The Excelera network was created, in part, as a response to the rise of Accountable Care Organization (ACO) arrangements which tied incentives to quality metrics and the total cost of care. Assuming more risk for patient outcomes and total cost of care provides incentives to deliver care with a more coordinated approach.
The Excelera model pulls together a national network of health system specialty pharmacies to provide payers a single point of entry for reporting, communication and contracting.
High Operational Performance
Excelera employs a stringent process for reviewing and accepting health systems for membership. These specialty pharmacies must be part of a health system with a fully functional electronic medical record (EMR), demonstrate operational performance capabilities, and comply with strict quality standards. Annual member reviews help ensure standards compliance, and continuous bench marking and best practice sharing reinforce and help streamline adoption of operational and clinical protocols.
Aggregate Population Health Data
Growth in risk based contracting has created financial incentives for health systems to reduce the cost of care in partnership with health plans. Specialty pharmacy costs are growing at an alarming rate and for-profit pharmacy chains are not connected to the prescribing physicians, which creates barriers to implement change. Excelera has access to large, aggregate patient volumes from multiple health systems and to information across a patient’s care experience (EMR, dispensing system, therapy management, etc.), as well as access to physician thought leaders and leading academics at prominent medical centers across the country.
Enhanced Value to Employer clients
The Excelera network helps payers deliver value to their employer clients nationwide in the form of improved outcomes, innovative programs to manage costs and improved patient satisfaction. The Excelera network’s reach includes centers of excellence across the country, allowing payer partners to provide value and convenience to employer clients with multiple locations.
Improved Patient Experiences and Clinical Outcomes
When specialty drugs must be procured from an outside source, usually one of the five large for-profit companies that dominate the specialty pharmacy marketplace, patients can experience delays in onset of treatment. When health systems have broad access to specialty drugs, it reduces potential delays in therapy, and increases visibility for the patient’s care team to treatment updates via the electronic medical record (EMR), which leads to better patient management and total cost of care.
Immediate, local access to specialized drugs
Because any given health system’s specialty pharmacy, on its own, cannot provide point-of-care service to all of a payer’s employer clients across the nation, health systems have pooled their expertise to offer a national network solution - a broad specialty pharmacy platform, with data aggregation and management capabilities - and are working together to improve outcomes.
Collaboration delivers value
As specialty drug costs increase, expensive new products come to the market, and new indications are approved for existing specialty products, the Excelera network model allows costs to be managed for critical population health segments. Since academic health centers define standards of care, the Excelera model presents a novel opportunity to implement point-of-care protocols that are both evidence-based and practical. A partnership with Excelera means payers can collaborate on creation of real-time policies that truly impact clinical and financial outcomes, rather than utilizing claims data review and retroactive policies.
The Excelera network is committed to minimizing disruptions in patient care, supporting the role of pharmacy in accountable care organizations and reducing the overall cost of care.