The Bridge

The provider-pharma relationship is 'broken.' Here's how pharmacy executives say it can be fixed.

by Jessica Liu and Brandi Greenberg

Brandi Greenberg, Managing Director, recently sat down with eight leading health system pharmacy executives. Her objective? Understand the shifting focus and needs of pharmacy executives. However, their conversation took a turn. In this Q&A with Advisory Board's Jessica Liu, Brandi explains why the conversation detoured and recaps the need-to-know insights for pharmaceutical companies.

Learn how leading provider organizations are rethinking their pharmaceutical management strategies

Pharmacy executives' current areas of focus

Jessica Liu: Brandi, thanks for taking time to give us the inside scoop. Our pharmaceutical members are always hungry to learn more about one of their key stakeholders. Obviously, a lot has changed and is changing in health care that impacts pharmacy execs—cost of care, outmigration of care, consumerism. With all they could focus on, where are most of them spending their time, effort, and resources?

Brandi Greenberg: A lot of pharmacy executives are increasingly interested in the outpatient pharmacy space. They talked about creating ambulatory-focused P&T committees to augment prescribing behaviors and aligning outpatient (OP) formularies with payer OP formularies to get better adherence.

And this all makes sense. First, more health systems are now part of either ACO arrangements or risk-based contracts with payers. Second—and more importantly—health systems are worried about narrow networks. If systems can't keep their overall care costs in line, they risk having patients steered away from their providers or, worse, being excluded from narrow networks entirely. So with a focus on bringing down the total cost of care (without sacrificing care quality, of course), pharmacy executives have to know what's happening on the outpatient side. And they all agree: They need to manage outpatient drug utilization more effectively to do this.

The basis of successful provider-pharmaceutical relationship

Liu: So it seems there's a big push towards value—but health systems and pharmacy executives are only a piece of this "value" chain. Pharmaceutical companies are another group that's eager to understand how they can partner with their provider customers toward the same end. Any suggestions?

Greenberg: Before I address that question, I think we need to talk about a bigger issue. To be honest, pharmacy executives don't trust pharmaceutical companies. Comments such as, "pharma companies only focus on their brands" and "manufacturers really only care about profits" were commonplace. Interestingly, the latter comments came in the same breath as detailed explanations of how their health system pharmacies are increasing revenues and improving financial performance. However, pharmacy executives see pharma as the problem; regardless of the truth, this is their perception. They just don't believe that pharma's intentions are to help providers. So before everyone jumps to conversations about "what solutions we could provide," I think life sciences leaders need to figure out what they can do earn customers' trust.

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Liu: Ok, we've got a broken relationship that needs to be fixed. Based on your experience over the past decade with pharma companies and health systems, is there anything pharma companies can do to overcome providers' negative perceptions?

Greenberg: It's not all doom and gloom. The execs did mention a few areas—clinical trial management, centralizing drug inventory, to name a few—that probably aren't news to pharmaceutical firms.

What is new (and garnered consensus support) are above-brand, disease-specific services around population health and medication adherence. I know it isn't easy, or even possible given current regulations, but that's what they want. Another area of new interest is EHR-integrated guides and order sets for clinical decision support. Just as we're hearing in other parts of health care, we heard again and again about the desire for more data that can enable smarter, more efficient decision making. So there is some good news here: There are genuine partnership opportunities, once trust has been reinjected into the relationship.

Learn the 8 steps for deploying clinical pharmacists in ambulatory care

Clinical pharmacists are uniquely skilled at identifying and correcting medication issues. In response, many health systems are deploying pharmacists in ambulatory care settings.

Check out our infographic to learn eight steps for how to deploy clinical pharmacists in outpatient clinics.

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