Dea Belazi, President & CEO, AscellaHealth
Most pharmaceutical drugs are inexpensive— nothing too serious to cause a dent in the fi-nances of either the insurance provider or the patient. But in the case of several rare disease states, the medicinal cost can go up stratospherically, putting a great co-payment burden on the patient and cost to the payer. For instance, Bloomberg reports that the FDA has recently approved gene therapy for a rare childhood disorder that is now the most expensive drug on the market costing $2.125 million per patient. When it comes to life or death, the treatment cost should never stand in the way, which is where AscellaHealth steps in. The company is a specialty pharmacy and medical benefit drug management services provider who acts as a mediator between the pharmaceutical company that manufactures specialty drugs, insurance providers, and pharmacies. What do they accomplish? By negotiating and working with their partners in the manufacturing and insurance sectors, the company can bring down the price of lifesaving specialty drugs to patients by up to 50 percent.
AscellaHealth notes that the specialty pharmacy drug spends in the U.S. is around 40 per-cent over the overall pharmacy spend and growing very fast. That’s where Dea Belazi, President that with innovative programs designed by AscellaHealth, they can minimize cost, maximize patient health and boost positive outcomes. He mentions, “This is where we as an organiza-tion are focused at—not just on the financial aspect, but also the clinical, quality and access components as well. As a specialty pharmacy management provider today, we are developing new models and systems for the benefit of the patient, which has been very big for us, and is our exclusive focus.”
A New Model for Better Quality of Care
AscellaHealth prioritizes patient care above all else. They seek ways to clinically manage the patient better, ensure specialty pharmacy management, provide timely delivery of drugs at the best price, and reduce drug wastage. They achieve these objectives with their alternative funding models that work together to bring prices down. “We are able to bring about excel-lent discounts with the manufacturers and pharmacies through our benefits management, to ultimately bring costs down for the patient,” adds Belazi.
The company’s latest initiative is the creation of brand new payment models. For instance, AscellaHealth notes that in the cell and gene therapy market, the products coming out are costly and that there must be a better way to pay for them. Consequently, the company has developed a structure/process that can provide, in essence, a loan-based structure to the cli-ents. The structure allows patients to pay their bills over an extended period of time instead of paying the entire sum all at once. As a result, AscellaHealth can manage the patient during that time, extend the episode of care in terms of the payment, turn it into a multi-year billing process to sink an employer group or health plan, preventing the use of stop-loss or reinsur-ance. In addition, the program provides a warranty with the manufacturer so that if a treatment doesn’t work or if there is a negative outcome, AscellaHealth can provide relief on the cost incurred. The company also provides an element of portability if the patient goes from one health plan or one employer to the next.
We have a very unique 340B program that utilizes telemedicine, that's creating some very comprehensive clinical services with our clinical partners, to provide exceptional discounts for many of these specialty medications
In such a case, AscellaHealth can carry that cost structure from one organization to the other. This is indeed an entirely new way to manage these high-cost specialty gene therapy expenses, which can bring a lot of sustainability and relief to the patients, and in turn, the pharmacies, manufacturers, and carriers. Consequently, patients are less likely to find themselves in a difficult situation without the necessary funds to purchase their medicines.
AscellaHealth’s other initiative involves an alternative funding model to facilitate discounts for the customers. The company has been doing it with specialty medication for a very long time, using everything from assistance to specific treatment programs. “We have a very unique 340B program that utilizes telemedicine, that’s creating some very comprehensive clinical services with our clinical partners, to provide exceptional discounts for many of these specialty medications,” states Belazi. AscellaHealth had started doing this five years ago and currently has several models, with the 340B model having gone live last year. The company has several health plans that are presently using this today, and they plan on promoting it more aggressively this year for the marketplace.
Delivering Results the Ascella Way
AscellaHealth’s initiatives always begin with assessing the market challenges, particularly around the specialty conditions states. This involves looking at the carrier data, claims in-formation, and patient records to understand the unique challenges they face in terms of the costs, waste, and methods to better clinical management. AscellaHealth strives to identify pharmacies and pricing models that can assist this effort, examining if manufacturers’ dis-counts can support clients at every stage of their therapy. The company always has a keen eye on the evolution of specialty disease states and the new therapies that are coming out. Thus, by analyzing the data, reviewing the space, and then coming to the client with a plan, Ascel-laHealth demonstrates their clinical, financial, and management programs as a whole. All of this helps them bring the cost of treatments down by 10 to 50 percent, depending on the treatment. Once AscellaHealth gets the client on board, they execute the plan very specifical-ly, starting with the “lowest hanging fruit” and then tackling the more challenging cases as they get more involved with the client process, patients, and specific client or patient needs.
“Holistically speaking, we have a specialty hub model within the organization which deals with all the needs of the patients and customers, and we really try to offer a white glove ser-vice to the clients, so that we are handling every aspect, including the delivery of their medi-cation, sending it directly to their home, and even sending a nurse to their home to facilitate administration,” adds Belazi. AscellaHealth can offer a betterdiscounted product to the tradi-tional hospital or provider site by managing site of care either to the home or to the physi-cian’s office or to an ambulatory care site. The company deals with alternative funding, which provides a unique discounting model to patients and clients in a unique manner so that they are generally paying significantly less. These programs are embedded through internal processes, the analysis of which helps AscellaHealth figure out where and what to target with patients.
The Future in the Making—a New Dawn in Specialty Therapy Models
With innovative programs designed by us at AscellaHealth, we are able to minimize cost, maximize patient health and boost positive outcomes
The company has had tremendous growth and are launching their new financial payment models, which many clients are interested in. AscellaHealth is currently excited about its val-ue to the marketplace. With their 340B specialty model, the company is looking to expand that nationally, which will be another massive initiative for them.
All of this could be possible only with the continued collaboration of the AscellaHealth team. In addition to traditional members like physicians and pharmacists, the company also has many IT pros and skilled members from financial services arena. They have given Ascel-laHealth a new perspective on managing the cost side when introducing these new approach-es. The company always tries to complement their teams with excellent customer service folks, especially when dealing with the patients, because that is an extremely high priority for AscellaHealth. “We want to make sure that the patients know that there is someone who cares, and we want to offer a real white glove service, with our specialty coordinators there to help them, even if it is not fulfilling a product, to say get a doctor’s appointment. This has helped build a culture of communication and innovation to try and get people to collaborate,” Belazi adds.
Due to AscellaHealth’s almost exclusive focus on specialty pharmacy, their customers love their flexible, customizable, and innovative ability. The company is constantly looking for different ways to manage specialty medicine costs, quality, and clinical outcomes, which fuels their drive as an organization. “We are innovative in trying to find better solutions for the market place and that is how we believe we are going to continue to grow,” concludes Belazi.