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Case Studies

Loma Linda University Medical Center

Building the Business Case for In-house Specialty Pharmacy

Executive Summary

LLUMC was investigating the opportunity of implementing a specialty pharmacy service for their patients to provide better patient care. Excelera was engaged to provide a market assessment and business case for a specialty pharmacy initiative. Once the assessment and business case were complete, LLUMC engaged Excelera in August, 2015 through network membership, to provide project management expertise for the development of a specialty pharmacy business, which included but was not limited to assisting LLUMC with the facility requirements, including design and build out of the specialty space, assisting with the interview process for the specialty pharmacy manager and overall project management expertise. Excelera provided guidance on the development of pharmacy support operations such as call center, revenue cycle and business office functions.

The goals of the engagement were:

  • Development of a business model and proforma to demonstrate viable business
  • Establishment of a program focused on positive patient outcomes
  • Creation of partnerships to gain access to payers and drugs
  • Mentoring during accreditation process and implementation of policies and procedures

Challenges

LLUMC desired to enter into the specialty pharmacy market, however did not have internal expertise nor dedicated resources to concentrate on either the market assessment or the specialty pharmacy operation. As health system resources are typically limited when developing a new service line; LLUMC decided they were in need of a partner and not just a consultant, which lead them to partner with Excelera. With capital funds being quite limited, LLUMC required Excelera to produce a business case which would support the capital expenditure request. The development of an accurate proforma based on LLUMC specific data which addressed market factors such as prescription capture, including payer and drug lock-out with evaluation of the impact of the 340B drug discount program on projections.

Solution

The partnership included the coordination of planning, development and implementation support for:

  • Overall Project Plan
  • Specialty Pharmacy Build-Out
  • Clinical Therapy Management
  • Call Center/Pre-Authorization and Financial Assistance
  • Human Resource Planning including staffing models and training process
  • Information Systems decision support for case management software, phone and reporting systems
  • Connectivity to Excelera data aggregation system
  • Compliance, quality, regulatory, and support in policy and procedure development

Results

LLUMC has successfully built out a new specialty pharmacy space and implemented their specialty pharmacy program. They have gained access to six limited distribution drugs through the network. The pharmacy is planning to be URAC specialty pharmacy accredited in early 2019.



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