How Hospitals and Health Systems are Transforming 340B Dollars into Community Impact – Part 2

Last month, Clearway Health’s Allison Arant, Senior Vice President, Client Development and Marketing, moderated a Becker’s Healthcare webinar on How Sinai Chicago and Cottage Health are Transforming 340B Dollars into Community Impact. The following Q&A is a continuation of the part 1 discussion. Topics featured include documenting and reporting 340B Program savings, key specialty pharmacy trends and best practices, preparing for the 340B rebate model, efforts to support uninsured and underinsured patients and how to optimize and grow a specialty pharmacy program. Joining the panel were:

• Sameer Shah, PharmD, MHA, CSSBB, FACHE, President, Mount Sinai Hospital, Sinai Chicago

• Scott Wester, President and CEO, Cottage Health

• Brandon Newman, PharmD, CEO, Clearway Health

Question and Answer:

Allison Arant: How important is it for health systems to document and report how they are reinvesting savings generated through the 340B program? Can you discuss how organizations can effectively measure and communicate their 340B impact, including demonstrating that those savings are being reinvested in compliant ways that support patient care and other essential services?

Scott Wester: Cottage Health is not a huge system. We don’t have the same depth of expertise that Clearway Health provides when it comes to understanding complex rules and regulations, along with the analytics and industry knowledge needed to support health systems of any size across the country. Our partnership allows us to tap into that expertise to ensure we remain compliant with regulations and stay focused on fulfilling the mission and purpose of being a 340B facility. We can tell story after story and document everything because of the systems we put in place.  

Sameer Shah: We have a team that closely tracks how we reinvest program savings, including investments in people such as pharmacists and patient liaisons. We are one of the top five hospitals for providing charity care in the nation. Through the 340B Program, we support a significant number of Medicaid, underinsured and uninsured patients. In fact, Sinai Chicago serves more Medicaid patients than any other hospital in the state and potentially the country. Regardless of a patient’s insurance status or ability to pay, everyone who comes through our doors receives the same high-quality care.

I’m proud that we’ve made medication access a key part of our specialty pharmacy program. Whether patients are insured, underinsured or uninsured, we find a way to make their medications accessible—through manufacturer assistance programs or by using our 340B savings to help cover the cost. We utilize opportunities through the 340B Program to make sure everyone gets the care they need.  

Allison Arant: Brandon, as you look across the hospitals and health systems you work with, what are some of the key trends or best practices you’re seeing?

Brandon Newman: There is a lot to unpack when we talk about expanding access and closing gaps. For example, what does access look like for patients when they leave the four walls of the hospital? Oftentimes, when we partner with a new health system and we interview the providers, they have no idea what happens after they write a prescription for the pharmacy and the patient leaves their appointment. In many cases, the physician may not speak with the patient again until their next visit, which could be four to six months later. They often have no way of knowing whether the patient ever received the medication or whether they stopped taking it. Without an in-house specialty pharmacy, providers lose that visibility, making it much harder to effectively manage and support their patients.

Some of the touch points of having an internal specialty pharmacy include the ability to communicate with these patients frequently between all their encounters with the providers. The pharmacy team provides clinical check-ins, calls patients to schedule their refills and documents all encounters, so the providers have insight into this history when a patient comes in for a follow-up. The physician can see when the patient received the medication after they prescribed it and will receive the specified number of refills. The prescribing provider will also see the pharmacy team’s notes if the patient had side effects and that the pharmacist helped them work through it. This clinical history gives much better visibility than what they would have had previously seen without an internal specialty pharmacy.  

Digital engagement is also an important part of keeping patients connected to their care. When patients become difficult to reach, phone calls can often turn into a frustrating game of phone tag. Instead, we can use text messages and push notifications to collect patient-reported outcomes and check in on how they are doing. These communications can be tailored to a patient’s specific condition and medications, giving us better knowledge of how they are feeling and how well their treatment is working. Patients can also conveniently schedule medication refills through these digital tools. We find that when patients can simply click a link and schedule a refill at their convenience, they are more likely to stay on track with their medications and spend fewer days without treatment.  

Allison Arant: With the proposed 340B Rebate Model now expected to begin in January 2027, along with the ongoing impacts of IRA and MFP changes, there is a great deal of uncertainty about the future. How are organizations preparing for these changes, and what steps should health systems take now to protect their 340B programs and remain financially sustainable? As you plan for the future, how are you approaching financial forecasting, drug pipeline growth, cash flow needs, and the additional operational resources that may be required under a rebate model?

Sameer Shah: Ultimately, our priority is to stay focused on patient care and ensure patients can access the medications they need. Many of these changes will add administrative burden for health systems, especially safety-net organizations that may not currently have the staffing or resources to manage them. If these changes move forward, we will need to adjust accordingly.

We are concerned about the cashflow implications with the 340B Rebate Program. We will need to add another third party into the mix and ultimately what happens is the patients are the ones that are going to be impacted. It's our job as a health system to protect our community. We are going to do whatever it takes to make sure patients continue to have access. I think the key is to look for opportunities across the health system where we can expand into new services, provide better support for our patients and increase our overall ability to provide care.

From an advocacy standpoint, we need to speak to our aldermen, senators and congressmen and women so they understand how much this is going to impact safety net hospitals. We have to continue to explain this to everyone before these policies are enacted. I think these conversations need to come back, and we need to get real about letting people know how this is going to impact patients, how this is going to harm patients. If you don't have access to medications, your outcomes will change. We must continue to focus on that as a group.  

Allison Arant: Scott, As the number of uninsured and underinsured patients continues to grow, particularly in today’s challenging economic environment, how are health systems adapting to better support these patients? We’ve already discussed efforts to expand access to care and specialty pharmacy services, but how else are your organizations evolving to meet the needs of patients who may have lost traditional sources of support?

Scott Wester: About a decade ago we started to integrate into the community through the work we've done with population health. The use of technology provides a lot more sophistication about how we treat the whole person, not just treat the acute issue that might be at hand. Care coordination has become essential not just at Cottage Health, but for many health systems. Working with community partners, predominantly on the social determinants of health, ensuring we direct the right resources to the right issue that are at hand for patients. We say it all the time here at Cottage Health, we don't have to control everything, but we better know how to coordinate and better understand what resources are available so we can do handoffs with our other community partners to ensure that patients are getting the care they deserve.  

More importantly, we want to help patients understand how to manage their health and take care of themselves, so they don’t have to rely as heavily on the emergency room for care. It’s been encouraging to see how organizations like ours are working more closely with community partners to make this happen.

Sameer Shah: There is a lot of uncertainty, as we all know. We see what's coming down the pipeline. I agree, continuing focus on preventative care and optimizing quality and patient safety for our patients is still a number one priority. We are putting a lot of work into our redetermination process. As potential HR1 implications come down the pathway, we want to make sure our communities have the navigation to help them with the increased number of Medicaid redeterminations. Patients are going to have to reapply twice a year now, so we're going to help them fill out the paperwork requirements. There is a lot of administrative work required of our patients, so we want to help them understand and complete the necessary paperwork to maintain their Medicaid coverage. This is a major initiative that we are already working on because if patients don’t complete the paperwork, they could lose their insurance, which can have a significant impact on our community.

Being cost-effective will always be a priority. We’re focused on providing the best possible care at the lowest cost while maintaining strong patient outcomes. That means improving how we use lab and pharmacy services and taking a closer look at imaging to make sure patients receive the right services—no more and no less. Our clinicians are working closely with us to make these improvements. We’re also focused on revenue cycle to make sure we are properly reimbursed for the care and services we provide.

Allison Arant: What advice would you give to other hospitals and health systems on how to optimize, grow, expand or start a specialty pharmacy program to serve your patients and your community?

Scott Wester: It takes time to get a specialty pharmacy system built and operationalized, but every day you don't think about it is a day you miss opportunities. Over a short period of time, Cottage Health has started to see the fruits of opening a specialty pharmacy in collaboration with Clearway Health. The results speak for themselves, but more importantly, this helps ensure patients have access to the care and medications they need, especially specialty medications. My advice is to leverage an experienced partner and subject matter experts who can help you navigate through this very complex world while ensuring compliance and operational excellence. A well-integrated specialty pharmacy is not just simply a pharmacy service. It is a strategic approach that improves patient access, strengthens care coordination, supports physicians and helps the health system care for the whole patient. As healthcare leaders, that is at the heart of what we do and why we do this work.

Sameer Shah: My advice is to start off with your strengths. Every health system has very strong service lines that would be even stronger with the addition of a specialty pharmacy program; I would start off with those. I would engage physicians early in the process. Talk to your key physicians and make sure they are aware and understand why the health system is investing in a specialty pharmacy, how this is going to make life easier for them, open access for their patients and improve outcomes. Finally, understand what you don’t know. Identify the gaps in your current specialty pharmacy model and where there may be opportunities for improvement.

There are many complex compliance, regulatory and safety requirements to manage. The key is to understand where your gaps are and either build that expertise internally or partner with someone who can help you scale quickly. We decided to partner with Clearway Health, and it's been a great partnership, and we have been able to scale more rapidly than we would have on our own. That was the number one rationale for doing what we did. Now what we see is access is going up, our program is growing and more importantly, patients are getting the treatments they need, that in a safety net system, they wouldn't have otherwise had access to and that's a game changer.

Brandon Newman: Do not underestimate the pace of the changing landscape and the complexity involved – not only for new specialty pharmacy medications coming from the drug pipeline, but also for 340B compliance.  

Secondly, don't delay. It's about being able to scale quickly and do this quickly. Every day you delay, just thinking through your initiatives and your strategy around specialty pharmacy, you're missing out on an opportunity to change the way your patients and your providers experience specialty pharmacy. You are foregoing an opportunity to be able to use the dollars generated from the 340B Program to reinvest in your patient populations in many ways. I hesitate to call it an easy button because it's not easy to create it, but once you do create a specialty pharmacy, and oftentimes that means working with a partner to accelerate it, it makes a huge impact, not only for your patients, but for your providers too. We hear so much about provider burnout and what they are facing and with nursing shortages. This has been a big satisfier that we have heard from many of our partners, as well, that it's just made that experience so much easier.