Community specialists play a critical role in chronic disease management and cost control

April 6, 2021
Pete Perron

The rising age of the U.S. population is driving many changes in healthcare, including the increasing demand for specialization.

The rising age of the U.S. population is driving many changes in healthcare, including the increasing demand for specialization. This aging patient population is fueling the rapid growth of patients presenting with long-term chronic diseases and other conditions that are often age-related. Specialists have the advanced competencies and cutting-edge technologies necessary to most effectively treat these challenging conditions. These providers, especially those who are community-based, offer cost-effective and accessible high-quality care for patients with complex, ongoing illnesses. Recognizing the vital role community-based specialists play in healthcare, McKesson has developed many innovative technologies and services to help support community specialty physicians and ensure their practices remain viable now and into the future.

Benefits from community specialists

Community specialists play a vital role in containing spiraling healthcare costs while driving quality outcomes. Evidence demonstrates community-based specialty care can be more cost-effective than hospital care, and the proof continues to grow. For instance, a recent study found treatment costs for breast, colorectal and lung cancer patients were significantly lower in community clinics. Monthly costs of care per patient were lower across all tumor types in the community setting ($12,548 vs $20,060).1 Costs are also reduced through better control of prescribed medications. Due to their frequently close proximity to patients, community specialists see patients more often, enabling them to closely monitor the effectiveness of a drug before increasing the dosage prescribed. This minimizes the disposal of costly medications prescribed in large quantities that would be discarded after a short time if they prove ineffective. 

Often conveniently located near the patient’s home and support network, community specialty clinics reduce travel time and minimize disruptions to the patient’s lifestyle, an important benefit for those requiring frequent treatment. Patients may also have convenient access to emerging therapies, as clinical trials draw many participants in the community setting. 

Advancing community care with innovative products and services

As healthcare becomes more complex, practicing medicine while also remaining financially sound has become quite challenging. The COVID-19 pandemic has only worsened the situation, leaving many providers struggling. Now more than ever, they rely on guidance and resources when unexpected calamities like a pandemic arise. For many practices, having an existing relationship in place with an organization that provides guidance and resources during those times can enable them to remain viable, rather than closing their doors or losing their independence.

As part of McKesson’s strong commitment to advance and support community care, the company has developed a comprehensive portfolio of consulting services and technologies for community-based specialists. These solutions have proven to be invaluable to McKesson’s customers during the pandemic, as many have indicated they would have struggled without McKesson’s assistance.

Following are a few McKesson solutions that help community specialists remain fiscally strong while delivering quality, cost-effective care:

Clinical products and advisory services

McKesson’s innovative technology products include industry-leading solutions, such as:

  • iKnowMedSM electronic health record (EHR) for oncology practices that provides comprehensive clinical information, evidence-based clinical guidelines and pathways to support informed decisions at the point of care, and 
  • Lynx® specialty medication inventory management system that tracks inventory and usage trends while identifying revenue and cash flow opportunities.

McKesson also has its own group purchasing organization, Onmark®, that aggregates practices together to achieve better pricing from life sciences companies. With a robust contract portfolio, Onmark provides savings on leading therapeutics in advanced specialties. Practices can also utilize Health Mart Atlas, the nation’s largest pharmacy services administrative organization (PSAO) that helps practices with medically integrated dispensing (MID) pharmacies contract with payers, so prescriptions are covered. Because of its relationship with various payers, Health Mart Atlas is in a unique position to assist MID practices with their strategic contracting, increased efficiencies and tools that drive high performance.

Of special note is an exciting new service from Biologics by McKesson, ScriptPAS™. A comprehensive service solution for MID pharmacies in oncology, ScriptPAS reduces barriers that delay care by assisting with benefits investigation, prior authorization and financial assistance for patients. In addition to expediting time to therapy, this service offers specialized support to meet staffing challenges. ScriptPAS is unique to McKesson and is being very well received by practices.

Other clinical consulting services are available to support quality care and clinical efficiency, covering such topics as USP compliance, therapeutic interchange and cost analytics for branded versus generic or biosimilar drugs. The company can also deploy a team of pharmacists to help physicians analyze their product mix or assist in standing up a MID pharmacy.

Business advisory products and services

McKesson offers expertise based on more than 20 years of proven know-how, providing specialty practices with business consulting and analytics to drive strong financial and operational performance. Team members collaborate with practices on revenue cycle optimization, managed care, payer negotiations, billing and coding, strategic planning, patient financial assistance and reimbursement models.

Technology products are available to strengthen core practice operations and optimize revenue. For instance, TotalViewSM provides practices a greater understanding of claims and remittance data, reimbursement trends and opportunities to identify missed revenue. 

Success stories

McKesson has helped hundreds of specialty providers deliver better care and promote financial health. Following are just a few that have relied on McKesson’s expertise to solve challenging problems:

  • Katmai Oncology Group, Alaska
    • McKesson helped the practice increase financial health by developing a practice model that incorporated financial counseling Additionally, with McKesson’s support the practice improved utilizing audits and staff education.
  • Arthritis Consultants of Tidewater, Virginia 
    • McKesson evaluated practice workflow and developed an action plan for improvement. After implementation, most accounts receivable moved to less than 30 days outstanding and the payment rates on co-pays and collections improved.

Advocating for community specialists 

McKesson is a resource for community specialists for navigating the complex healthcare system comprised of payers, legislators and manufacturers. Many have seen financial impacts of COVID-19, and the company has helped these practices secure extended payment terms on certain specialty drugs. McKesson has also leveraged its substantial resources to help practices navigate recent changes in healthcare policy due to COVID-19, including the Paycheck Protection Program, new telehealth guidelines and regulations impacting reimbursement for virtual visits. McKesson also collaborates with specialty organizations to stay in touch with provider concerns in each area.

Community specialists are under threat

The healthcare ecosystem needs community specialists to thrive, not only to control spiraling costs, but to care for patients with serious or chronic diseases who need these highly skilled physicians by their side. Unfortunately, these specialists are under constant threat. Many are closing their doors because the environment is simply too complex to conquer, while others are being acquired. 

McKesson is strongly committed to community specialists who play a vital role in healthcare. The advanced care they deliver is critical to very ill patients, cost-effective and often available right in the neighborhoods where patients live. McKesson’s dedicated team is working tirelessly to support these providers during the pandemic and will continue to do everything possible to help them thrive in the future. By providing innovative products and services and caring for the business side of the practice, McKesson empowers these community specialists to do what they do best—deliver superior care. 

Pete Perron is president of Provider Solutions at McKesson.