Dea Belazi, CEO & President, Ascellahealth
Dea Belazi, the CEO and President of AscellaHealth, speaks proudly about how their service helped a baby suffering from spinal muscular atrophy, a rare genetic disease. A multinational drug manufacturer had just launched a gene therapy for the same, and the physicians wanted to try it on the baby. However, there was only one pharmacy that sold the medicine, and it had a steep price point. Desperate for a way forward, the Third Party Administrator (TPA) reached out to AscellaHealth, who, in the matter of a week, was able to come up with an affordable solution. AscellaHelath approached the drug manufacturer and their healthcare provider and availed additional discount for the medication. “We coordinated with the patient’s family, physicians, and the healthcare provider to manage this scenario in a way to provide qualitative care,” says Belazi. As the company acted at the right time and implemented a custom pharmacy benefits model in a short period, the TPA was able to procure the necessary treatment for the patient at an affordable cost. In addition to getting the prescription drug administered to the patient, AscellaHealth also helped the TPA save significantly on the treatment.
"Our approach provides clients with the advantage of a full suite of sophisticated SPBM services"
Such success stories stem from AscellaHealth’s tactical abilities pertaining to specialty pharmacy benefit management. As an innovative, specialty pharmacy benefit manager (SPBM), AscellaHealth offers high-quality prescription drug management services. The company concentrates on specialty or rare diseases that have limited treatment possibilities and often costs high. “We take a humane approach and use innovative methods to understand the needs of TPAs and patients before entering into a contract with them,” mentions Belazi. AscellaHealth works with physicians, pharmacies, drug manufacturers, TPAs, and healthcare providers to manage treatments in a way that supports affordable and qualitative care.
Soup to Nut Approach
While most PBMs follow a cookie-cutter approach to pharmacy benefit management, AscellaHealth’s operating model focuses on delivering personalized and customized experiences. “We offer flexible options for health plans, employer groups, TPAs, brokers, unions, and hospitals. Our approach provides clients with the advantage of a full suite of sophisticated SPBM services,” states Belazi. The company achieves this by designing unique benefits programs for their clients.
AscellaHealth adopts a distinctive methodology while designing the programs. For instance, for clients looking for cost containment programs, AscellaHealth comes up with a better price point through a thorough analysis of specialty drug utilization. The cost savings are also achieved through limited specialty drug programs and utilization management, therapy optimization programs, and by making use of AscellaHealth’s pharmacy network service. By renegotiating agreements made with pharmacies, hospitals, and working with healthcare providers, the company helps to create a payment model that benefits all stakeholders. Clients can also integrate medical and pharmacy benefits and design a plan that best fits their members.
We take a humane approach and use innovative methods to understand the needs of TPAs and patients before entering into a contract with them
AscellaHealth follows an Amazon-like service delivery model wherein they have a nationwide pharmacy network for specialty drug prescriptions, which is primarily delivered via mail-order. This network enables the company to give patients easy access to specialty medications for treating complex chronic conditions at a low cost. AscellaHealth’s association with pharmacy networks proves to be extremely beneficial also for hospitals. As the network can be integrated with hospital pharmacy, hospitals can reap the benefits of limited-distribution specialty drug programs that the company offers.
Going beyond typical PBMs, AscellaHealth also provides solutions for patient engagement. The company makes use of innovative solutions that are accessible via the web or mobile application for its clients as well as patients. The applications ensure that patients are actively involved in their health and pharmacy decisions. It features informative tools such as personalized reminder messaging, drug price comparisons, and pharmacy locator—tools that encourage member engagement. Besides, the company leverages its technical prowess while processing the claims adjudication for patients. Their claims processing system and web-based reporting tools enable users to access cost data in real-time, thereby making the adjudication process seamless.
Caring for the Future
A key component of AscellaHealth’s pharmacy benefits program is its specialty coordinators. These coordinators play a significant role in ensuring the seamless collaboration of various entities such as the patient, the physician, and the pharmacy. “Our specialty coordinators are like the quarterbacks,” mentions Belazi. For instance, patients have limited options when it comes to tackling drug prices. Coordinators assist them through copayment assistance programs that reduce the patients’ cost. In essence, the specialty coordinators manage the patient and give them a concierge level of service by making sure that they’re connected to doctors and to specialty pharmacies.
When a patient switches from a traditional PBM to AscellaHealth, it is crucial to ensure that they face only minimal disruption from the treatment they are undergoing. The specialty coordinators take care of such situations. In addition, they ensure that the medical facilities that can infuse specialty medications are equipped and capable for admitting new patients. For patients located in remote areas where infusion centers are not available, the specialty coordinators make sure that infusion services reach their homes.
Relegating the One Size Fits All Approach
“Our approach to PBM is not a one size fits all model; should the need arise, we make necessary modifications to the model,” mentions Belazi. As customizing the SPBM services for varying client demands requires a unique and well-planned process, AscellaHealth follows a unique process flow that helps its representatives understand exactly what their clients are looking for.
The client onboarding starts with the evaluation process, where AscellaHealth’s representatives look into the whereabouts, needs and challenges of the client. While doing so, representatives also go through claims data to find opportunities for cost savings. There can be instances when data fail to provide information about some of the minor challenges faced by the client. In that case, representatives engage with the client to obtain the missing information. After the evaluation, the firm designs an alternate, feasible model that matches the client’s requirements. After developing a unique model, AscellaHealth moves to the next phase of implementation, during which the company connects physicians, patients, and pharmacies for seamless service delivery. At this stage, AscellaHealth also exchanges the required data between employer groups, TPAs, and hospitals. For TPAs that are engaged in population health, this data is of significant importance as it gives real-time information and actionable insights into the dynamics and needs of patient populations.
Apart from being a full-service SPBM, AscellaHealth specializes in a program for all-inclusive care for the elderly or PACE. Most PACE plans are small in scale, comprising 50 to a few hundred members and, thus, don’t pique the interest of large PBMs. AscellaHealth, however, outlines the best pharmacy practices that enable senior citizens to receive the entire continuum of care from the comfort of their homes.
Another focus area for AscellaHealth is its hemophilia management program. By harnessing a variety of resources to manage treatments for hemophilia, AscellaHealth provides unprecedented control, transparency, and accountability for physicians, specialty pharmacies, and patients. Not only does AscellaHealth leverage its specialty pharmacy network to obtain the best prices for hemophilia medication, but it also utilizes innovative technology to monitor medication dispensing in real-time and provide clinical interventions to all stakeholders when necessary.
Moving ahead, AscellaHealth is looking to further differentiate itself through state-of-the-art tools that will enhance the engagement of patients and attainment and management of medications and diseases. “We are doubling our IT budget to bring technology at the forefront of our efforts to care for our customers efficiently,” mentions Belazi. The company is also investigating methods to make its engagements with physicians more seamless. With their indomitable customer-centric strategy and focus on innovation, AscellaHealth is set to be a winner in the Specialty PBM landscape.