Data can be a useful tool for unifying acquired partners who formerly functioned as disparate business entities. If one or more partners are referencing outdated resources to support drug safety, clinical, and formulary decisions, there’s potential for costly and unwarranted variation in healthcare within the vertical and inconsistent, inefficient communication between partner organizations.
Vertical integration in healthcare works best if all partners are aligned using a holistic decision support solution suite with consistent content. It enables you to set three goals to improve outcomes for all member organizations in the vertical:
- Reduce variation in care
- Enhance access to current evidence-based information and contextual screening
- Build a better healthcare experience
Striving for more consistent patient outcomes
From 2017 to 2020, organized market channels have evolved from two, to five, to seven major verticals that incorporate insurers, PBMs, retail pharmacies, specialty pharmacies, long-term care pharmacies, and provider services within a single business affiliation. The concept: with everything from prescribing, to dispensing, to adjudicating claims under one umbrella, economies of scale would be realized, and money would be kept “in house.”
While most market watchers are interested in the long-term financial outcomes of these mergers and acquisitions, vertical integration in healthcare creates potential for consolidation of care quality goals as well.
By nature, a well-constructed vertical should have more control over a patient’s journey, so you should set goals to reduce unwarranted variation in care. The first step is to align all partners onto the same data platform, using consistent clinical content.
With aligned drug vocabularies, clinical recommendations, and even unified drug pricing data, your partners will be more likely to follow consistent best practices, formulary protocols, and established standards of practice.
Situations will inevitably arise where clinicians within the vertical will want to look up more information to research clinical screening results, such as a drug interaction warning. If content is not consistent between screening results and your electronic references, as well as across partners in the vertical, communication (e.g., to confirm a question about a prescription or prior authorization) may reveal different ratings, conflicting recommendations, or missing information between partner organizations. Any confusion will create a breakdown of trust and communication between members of your own vertical, while the additional time spent researching the information will slow down workflow and may jeopardize care.
The same applies to understanding drug pricing. Consistency and reliability of data across your various partners can help streamline therapeutic cost comparisons, cost-effective substitutions, and formulary management without creating disparities or confusion. It can also benefit overall drug pricing analysis.
Your investment in clinical content and data becomes more useful and valuable as you establish and maintain consistency. If partners are called upon to adopt new systems, remind them of the importance of one organization speaking the same language.
Gathering context today for safer and more personalized care tomorrow
With more access to patient information from your various partners, your second goal should be to improve safety and contextual decision making.
As a patient travels through your vertical, you’re going to know more about them than if they were to hop across to other providers and pharmacies that aren’t vertically integrated within your channels. And the more you know about an individual patient, the more you are going to be able to provide personalized care and precision medicine.
In the simplest form, that could mean you know that Patient A is 55 years old, so your system won’t need to fire an alert about medication risks to pediatric patients during any of her contact points with your organizations. In the most complex terms, it could allow for possibilities that aren’t common practice today. For example, if you have Patient A’s genetic testing labs on file, when she goes to the retail pharmacy, the pharmacists can see that she’s a slow metabolizer of a particular medication. They immediately recognize the need to call the prescribing physician back to discuss the possibility of increasing Patient A’s dose.
That kind of precision medicine isn’t happening today. It’s an aspiration for the future of medication safety screening, but one for which vertical integration could help open the door.
Not only would access to greater contextual information increase patient safety, but also, as you move toward more personalized care, you should, in theory, move away from alert fatigue. Without context, a clinical or pharmacy screening system doesn’t know enough about a patient, so it’s going to assume the worst and hit the physician or pharmacist with every alert that could be relevant. That’s why studies have found alert override rates of anywhere from 49-96%.
In your vertical, when all partners are using the same content, finding data points the same way, and capable of sharing contextual clues, you should experience greater precision in medication safety screening and overall better patient safety.
