Why Choose Outcome Resources as your Hospice PBM

Hospice care alleviates pain and other distressing symptoms associated with a terminal illness. Given the importance of medication therapy to the overall goal, it is not surprising that pharmacists play such a pivotal role in their patient’s healthcare. The hospice PBM has similar responsibilities.

A PBM’s primary function in the healthcare industry is to handle claims and pay pharmacies for the drugs they dispense. Through formulary management and price negotiations with pharmaceutical firms, they also aid in controlling drug expenditures.

Since hospices have specific requirements, they frequently work with pharmacy benefit managers (PBMs) and other hospice-focused pharmacy service providers. The hospice industry is where SpectrumPS Pharmacia started, making it one of the earliest specialty pharmacies and PBMs. It now provides care for approximately 90,000 patients daily through a network of about 450 hospices.

The Functions of a Hospice PBM.

Different hospice PBMs provide a diverse range of helpful options. Generally speaking, they can be broken down into the following groups:

  • Access to Medication
  • Methods for controlling resource use
  • Pharmaceutical direction
  • Maintaining a high level of conformity with applicable regulations
  • Streamlining Processes
  • Drug Availability

Hospice patients often rely on potent pain management medicines that can’t be found at your local drugstore. Even their conditions can shift from one hour to the next. To ensure symptom relief, it may be necessary to implement alternative treatments quickly.

Pharmaceutical Benefits Managers (PBMs) in hospice care facilitate access to medication in several ways. To meet the needs of their patients, several hospice PBMs either own or contract with a network of “closed-door” non-retail pharmacies located all across the country. However, there are places where it is difficult to keep up enough coverage. SpectrumPS provides several options, all of which are based on the utilization of retail pharmacies and, frequently, SpectrumPS’s own mail-order pharmacy, which is able to serve next-day requirements.

SpectrumPS’s Neighborhood Connections initiative ensures life-sustaining drugs for hospice patients may be obtained close to home. Among the roughly 65,000 total locations, over 7,000 are pharmacies that are actively administered by the system. These drugstores have committed to carrying hospice meds and to providing other required services. The hospices in their service area can benefit from the help of the Neighborhood Connections team in establishing a working connection with local pharmacies. This structure allows SpectrumPS to process payments for supplementary services like courier delivery.

Management of Resource Use

In most hospices, medication is the third greatest expense after staff and physical space. Hospice PBMs can advise their customers on the most effective methods of reducing waste and maximizing efficiency. Clinical pharmacists at SpectrumPS make use of a wide range of resources, including

  • Exclusive Recipes
  • Algorithms for therapy based on available evidence
  • Protocols for reducing prescriptions
  • Training on less expensive, equally effective options

Reporting is also a useful instrument in utilization management. SpectrumPS’s EnclarityTM platform is a business intelligence tool that displays real-time data trends. Users can select a certain degree of granularity (e.g., site and team) to investigate potential areas for care enhancement and cost control. An increase in costs can be flagged in real-time by means of personalized warnings.

Pharmaceutical Direction

Both the goals and the pharmacology of hospice care are distinct from those of curative medicine. It can be difficult to find reliable information on the efficacy of specific medications for terminally ill patients. The changing metabolic needs of drugs during terminal illness constitute a formidable issue. As their Health  worsens, patients may also require administration by non-oral means.

Hospice pharmacy benefit managers (PBMs) should offer timely access to drug information and education in addition to specialized clinical services for hospice and palliative care. One strategy to address concerns about pharmaceutical availability or to better meet individual patients’ requirements is to provide a range of evidence-based options for administering the medication in question.

To complement the interdisciplinary team, SpectrumPS’s clinical support program provides strategic utilization management, educational opportunities, and round-the-clock access to pharmacists who can aid in the management of prescription therapy. They help with a wide range of issues that nurses and doctors face, such as:

  • Problematic Examples
  • Tolerance and dose adjustment
  • Substitutes for Drugs
  • Precautions
  • Deprescribing

Legal Obligation

Medication use, and other aspects of hospice care, are subject to strict oversight. Consider, for illustration’s sake,

To comply with Medicare’s Conditions of Participation, prescription utilization evaluations must be performed both before to admission and on a regular basis. These cover all a patient’s prescription and over-the-counter medications, herbal therapies, and other alternative treatments that potentially affect drug therapy. SpectrumPS clinical pharmacists utilize this as an opportunity to look critically at the prescription list to discover medicines for which risks may exceed benefits. They can be especially helpful in assessing over-the-counter drugs and supplements with potential for harmful effects or interactions.

Over the last several years, concerns about opioids have led to increasing regulation of restricted medications. By implementing the right policies, practices, and workflows, SpectrumPS assists hospices in improving their compliance with current and future state and federal laws. SpectrumPS can also analyze usage patterns to find vulnerabilities.

Optimization of Workflow

For the benefit of both the patient and their caretakers, hospice nurses cultivate trusting relationships with both parties. Medication management processes that are too complicated or out of date may divert them from their vital duties. Ordering prescriptions, finding missing faxes, and entering data into different systems can take nurses a significant amount of time. Because of this, not only is patient care delayed, but so is the morale and retention of the workforce.

SpectrumPS has invested in tools and processes that allow nurses to focus on patient care. In conjunction with an e-prescribing provider, both mail order and local pharmacy use are supported by the E3 platform’s mobile and desktop medication management applications. There is no need for duplicate data entry because our software is compatible with the industry’s most popular hospice electronic medical record (EMR) systems. An organized and cooperative deployment procedure is also employed to guarantee digital technologies translate into production operations.

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By Nikitha

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