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2 05/01/2023Shields Health Solutions
Shields Family Of Businesses - Overview Dialysis
(1970s – 1980s)Advanced Imaging
(1980s – Today)Radiation Therapy (1990s – Today) Specialty Pharmacy (2010 – Today)
Market Need - Local market dominated by national for-profit entity (later Fresenius)
- Poor quality and patient service- No community-based providers- No low cost / high quality
option for patients, employees & insurance plans
- Market dominated by teaching hospitals
- No community hospital providers- Extensive capex and operating
costs- No low cost / high quality option
for patients, employees & insurance plans
- Market dominated by teaching hospitals
- No community-based providers- Extensive capex and operating
costs- No low cost / high quality option
for patients, employees & insurance plans
- Market dominated by Fortune 100 companies (PBMs)
- Fragmentation of care & poor patient care/service
- Infrastructure required to hold payer/drug contracts and provide patient advocacy services
- No low cost / high quality option for patients, employees & insurances
Shields Model & Hospital Solution
- Compete with market monopoly- Improve care quality & patient
service- Bring highest quality patient care
to community setting
- Compete with Boston teaching hospitals
- Partner with academic medical centers outside of Boston (& Boston teaching hospitals)
- Bring highest quality patient care & service to local communities at lowest cost
- Develop centralized infrastructure to provide hospital partners with expertise and immediate economies of scale
- Compete with Boston teaching hospitals
- Partner with academic medical centers (including Boston teaching hospitals) in community setting
- Bring highest quality patient care & service to local communities at lowest cost
- Develop centralized infrastructure to provide hospital partners with expertise and immediate economies of scale
- Compete with Fortune 100 companies - Assist academic medical centers in
eliminating care fragmentation and optimizing specialty pharmacy opportunity
- Bring highest quality patient care & service at lowest cost point
- Develop centralized infrastructure to provide hospital partners with expertise, patient advocacy services, PBM-like requirements and immediate scale
Results - 2nd largest dialysis provider in New England
- Highest quality patient care/service at lowest cost in market
- Largest imaging provider in New England with 1/3 market share in MA
- 40 hospital joint venture partnerships- Highest quality patient care/service at
lowest cost in market
- Largest independent RT provider in New England
- Highest quality patient care/service at lowest cost in market
- Largest hospital-centric specialty pharmacy provider in USA
- Highest quality patient care/service at lowest cost
- Unparalleled patient, provider and partner satisfaction/results
- Solution to $200B market and ability to lower TME
Shields Formula For Success- Identify opportunity where market dominant players have lost focus on what is truly important - highest quality patient care / service at an affordable price point
- Compete directly with market dominant players by focusing on what is best for patients - highest quality care / service at the lowest cost point
- Never compromise patient care and clinical / front line resources, yet generate economies of scale / cost efficiencies through a centralized infrastructure
- Partner with academic medical centers and community hospitals to provide a value-added solution - extend patient services / outreach and improve hospital revenue / margin opportunities
- Become an industry leader in respective healthcare services verticals – dialysis, advanced imaging, radiation therapy and specialty pharmacy
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SHIELDS MRI – BUSINESS CASE
11 Health System Partners | 16 Hospitals | MRI, PET/CT, Oncology, ASC
4 Shields Health Solutions
SHIELDS NETWORK – SPECIALTY PHARMACY8 Health System Partners | 14 Hospitals
Pittsfield, MASpringfield, MA
Worcester, MA
Pawtucket, RI
Providence, RI
Warwick, RI
Wilmantic, CTNorwich, CT
Hartford, CT
Meriden, CTSouthington, CT
Newark, NJ
Camden, NJ
New York, NY
*Launching
5 Shields Health Solutions
NEW FINANCIAL OPPORTUNITIES FOR HOSPITAL
Specialty pharmacy represents
15% new, incremental revenue to a health system
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SHIELDS LEGENDARY CARE MODEL
PATIENT LIAISONS
OPERATIONAL
SUPPORT
DATAANALYTICS
Limited Distribution Drug ACCESS
PATIENT SUPPORT CENTER
PAYOR CONTRACTING/ Pharmacy Accreditation
REVENUECYCLE MANAGEMENT
340B Expertise
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CONTRACT PHARMACY PITFALLS - $100M OPPORTUNITY
- Hospitals can receive roughly 1% of the total opportunity- Fortune 100 companies take most of the 340B savings while capturing:
- Additional patients, scripts, and data- Free sales and marketing from hospital- Hold all of the leverage. Hospital has no options if contract pharmacy relationship ends
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HOSPITAL OWNED SPECIALTY PHARMACY- $100M OPPORTUNITY
- Fortune 100 companies are excluded from 340B savings intended for safety net hospitals- Hospitals retain all patients, scripts, and data- Hospitals can use this data and improved care model to bend the cost curve and go at risk
with payers
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HOSPITAL BASED SPECIALTY PHARMACY LEVERAGING BEST PRACTICES
Accreditation
Limited Distribution
Drugs
Data Analytics
Telemetry Center
Direct to Payers
Population Health
Minimum 1 year in business. Required for
national payer contracts
Payer Contracts
Infrastructure required to hold payer contracts:
24/7/365 patient support center,
medication adherence monitoring, specialty drug access, statistical tracking, accreditation standards/procedures
Develop a care model with a
proven track record with manufacturers.
Data collection capabilities and
reporting metrics are required
Software tools needed to provide
reports to payers and manufacturers on a
weekly, monthly and annual basis
All required reporting and patient
monitoring capabilities built out
and scalable
Ability to dive deeply into data and derive
meaningful information
Precision approach related to patient
outreach, appointment lists,
patient eligibility, and prescription transfer
success rates
Eliminate the “bump in” model
300 weekly appointments
narrowed to 12 meaningful
interventions
Leverage in-house specialty pharmacy
expertise and medication
adherence rates to improve patient outcomes and
financial profitability of health system
Ability to effectively manage most chronically ill
patients across health system
Engage in “at risk” contracts with
commercial and government
insurance plans
Bundled payments
Required for fairness to patient
Required to be effective
Where healthcare is going
Care Model
Staff in Clinic
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SHIELDS’ COMPLEX DATA ANALYTICS HELPS HOSPITALS IDENTIFY TARGETED PATIENTS
EMR data
Doctor’s notes
Behavior psychology
Past drug-drug interactions
Data InputsFrom Clinics:
Telemetry Center
Financial assistancefunding
Data InputFrom Liaison:
Lab Results
Output:Targeted, specific, patient focused outreach based on eligibility and copays
Input from caretaker / family members
Patient support center feedbackMedication management issuesPatient expressed financial concernsSocioeconomic Conditions and concerns
Results:Improved patient care
More efficient utilization of clinical staff timeIncreased satisfaction for clinicians and patients
Example:- A hospital’s RA clinic had 300 patient appointments in a week- Based on the multiple inputs, the Telemetry Center identified 12 key patients who were on
specialty medications & had insurances that could fill through the hospital pharmacy- Liaison met with all 12 patients and effectively addressed their medical and financial concerns- Since in-person interaction at the appropriate time, 6 patients chose use the care model
Eligibility to utilize pharmacy/pharmaciesInsurance
Current Model
- Multiple patient appointments during the week
- Physician prescribes complex / specialty medication
- Liaison / pharm tech happens to be in the vicinity and is able to discuss the care model with patient
- Patient agrees to learn more about the program
- Liaison evaluates ability to service the patient
Output:Haphazard, “bump-in” outreach
Results:Inconsistent conversions
Frustrated patient and staff. Few will be eligible and will
result in frustration and inconvenience
Shields Health Solutions
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SHIELDS PARTNER HOSPITALS: 2015 OUTCOMES
Oncology Transplant RA Infectious Disease Hepatitis C Multiple Sclerosis GI Neurology
Medication Adherence: PDC by Specialty
87%98% 93% 93% 97% 94% 92% 97%
N A T I O N A L A V E R A G E
100%
80%
60%
40%
20%
0%
Overall Experience Comparison to other
PharmaciesOverall Experience Recommend to a Friend
Patient Survey Physician Survey
Shields Health Solutions
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PERSPECTIVES ON THE SPECIALTY CARE MODEL
Our collaboration with UMass Memorial Specialty Pharmacy has significantly improved the care our patients receive. The pharmacy is seamlessly integrated into our inpatient and outpatient operations serving as an extension of our clinical team to improve medication adherence, readmissions and patient satisfaction
“”Dr. Adel Bozorgzadeh, Chief of
Transplant Surgery, UMass Memorial Health Care
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FINANCIAL ASSISTANCE – SUCCESS STORIES“Patient A.O was having problems with his present pharmacy at Walgreens because they were telling him his immunosuppressant medication was not covered and he would have to spend over $1,000 to get it filled. There was a little language barrier with the patient and he wasn’t understanding what Medicare was trying to tell him. I was able to organize a conference call between Medicare, the patient and I to try to figure out why his Medicare was not covering his medication. Luckily because we did the 3 way call, Medicare was able to fix the glitch in the system and patient was able to get his medication.”
“Patient C.B’s insurance became terminated in 9/2015 and would be active again in mid 10/2015. I was able to get patient assistance for his Xifaxan through the manufacturer Salix. He was able to get medication free of charge until the end of 2015.”
“Patient AV has been paying $450/month for his prescription for Viread, he called me asking if there is anything that could be done with his co-pay. I applied him for patient assistance through the Pan Access Network and he was approved with a $0 copay monthly. Patient was extremely grateful for the assistance because now it was extra money he could have in his pocket for his grandkids.”
http://www.telegram.com/article/20150311/NEWS/303119981
In the news:
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BENEFITS OF A HOSPITAL OWNED SPECIALTY PHARMACY
• Hospital branded
• Capture margin on non-340B drugs
• Gain access to additional limited distribution drugs
• Contract directly with payors
• Convenient on-site location allows for real-time dispensing
• Ability to carve-in Managed Medicaid business
• Improved patient monitoring
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THE CONTRACT PHARMACY ARRANGEMENT RESULTS IN LOSS OF INFLUENCE AND CONTROL
Hospital Pharmacy
Adherence
Care Continuum
EMR
Payor Contracts
Dispensing Fees
Software Fees
Contract Pharmacy
Adherence
Care Continuum
EMR
Payor Contracts
Dispensing Fees
Software Fees
Hospital’s Sphere of Influence / Control
Hospital’s Sphere of Influence / Control
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PARTNERS
17 Shields Health Solutions
CHIEF EXECUTIVE OFFICERJACK SHIELDS
508-400-6600
VP OF BUSINESS DEVELOPMENTERIC SUCHECKI
949-842-7847
