain and other symptoms associated with terminal illnesses. Given the centrality of medication therapy to that purpose, it’s unsurprising that pharmacists play a significant role in inpatient care. Likewise, the hospice pharmacy benefit manager, or PBM, does the same thing.
A PBM’s primary function in the broader healthcare market is to handle claims and reimburse pharmacies for prescription distribution. Additionally, they assist in cost management by managing formularies and negotiating pricing with pharmaceutical firms.
Due to the specialized demands of hospices, they frequently rely on PBMs and other pharmacy providers that specialize in hospice care. SpectrumPS Pharmacia’s origins date back to some of the first pharmacies and PBM providers specializing in hospice care. It now serves over 450 hospices and over 90,000 daily patients.
What Is the Function of a Hospice PBM?
Each hospice PBM provides a distinct set of services. They are classified into several broad categories.
- Access to medication
- Management of utilization
- Pharmacological direction
- Compliance with applicable regulations
- Optimization of work processes
Access to Medication
Hospice patients are often treated at home but may require severe pain management medications not available at your neighborhood drugstore. Additionally, their circumstances can fluctuate from hour to hour. Assuring symptom relief may necessitate the addition of new drugs, doses, or formulations.
Hospice pharmacy benefit managers (PBMs) provide medication access in various ways. Certain hospice PBMs operate or contract with a network of “closed-door” non-retail pharmacies located throughout the country. Maintaining appropriate coverage can be difficult in some places. SpectrumPS offers numerous models based on the utilization of retail pharmacies and its own mail-order pharmacy capable of meeting needs.
SpectrumPS’s initiative assures local access to hospice-critical drugs. Its more comprehensive network of over 65,000 drugstore locations includes an actively maintained network of over 7,000 pharmacy sites. These pharmacies have agreed to keep a supply of hospice-critical drugs and adhere to other service criteria. The team assists hospices in developing ties with pharmacies located within their service region. SpectrumPS can also bill for auxiliary services such as courier delivery using this paradigm.
Management of Utilization
Drug expenditures are sometimes the second-highest price for a hospice, after personnel and facilities. Hospice PBMs can assist clients in developing tools and best practices for quality improvement and cost management. Clinical pharmacists at SpectrumPS employ a variety of tools, including the following:
- Formularies created to order
- Algorithms for therapy based on evidence
- Protocols for deprescribing
- Education on clinically acceptable, less expensive alternatives
Reporting is another critical component of utilization management. SpectrumPS’s patented business intelligence platform, Enclarity, provides trending data and visualization in real-time. Users can dig down to multiple levels (e.g., location and team) to uncover potential for care improvement and cost management. Custom alerts can notify you in real-time of anticipated cost hikes.
Hospice care has distinct goals from curative health care. There is insufficient data on the efficacy of specific medications in terminally ill patients. The dying process poses numerous complications with the metabolization of drugs. As patients’ health deteriorates, they may require alternate administration methods.
Hospice PMBs should provide specialized clinical services in hospice and palliative care and fast access to medication information and education. This includes providing evidence-based alternatives for administering medicine to address availability difficulties or better meet patient needs.
SpectrumPS’s clinical support program includes strategic use management and training opportunities, and pharmacists available 24 hours a day to assist with drug therapy management, hence boosting the interdisciplinary team’s effectiveness. They assist nurses and prescribers with a variety of issues, including the following:
- Complicated cases
- Conversion of doses
- Substitutions for medications
Compliance with Regulations
Hospices are heavily controlled, including drug administration. For example, Medicare’s Conditions of Participation mandate initial and ongoing drug usage evaluations. These include prescription and over-the-counter medications, herbal remedies, and other alternative therapies that may interact with pharmacological treatment. SpectrumPS clinical pharmacists use this chance to conduct a comprehensive review of the prescription list to discover medicines whose hazards may outweigh their benefits. They are particularly beneficial for reviewing over-the-counter drugs and supplements that may have detrimental effects or interactions.
Concerns over opioids have resulted in greater regulation of controlled substances over the last several years. Through appropriate policies, practices, and processes, SpectrumPS assists hospices in strengthening compliance with existing and emerging state and federal laws. SpectrumPS can also conduct an overall utilization review to identify potential danger areas.
Optimization of Workflows
Hospice nurses develop strong bonds with patients and caregivers to promote trust and ensure superb quality of care. Complicated or out-of-date drug management routines can divert their attention from critical duties. Nurses can spend hours ordering drugs, locating faxes, and reentering data into several systems. This disrupts patient care and has a detrimental effect on employee morale and retention.
SpectrumPS has invested in technology and best practices that enable nurses to perform their jobs effectively. The E3 platform offers mobile and desktop medication management tools that facilitate mail order an in-person pharmacy utilization through a collaboration with an e-prescribing provider. Integrating with an expanding range of the industry’s major electronic medical record (EMR) systems for hospices eliminates double entry. Additionally, a disciplined and collaborative implementation approach ensures that digital technologies translate into efficient workflows.