What does the PBM hospice do?

Hospice care aims to keep patients comfortable by addressing the pain and other symptoms associated with a terminal illness. Given the centrality of pharmacotherapy to this end, it is not surprising that pharmacists play an important role in inpatient care. Likewise, the hospice Pharmacy Benefits Manager, or PBM, does the same thing.

The primary role of a PBM in the broader healthcare market is to manage claims and reimburse pharmacies for dispensing prescriptions. Additionally, they help with cost management by managing formularies and negotiating prices with pharmaceutical companies.

Due to the specialized demands of hospices, they often rely on PBMs and other pharmaceutical providers who specialize in hospice care. The origins of SpectrumPS Pharmacia can be traced back to some of the earliest pharmacies and PBM providers specializing in hospice care. It now serves more than 450 hospices and more than 90,000 patients daily.

What is the role of a PBM hospice?

Each PBM hospice provides a different set of services. They fall into several broad categories.

• Access to medicines

• Usage Management

• pharmacological direction

• Compliance with applicable regulations

• Optimization of work processes

Access to medicines

Hospice patients often receive treatment at home, but may need medication to control severe pain that is not available at your local pharmacy. In addition, your situation may fluctuate from hour to hour. Providing symptom relief may require the addition of new drugs, dosages, or formulations.

Hospice Pharmacy Benefit Managers (PBMs) provide access to medications in a variety of ways. Some hospice PBMs operate or contract with a network of "closed-door" non-retail pharmacies located throughout the country. Maintaining adequate coverage can be difficult in some places. SpectrumPS offers many models based on retail pharmacy usage and its own mail-order pharmacy that can meet the needs.

The SpectrumPS initiative ensures local access to essential hospice medicines. Its most comprehensive network of over 65,000 pharmacies includes an actively maintained network of over 7,000 pharmacies. These pharmacies have agreed to maintain a supply of critical hospice drugs and meet other service criteria. The team helps hospices develop links with pharmacies located in their service area. SpectrumPS can also charge for ancillary services such as courier delivery using this paradigm.

Usage Management

Drug expenses are sometimes the second-highest price for a hospice, after staff and facilities. Hospice PBMs can help clients develop tools and best practices for quality improvement and cost management. SpectrumPS clinical pharmacists use a variety of tools, including the following:

• Forms created on demand

• Algorithms for evidence-based therapy

• Protocols to deprescribe

• Education on clinically acceptable and less expensive alternatives

Another essential part of user management is reporting. In clarity, SpectrumPS' proprietary business intelligence platform, provides real-time visualization and trending data. Users can explore multiple levels (eg, location and team) to uncover the potential for managing costs and improving care. Custom alerts can notify you in real-time of anticipated cost increases.

Pharmacy

Hospice care has different goals than curative medical care. There are insufficient data on the effectiveness of specific drugs in terminally ill patients. The dying process poses many complications with drug metabolism. As patients' health deteriorates, they may require alternate methods of administration.

Hospice PMBs must provide specialized hospice and palliative care clinical services and timely access to medication information and education. This includes providing evidence-based alternatives to drug delivery to address availability challenges or better meet patient needs.

SpectrumPS' clinical support program includes strategic utilization management and training opportunities, as well as pharmacists available around the clock to assist with the administration of drug therapy, increasing team efficiency interdisciplinary. They help nurses and prescribers with a variety of issues, including:

• Complicated cases

• Dose conversion

• Drug substitutions

• Precautions

• Deprescribing

Regulatory conformity

Hospices are very controlled, including the administration of drugs. For example, Medicare's terms of participation require initial and ongoing reviews of drug use. These include prescription and over-the-counter medications, herbal remedies, and other alternative therapies that may interact with drug treatment. SpectrumPS clinical pharmacists take this opportunity to perform a comprehensive review of the prescription list to uncover medications whose dangers may outweigh their benefits. They are especially useful for reviewing over-the-counter medications and supplements that may have adverse effects or interactions.

Concerns about opioids have led to increased regulation of controlled substances in recent years. Through appropriate policies, practices, and processes, SpectrumPS helps hospices strengthen compliance with existing and emerging state and federal laws. SpectrumPS can also perform a general usage review to identify potential trouble spots.

Workflow optimization

Hospice nurses develop strong bonds with patients and caregivers to foster trust and ensure excellent quality of care. Complicated or outdated medication management routines can divert your attention from critical tasks. Nurses can spend hours ordering medications, locating faxes, and re-entering data into various systems. This disrupts patient care and has a detrimental effect on employee morale and retention.

SpectrumPS has invested in technology and best practices that enable nurses to do their jobs effectively. The E3 platform offers mobile and desktop medication management tools that facilitate mail order an in-person pharmacy use through a partnership with an e-prescribing provider. Integration with a growing range of industry-leading electronic medical record (EMR) systems for hospice care eliminates double entry. Additionally, a disciplined and collaborative implementation approach ensures that digital technologies translate into efficient workflows.