Introducing Specialty Care Close to Home | TWIRx

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Nested Knowledge, the standard in evidence synthesis. You are listening to the Global Network of Podcasters dedicated to the pharmacy profession. Welcome to the Pharmacy Podcast Network. Specialty pharmacy is becoming one of the most important access points in modern healthcare, especially for patients managing complex, chronic, rare, and high-cost conditions. As therapies advance and patient needs become more sophisticated, health systems are rethinking how specialty pharmacy can improve access, continuity of care, clinical outcomes, affordability, and the overall patient experience. Specialty Care Close to Home is a new Twerk Special Series from the Pharmacy Podcast Network examining how hospitals and health systems are building, supporting, and scaling specialty pharmacy services within both health system and community-based care models. The special This Week in Pharmacy episode features Dr. Laura Mark, Vice President of Pharmacy at Allegheny Health Network, Allison Arendt, Senior Vice President with Clearway Health, and Chris Corsi, CEO of CassianRx. Together, they will explore why health system specialty pharmacy expansion matters, what makes these programs successful, where the greatest operational and strategic challenges exist, and how collaboration can improve patient access and therapy management. Future episodes will examine accreditation, payer access, manufacturer relationships, patient engagement, clinical workflow, technology, data reporting, community access, and long-term sustainability, while inviting pharmacy leaders from health systems across the country to share how they are delivering specialty care closer to home. Hey, welcome to the Specialty Care Close to Home, a special This Week in Pharmacy series from the Pharmacy Podcast Network. I'm the founder of the Pharmacy Podcast Network in 2009, releasing the first episode about our profession, the first podcast about our profession, digging into the mindshare of so many of you who have over 17 years giving me so much information that we've shared and it's led us to sectors of pharmacy that need more attention and need more dialogue. And today we're exploring how health systems are expanding specialty pharmacy services to improve access, strengthen continuity of care, supporting better therapy outcomes and building trust models of pharmacy excellence inside the communities they serve. And when you put that on top of what complexities there are in specialty and the stress that is placed on the patient, the patient's family, the care team, the insurance providers, we have something to really open up and talk about today. I'm so excited about our panel of experts who really know, they have hearts that are all about specialty pharmacy. I want to introduce Dr. Laura Mark. I would like to bring Dr. Mark in, a fellow Pittsburgher, and just welcome you to the series. Todd, thanks for inviting me. I'm so happy to be here with this panel. Laura Mark, I'm Vice President of Pharmacy Allegheny Health Network in servicing Western PA. We're very excited about the specialty pharmacy growth that we've had and being able to really be an extension of the care team for our providers and then servicing our patients in Western PA. So thank you. Thank you for being here, Laura. We are excited about Allison Arant here. She's the Senior Vice President for Clearway Health. Very excited that you're part of this. Very excited to have you here, Allison, because you've already taught me that there is gaps in many attempts and efforts to build out profitable and sustainable specialty pharmacies throughout the nation and our health systems. Yeah, introduce yourself to the listeners. Let us know more about you. Todd, thanks. It's great to be here with Chris and Laura. I'm excited to be a part of the series. I am Allison Ariant. I am Senior Vice President at Clearway Health and Lead Growth for our organization. And primarily what that means is we are building new client partnerships with hospitals and health systems across the country. And Todd, you talked about understanding the gaps, no matter how hard some hospitals try to build these specialty pharmacy programs because they are wildly complex and an incredibly changing landscape with disparate technologies and fights happening between different organizations all around them. And it is incredibly hard. And we try to quiet that noise and find ways to focus on helping hospitals build sustainable, successful specialty pharmacy programs. And so Clearweight Health is owned by Boston Medical Center health system. And for more than a decade, Boston Medical Center has been providing specialty pharmacy services to incredibly underserved patients on their side of Boston. And we have become an extension of that legacy in the ways that we partner with hospitals and health systems. So truly understanding because we've lived it, the experience of navigating how hard it is to build a program that serves patients and then is a good steward of the dollars of the 340B program and then reinvest them back into the community and the ways that they're able to serve their patients. So really excited about the concept of specialty care close to home. Clearway Health believes that a hospital is the very best provider of pharmacy services to patients. And so there are a lot of different players in this landscape that all have incredibly important roles, but the one that the hospital or health system should play is serving their patient and providing fulfillment and specialty pharmacy services to their patients. So really excited to get to have this conversation and thanks again for having me. Thank you for being here, Alison. This is exciting. And to have those resources that you'll be able to bring to the series is also exciting. Chris Corsi, CEO of Cassian RX, the technology. That's my nerdy-ness coming out because that's how I entered pharmacies was the technology systems that we're helping to run our pharmacies. Chris, introduce yourself to our listeners. Thanks, Todd. I'm excited to be here with this great group that we have. I'm Chris Corsi, CEO of Cassian Rx. I actually started Cassian as well about a decade ago, and our mission was pretty simple and still is pretty simple to really take some of that weight off of the specialty patients and their families, and we believe technology can do so much of that. What we've learned over that last decade is really that specialty pharmacy was never built to work as one full connected system with all those different stakeholders. And patients and those care teams really end up getting stuck in the gaps, right? You think about all those times where we hear about delays, patients that didn't end up getting the refill, all of those different problems that occur. So really at Cassian, we support a wide cross-section of this industry, not only those integrated delivery networks and health systems that we're talking about, but also independent pharmacies, hub service providers, and vertically aligned pharmacies as well. So I'm excited to be here with the group, talk a little bit about technology and how we can help those patients and their caregivers have success with those treatments. Chris, can't wait to nerd out with you and get into the bits and the bites. So this is important to have you as a part of this series. All right. So listeners, you are in the trenches. You know what's going on. Our pharmacy technicians, are pharmacists, people in administration, these enormous hospital systems and the complexities that are part of that And the extra element that health system pharmacies are facing in comparison to maybe a community pharmacy or a more controllable long care pharmacy or even a specialty pharmacy that isn't part of a health system per se and that is the stress you think about the families you think about the patients that come to a hospital what eight out of ten times I'm just throwing numbers out, but there's probably something happening in their lives that's disastrous, that's a horrible experience, the heightened elevation of stress. That's a whole other element that we're going to kind of pour into. We're going to be inviting a psychologist to our series to really talk about the impact of sickness and having to deal with sickness and where specialty kind of is an extra special place for pharmacists to fill in care gaps. And health systems are uniquely positioned to integrate our specialty pharmacies into that broader care journey and creating a safe place with education and hand-holding through every one of these processes. My first question, I really want to open up to Laura because you're the one that is experiencing so many sides of all of this and the complexity. And we could tell a whole nother story about Allegheny Health Network and talk about bringing hospitals all together and that'll be another podcast. But today, specialty pharmacy has become one of those most important areas of modern pharmacy care. People know that there's a difference now. They're being educated. Sometimes they don't, but there's very intelligent consumers out there. From your perspective, Laura, why is now such a critical time for health systems to invest in specialty pharmacy services? Well, I think Allison said it too, that not only is it hard to build these, these are wildly complex and hard, but this is wildly complex and hard for patients and providers too to figure this out. You know, when we go home, We built a meds-to-beds program, a discharge prescription program where patients go home with their medications. They go home with their medications, but they might not go home with a specialty medication because that's coming from a mail order or another place where they're being provided with those medications. So I think it's confusing for patients but also providers. Like I send the prescription in. When do I get it? When will I hear from somebody? I can't necessarily, from a patient perspective, go up and walk and talk to somebody like I would normally at prescription. So I think that's where it's really complex for patients and providers. By being in a health system, it really does help by we're having pharmacists talk to those patients. We're calling and doing a follow-up right after they're discharged too as well when we get those prescriptions. So there's a connection. We just have to make that connection differently for our patient and providers. Luckily for us, too, with our providers and our patients, is that our pharmacies are interconnected with our electronic health record. So providers will see any time point where that prescription is in the process. They can see that. But then patients also have that access through like a MyChart or messages that we can connect with them. So it's all in one place for them. So making it easier for patients and providers is really what our objective is. Laura, I think one of the things you said about making it easy is so interesting. I, years and years ago, worked for another organization that was owned by a health system, and they went through a major rebrand. And one of the big focuses and taglines was easy for me. But easy for me did not mean Allison or the other people who worked there. it meant easy for me, the patient, to make sure that they had the most accessible way to receive care. And so your points about connecting technology and then education is so important. We spend so much of our time with our hospital and health system clients talking about two pathways for education, patients and providers. Providers are very used to dropping down to the preferred pharmacy that the patient has gone to forever and ever in the EHR and then sending a that ultimately that pharmacy on the corner really probably can't fill because it's a specialty med that has all of these other complexities required. And so having the conversation that's really about change management to help them understand there is an option within the four walls of the health system. Here is how we can help you. Not only do we have the technology connectivity, but we also have the people to help you navigate it. So we're providing, like you have, the pharmacists, the liaisons inside of the clinics who are really intercepting all of the things that are kind of getting pitched over to the wrong place to say, hey, next time, if you have this prescription, here's how you can help educate your patient on the right to choose to have it built here in a place where they're already comfortable and confident receiving care. For the patients, you know, we've talked even in this group about the hard parts of becoming so largely virtual and remote that patients are losing that personal connection and touch. And so the people that we're putting in touch with them, the liaisons and the pharmacists are really, they're navigators in this really hard specialty pharmacy process. And so it's that connection point of education and change management that I think is so important. And it gets back to Todd's question, which is why are hospitals looking to do this work now? And I think oftentimes people find themselves in this hard place between is it too late, but also we have to start now because the longer you wait, the more compounding loss you have and the ability to drive some pretty sustainable financial resources back into the organization. Yeah. And going off of that, Laura, even just from a technology standpoint and visibility standpoint, a lot of those patients end up getting lost and don't even know what's going on with their script for, you know, it could be weeks. It could be maybe a month at a certain point, right? So giving them that visibility, into where they are at, what actually is a PA, what is required to get your insurance and payer to cover this medication, and giving them that visibility from the beginning of when that script is written all the way through when it actually gets filled. We've ran countless programs for countless entities trying to give those patients that increased visibility and support line to be able to call in or even just get a status update by texting into the web application that is supporting their pharmacy to get a status update on where their medication is at, if there's any actual activities that need to be completed on the patient side or even the physician side so they can reach out to the physician to help move that script along. So from a technology standpoint, I think that there's so much that now in 2020s, we're able to support a patient so much more than we were maybe in the 2010s with what's available from a technology standpoint. Awesome. Allison, I think you make a great point too, and Chris, making it easy for me. And Chris brought up the prior authorization piece. That piece alone, people are confused about what do you mean I have to wait for a couple of days? What does that mean? Like, am I going to get it? What if I'm not approved? So I think that that piece is really from education. You know, we we want to make sure that we close that gap for them. And there's some assurance that we do reach out to them to say we're working on this and we're processing this. So they have that, you know, it's coming in the next 24 hours, 48 hours. However, we can get that prior authorization quickly for them too as well. Yeah. And Laura, I joke when I say this sometimes, but I always compare, you know, starting something very serious, right? Like an oncology medication or an MS or autoimmune medication. That's very serious medication to someone walking into a restaurant the first time. If you walk into the restaurant and you see a rat running around and the floor is dirty and it's just gross. You want to walk out. I don't want to do this, right? But same kind of experience. If I start and I'm getting no attention, I'm not covered, it's taking a long time. From a compliance adherence perspective, is that patient really going to want to stick on that drug because they just had such a bad start, right? And giving them that increased visibility, helping them understand and educate them on what the process is, is a lot of the work to make sure that patient has a good outcome long-term. And I think in community pharmacy and the integrated delivery networks, they do such a great job of helping educate that patient, right? They're there in person. They're walking them through that. They're having that high touch of care that maybe at some other pharmacy settings you're not getting. So I think that they're playing a really good role in helping improve some of those outcomes and adherence as well. Chris, I agree. I think the the patient satisfaction part is hugely important to make sure you have the VP customers, you know, so to speak in the commercial space. And Laura, your point about prior authorizations and turnaround is so, so well received and understood because, you know, Chris ended with, and it drives the adherence and the outcomes. You have to have patients who want to come back. If you think about how hard it is to educate a patient on their right to choose to change the pharmacy that they have been using for a very long time That takes sometimes a significant amount of work If you get that first fill but you don get the refill you have lost so much momentum and you're starting all over again. So it's not just patient acquisition, it's patient retention and making sure that you're navigating and using all of the services you possibly can to ensure that they are receiving high quality care. They want to choose to fill their refill again at that hospital pharmacy. The other side of it, though, is time to med in hand. And that gets, Laura, to the PA turnaround piece where, you know, sometimes industry averages are well above seven days. We have had many partners who were in the 20 and 30 day turnaround, depending on which specialty med and the complexity that it required. I am really proud to say that we consistently deliver under two days, often under one for those prior offs. And it was no one's fault that it was taking so long the first time because it is so hard. You have nurses and MAs who are running ragged, ensuring that their patients are receiving the best care. They don't have time to sit on hold with insurance companies for days and days on end after denial, after denial, after denial. And so knowing how to navigate that process is so important so that we can make sure that that prior off comes around quickly, the patient has their med, and they're starting the therapy that they need as quickly as they possibly can. And Allison, I think you brought up a good point about customer service and even how we're hiring into these positions to support specialty pharmacy with our technicians and our pharmacists. The customer service piece and that empathy is so important. They have to be a unique sort of individual that can manage that sort of fear, but I'm going to have you and make it easier for you for the patient. But then also on the back end, understanding from a prior authorization and all of that pieces to work through that, take that prescription from the electronic health record and really following it through the whole way. So I think that that is a really unique individual that we really seek to hire to as well. We could probably talk for another five hours on this. Yes. All right. So I have a question for Allison, and it's really around operations. I want to let the listeners know we are going to be breaking up this series into very specific subjects. We're going to be talking about operations, technology, operations and workflow. Actually, we're going together reimbursement, insurance issues, fundraising, 340B. But in opening, in kind of this intro episode, Allison, and you're the one that actually to come clean to the listeners, it's Allison that got me thinking that this was a necessary series. I searched for operational demystifying of what's happening in our health system. Hospital pharmacies out there could find zero topics talking about it. So I want to thank Allison for getting me to think about the series overall, but just operational realities. Let's focus on that for just a second. And that is, how do you get health systems to really understand what they're wanting to do? Laura runs this well-oiled machine serving the patient population in that building, on that premise, on that campus. and the technicians and the pharmacists that are serving the nurses and the nurses that are coordinating with the physicians and the bedside delivery and the whole thing and the robots sometimes that are going down the hallways. The SOPs of that whole operation are pretty, hey, we got it. We know exactly what's going on. Now you inject a specialty pharmacy into that operations. That's not the same animal of serving the internal per se of what happens when you say, okay, it's time to go to specialty. So what are the operational realities that the other health system leaders really need to understand? I'll start by saying organizations like Allegheny Health Network are so fortunate to have people like Laura Mark doing this work because having people who have experience and exclusive focus on pharmacy and specialty pharmacy in the outpatient care setting is just so important for the success of a program like this. And for organizations that don't have a Laura Mark, it is hard. And that's why we have the partnerships that we have with health systems across the country. Pharmacy for a very long time has been so inpatient focused. And so even when it started looking at an outpatient care setting, specialty was still a straggler and still is for many hospitals across the nation. So operationally, there is so much that you have to consider. First, if you haven't yet, you are shifting the concept of an inpatient service line to an outpatient service line for the first time. There is a significant financial shift when the mindset goes from a cost center to a margin generator, because when you think about specialty pharmacy, especially in a 340B environment, you are now looking at ways to provide what I think is an incredibly hard trifecta to find. You are now delivering clinical, financial, and operational value in one single service line. Tell me what other service line does that in the way the specialty pharmacy does. So when hospitals start this journey, there are so many different operational components to consider. I'll start with data. Every engagement starts with understanding the data, which is the prescribing patterns of the providers who are writing specialty pharmacy prescriptions for patients being cared for. by that help system. The data is there, but being able to analyze it to understand the value of the specialty pharmacy service is really hard. It's hard because even if you understand your total market, it doesn't mean that you're going to have access to it right away. And so that gets into the other operational challenges, things like what accreditations will be required for the pharmacy? How do I gain access to the limited distribution drugs or LDDs that I need? How do I partner with the manufacturers to make sure that I get the drug zone formulary that I need for the hospital? How do I navigate 340B optimization and pressures in a compliant way that demonstrate how we're investing those dollars back into the community? And that's all to suggest that you have a pharmacy to start doing the work. If you don't, we have to build one. So how do we find space to build the pharmacy? You can think about things like eligibility and managing the HOPD versus the clinics who have 340B eligibility. You're balancing things like Medicare cost reports. It is so hard and it is so much. And so when you ask about the operational considerations, it's really tough. Clearway Health really breaks it into two buckets. We first start with how do we grow the program and accelerate the capture and the ways that we're serving patients and sitting alongside the providers and the care team to do the work. The second bucket is the management of dispensing and operating the pharmacy. And you have to have both. And so ultimately, as we get into more and more conversations about the operations of specialty pharmacy programs, the most exciting and complex thing is ensuring that you have so many multi-parallel paths of growth that you can juggle all at once. Because if you wait and do one and then the next and then the next, you're limiting your ability to grow and serve patients and drive that trifecta of clinical, financial, and operational outcomes. Operational outcomes, Chris, we can't have any of that if we don't have technology in place in order to keep up with a unique workflow, tie into the EHR systems, getting ready for the advent of more artificial intelligence that's now playing into the decision-making of insurance claims and battling that on the other side of the hospital system that's fighting for their patient. And so let's talk about technology. What technology gaps slow down the specialty pharmacy programs? Yeah, that's a good one, Todd. I mean, looking at it from operations, right, typically you have a lot of fragmented systems, right? You're usually going to have your PMS, you're going to have probably your EHR if you're a health system. In some cases, you might even have a clinical management platform as well. Also, in many cases, there could be other supporting platforms, too, like digital patient engagement bolt-ons, prior auth bolt-ons as well. I mean, I've seen some pharmacies have a streamline of six, seven, eight different vendors from a technology perspective when you start thinking about like telephony and things of that nature, right? Pulling all of those different systems together and then, I like to say, orchestrating it, right? It kind of like a dance How do you make all of this work for that one patient journey end to end seamlessly without them knowing hey it actually 10 different fragmented systems and five different people in the back end supporting this to make sure that this all goes through and you end up getting your medication on the other side and hopefully what is less than a few days Right. So technology plays a really big role. And what we've seen is is really trying to consolidate a lot of those different platforms down and have one orchestration platform that that controls sort of everything that goes along along the journey. So as opposed to having a lot of different point solutions trying to integrate them together, really, if you can have an integration layer or an organization layer that pulls those point solutions together to work in tandem to drive the workflow autonomously, whether you're driving that with AI agents in some cases, we've seen pharmacies starting to leverage now, or just manual automation logic based of, hey, I've triggered this and I'm moving into the next status of the workflow. I mean, technology continues to evolve and continues to accelerate. Some of the cooler things I've seen on the technology forefront from an operation side, when we get in, especially in the AI topic, and maybe Allison or Lara have seen some of this too, but agentic voice bots where people are actually calling in, processing a refill with that voice agent. And we've done a decent amount of that type of work at Cassian with some of our partner pharmacies. or whether that's just making simple updates over the phone as well to their profile, med allergies, those types of profile updates as well. Some other really cool things with agents we've seen is building out specialized agents for different aspects of the care journey, whether that's focused on just like the prior auth and benefits aspect of it or whether that's focused on processing that patient through the different clinical assessments, clinical interventions. and driving those to the top and forefront to make sure that we're risk stratifying those patients appropriately, targeting those patients to make sure that they're getting that high quality of care that they need. So AI is really, I think, playing a really big role in the future of pharmacy. I think it's going to help us identify where operations should go, where are those patients that are struggling, where are things getting held up in the queue, and how do we help drive that better outcome and better quality of life patient satisfaction for those patients. Chris, you talk about the technology elements and the patient engagement parts of it. And I think that is such an important part of where pharmacy is going. And it's almost like pharmacies catching up to where healthcare has been a little bit for a while related to patient engagement and consumerism. I would even go, well, there you go. I was going to even say consumerism and just commercial applications, right? At a certain point, healthcare, I feel like, man, was two decades behind. Maybe it's getting closer to five years behind now. You see it, right? I mean, we even support a lot of direct-to-employer programs and direct-to-patient programs with some of our pharma partners. And through that, I mean, you're just seeing like the push for higher quality patient applications, higher quality user interfaces, understanding how this actually works and helping that patient navigate it. Whereas before it was like, hey, here's a message, click in and pretty much it's a dead end. Right. And it's like call pharmacy. Man, why did I even click into the application in the beginning to go into my chart to say call pharmacy? Great. I could have just picked up the phone anyway. So I think some of that change on the pharma side is also helping accelerating that for some of those vertically aligned pharmacies and some of those independent pharmacies and even just from a technology perspective as well, just all of those different synergies that we're getting. It's really helping us elevate everyone, right? We're kind of raising the C across the board as opposed to certain pockets of it. Yeah, I agree, Chris, completely. I also think it's interesting when you start the connectivity of things like the patient engagement to consumerism, to other growth strategies within health systems, because when you have engaged patients who are receiving a service in a very consumeristic way, then you start to think about capture and reducing leakage. And there is not a single conversation that I have with a hospital or health system where the word capture or leakage or retention or market share does not come up. But often I think retention and leakage is looked at as more of an ambulatory concept and where patients are choosing to go to receive their ambulatory care. But not often does pharmacy come up in that same conversation. conversation. And so when we expand this consumerism, outpatient care landscape to include pharmacy, that's where we're going to see some impactful change. Because when you talk about leakage, we had a conversation recently with an organization who was looking to increase their capture rate for their outpatient oncology services. Incredibly competitive landscape, like most hospitals face. And so we said, well, we have people who are talking to your patients every single day, how can we help? And so together, we put together this plan to say, when we're engaging patients and educating them on their specialty therapy, on their right to choose to have it filled here, let's talk about, you know, keeping them in network in ways that we can connect even to primary care and other parts of the organization that they haven't had before. So there is so much that drives a successful program that then touches so many other parts of the organization. Oh, 100%. And other aspects of it that also get me super excited is when you start pulling in and thinking of the future of medicine and getting into precision medicine, right? I think it's 70% or 80% of medications now in the FDA pipeline are specialty meds. So that market share is just going to keep growing. And eventually, it's going to be personalized to you, your genome, et cetera. So when you start thinking about introducing additional data sets on top of just what we're collecting from the pharmacy and then looking long-term of like, what is that patient's goal? Where do they want to go? Are they trying to make it to their son's wedding? Are they trying to have it, hey, I'm trying to get to see my granddaughter that's due in three months. I have a trip coming up, right? Where am I trying to go with my life? How do you start pulling in some of those other data elements, whether that's like genomic data, whether that's wearable data and correlating across all of that and kind of also elevating that experience holistically from a data perspective or real-world evidence perspective, outcomes perspective, on top of even just, hey, capture, retention, leakage, all of those types of metrics that we carry in a health system, but even looking at the outcome. And is that medicine working for the patient and driving them to the goal that they actually have? That's an area that also gets me super excited as you think about the pipeline and think about where medicine's going long term as well. Specialty care close to home. This is a special series from the Pharmacy Podcast Network. Buckle up, listeners. We're going to dig into technology. We're going to go deep into operations. We're going to be talking about the financial side of this, building your specialty pharmacy from scratch. And we're going to have participation from people that are leading health system specialty pharmacy throughout the nation. I would like to thank Dr. Laura Mark. You're kind of the guinea pig of the opening of this wonderful series that we're so excited. But thank you so much, Dr. Laura Mark, for being part of this. Thank you. Thanks for having me again. Oh, Allison, thank you for spawning this entire idea and helping me to think this is very important. And like I said, there wasn't enough, there's not enough out there talking about specifically the special care, the special implementation that's necessary for our health system, especially pharmacies to thrive. Thank you so much for being part of this, Alison. Thanks for making space. It's an important topic and a really important conversation. Thanks for having me. Chris Corsi with Cassie and Rx. Thank you so much for being part of this. We're going to be bringing you back for lots of tech talk and digging much deeper into the AI component of this. We have lots of questions and the listeners are very curious. Thank you so much for being part of this. Yeah, Tom, excited to continue to talk about technology and how it's going to reshape the pharmacy world. So thank you. be sure to subscribe on any of your podcasts favorite podcast platforms spotify apple or even on youtube uh just to get this information send us questions don't wait for the remainder of the series there's going to be multiple parts this is going to continue throughout 2026 you will have access to chris to laura and to allison's linkedin profiles it's going to be in the show notes and with that we thank you so much for listening to this week in pharmacy and our special episode our special specialty care close to home series