Why Lakeland Regional Health Created Its Own Specialty Pharmacy

At nonprofit Lakeland Regional Health in Central Florida, Ana Kalman wears many hats. She is senior vice president and chief information officer, chief applications officer, and chief operating officer at the health system’s 910-bed medical center. As CIO and chief applications officer, she is in charge of the digital aspects of the enterprise; as COO for the medical center, she has responsibility for several support departments, including pharmacy. 

In a recent interview, Kalman spoke about why Lakeland chose to create its own specialty pharmacy operation, starting with oncology and rheumatology, with plans to expand into additional specialties over time. 

“The greatest benefit is our ability to control the level of care that we can provide our patients,” she said. “We can have closer contact with our patients to make sure that they have what they need when they need it, and also that they can be compliant with their therapies, because they don't have to worry about all the minutiae in the complex process of pre-authorizations and financial support. We can make sure that there are no interactions with other drugs, and that they understand the secondary effects of these drugs, so we can extend our care past the encounter.”

Kalman explained that the model includes new positions called “liaisons.” Placed in each of the practices leveraging the service, these liaisons are Lakeland Regional Health employees who are the point of contact for the patients, clinicians, and financial staff involved in this process. 

“These are the people who are the channel for our patients to become aware of the service and to enroll in the service,” Kalman said. “They work with people who are off-site who help process the authorizations and all the paperwork that is required for the patients to obtain the medications.”

When Lakeland decided to set up its own specialty pharmacy operation, it partnered with a company that calls itself a “specialty pharmacy accelerator” — Shields Health Solutions, which has worked with more than 80 health systems nationwide. 

“When we made the decision at an executive level that we wanted to pursue the creation of a specialty pharmacy, we developed an RFP just to make sure that we considered other vendors,” Kalman explained. “We did a review of capabilities. We had an enormous amount of discussion about the model and how to go about it. What component of the process would the vendor support us with and what would we have to do? Based on all of these things, we made a decision that Shields was the best-suited partner for us.”

Dylan Collins, regional vice president of operations for Shields Health Solutions, said his company often works with health systems creating specialty pharmacy operations from scratch. “In some instances, we work with healthcare systems that want to accelerate the growth of their specialty pharmacy programs. And then there are health systems like Lakeland, where they need a place to start, and they partner with Shields to help found the project, and then subsequently grow over the course of many years.”

Collins said the company’s integrated solutions span technology services and operational support. “Working closely with Ana and her team, we've really ensured that the care model is fully embedded into clinic and pharmacy workflows for a seamless launch. Our focus is the patients who are most in need, and specialty pharmacy presents that opportunity. We find that health systems really need that expertise to start and grow their programs.”

He added that the care model is fully integrated in the EHR, so the prior authorizations, financial assistance, and clinical interventions are all documented directly in the EHR, which provides transparency and continuity of care. Collins said that information also gets leveraged by providers, clinicians, and administrators to track the patient journey. “I would say that reporting and analytics are essential to program success. Shields provides comprehensive support for accreditation as well as payer and manufacturer reporting, which includes metrics on patient adherence, time to therapy, financial assistance, and outcomes. We also review and provide analytics to inform strategic initiatives. That's all in service of expanding the care model to as many patients in the health system as possible.”

The specialty pharmacy has only been operating for a few weeks, but Kalman said it has been well-received by patients and providers across those two practices. “So far, we have received great reviews and are very excited to continue to promote this program. Eventually, we will expand to other practices where it makes sense, where specialty prescriptions are common, because we want to make sure all our patients benefit from this improved service. So that's the plan for next year.”

Collins noted that in working with other health systems, before the care model is implemented Shields often finds that clinic operations are fragmented or decentralized, meaning each clinic or practice has its own way to navigate a prescription, and that can lead to delays in therapy initiation. “The care model is designed to address these challenges by streamlining prior authorization, overcoming financial barriers and ensuring patients receive medication as quickly as possible,” he said. “The reception from practices is usually ‘When can you start?’ because they're drowning in that administrative burden, and we're happy to take that on and create a solution that's centralized and streamlined across the health system.”