CASE STUDY
www.cps.com
IMPROVING PATIENT CARE:
UNION HEALTH IMPLEMENTS
SYSTEMWIDE SPECIALTY
PHARMACY SERVICES
BACKGROUND
n An Integrated Health System Dedicated to Treating the Whole Patient
Union Health is an integrated health system serving communities throughout western
Indiana and eastern Illinois. The main campus, Union Hospital, is a 350-bed not-for-profit
community hospital in Terre Haute, Indiana. The health system also includes Union
Medical Group, which is comprised of over 130 providers in 20 specialties practicing
at locations throughout the region — making it Wabash Valley’s largest multi-specialty
provider group.
Union Health strives to provide patient-centered care using a collaborative,
multidisciplinary approach. An essential part of that care is helping patients get
affordable access to the medications they need. That’s why Union Health had
long operated two outpatient retail pharmacies — one in the main hospital serving
discharged patients and employees and another for the general public in their medical
office building. However, at that time, the health system did not have its own specialty
pharmacy, which left a gap in its ability to provide exceptional patient care for those
prescribed complex, expensive therapies to manage cancer, rheumatoid arthritis, HIV,
multiple sclerosis, and other chronic conditions.
THE CHALLENGE
n Navigating the Complexities of Specialty Medication Access
According to System Director of Pharmacy Services, Dan Cleveland, PharmD, BCPS, for
Union Health, without a specialty pharmacy — patients and providers were left to navigate
an often confusing process on their own.
“The trouble is that process is not always straightforward,”
explains Cleveland. That’s because specialty medications require
pre-authorizations, so there can be a lot of back and forth and
follow-up required. “We were hearing from providers, especially
Dan Cleveland, PharmD, BCPS
System Director of Pharmacy
Services
~ Union Health
Kathy Canup, PharmD
Clinical Operations Manager
~ CPS Solutions, LLC/Union Health
CASE STUDY
www.cps.com
“
those in the oncology and rheumatology space, that patients were waiting weeks before
they started therapy.”
Plus, since specialty medications are often very expensive, most patients need financial
assistance above and beyond insurance coverage. “That’s just another process to be
managed and can be a barrier to treatment,” says Cleveland. “And while our providers did
what they could — they simply didn’t have the dedicated staff necessary to handle all the
administration that comes along with specialty medications.” That’s why he decided to
explore how Union Health could establish an onsite specialty pharmacy to elevate
patient care.
THE SOLUTION
n A Partnership That Paved the Way for Patient-Centered Specialty Pharmacy Services
After conversations with a number of potential partners, Union Health ultimately chose
CPS Solutions, LLC (CPS), one of the nation’s largest pharmacy and hospital services
providers, to build out and manage their specialty pharmacy. “One of the things that stood
out about CPS was their expertise and relationships with payors and manufacturers,”
Cleveland says. Most payors require dual accreditation for specialty pharmacies to gain
access to their specialty networks and limited distribution drugs — and CPS’ team of
experts helps systems like Union Health earn those accreditations rapidly. “I just knew
my team and I would not have the time to navigate that piece of the puzzle, so it was
important for me.”
While payor access is one of the keys to a successful specialty pharmacy — having the
people and processes in place to help patients is also critical. That’s why CPS hires and
integrates pharmacists and liaisons in clinics to work directly with staff and providers
under Union Health’s brand. The benefit of CPS’ locally-focused approach is that when
one of the specialty pharmacy team reaches out to patients — they know they are talking
to someone from their community. “We’ve found that having a local Terre Haute patient
talking to a Terre Haute-based pharmacist or liaison has made a difference in building
trust and helping them understand we have a specialty pharmacy right here onsite,” says
Senior Vice President, Zel Skrtic, PharmD, of Onsite Operations for CPS.
Clinical Operations Manager, Kathy Canup, PharmD, who grew up in Wabash County and
has been with the health system for 13 years, oversees the specialty pharmacy operations.
She and her team take the time to work with patients to get medications into their hands
as quickly as possible. “We get prior authorizations and do what we can to make the
medication affordable through insurance, copay cards, financial assistance programs, or
grants,” Canup says. Beyond that, specialty pharmacists and liaisons support patient needs
— walking them through treatment plans, helping them manage refills, and more.
THE RESULTS
n Fast, Affordable Access to Critical Specialty Medications
Union Health Specialty Pharmacy opened its doors in February of 2021. “Once we signed
the contract — it was pretty much plug and play from our
standpoint,” says Cleveland. CPS handled everything, including
absorbing the upfront risk from a capital and operational staffing
perspective. “Hospitals our size don’t often have an onsite
Hospitals our size
don’t often have
an onsite specialty
pharmacy. Being
able to help our
patients access
and manage
these complex
medications
improve their
experience and
outcomes — and
that’s something
we couldn’t have
done without the
help of CPS.”
Dan Cleveland, PharmD, BCPS
System Director of Pharmacy
Services
~ Union Health
CASE STUDY
www.cps.com
“
specialty pharmacy,” he explains. “Being able to help our patients access and manage
these complex medications improves their experience and outcomes — and that’s
something we couldn’t have done without the help of CPS.”
Today, the specialty pharmacy supports Union Health’s patients who are dealing with
various cancers, rheumatoid arthritis, neurological disorders, infectious diseases, and
respiratory conditions. Canup says having pharmacists and liaisons onsite is a big win
for clinic staff. “I didn’t realize the workload nurses were taking on trying to obtain prior
authorizations and help patients research and apply for financial assistance.” Now, with
dedicated staff to manage the process, provider satisfaction has improved. Moreover,
patients are better able to access and afford their therapies. “The specialty pharmacy
maintains a 96.7% prior authorization approval rate and has saved patients over $2.6M in
financial assistance,” says Canup.
As a result, patient satisfaction has increased, too. Union Health earned a Net Promoter
Score (NPS) of 97.7, placing it as the 2024 winner and top performer for patient loyalty in
Managed Markets Insight & Technology’s (MMIT) 9th Annual Specialty Pharmacy Patient
Choice Awards. This is a significant honor as the MMIT awards recognize health system
specialty pharmacies nationwide that provide exemplary patient satisfaction.
ADDING VALUE
n Uncovering New Opportunities
Working with CPS provides Union Health with opportunities to serve that community
that would not otherwise have been possible. This includes focusing on programs and
initiatives to improve patient adherence and outcomes.
In 2023, the specialty pharmacy team began working with a group of local neurologists
to follow their migraine patients closely. “Starting with a patient’s baseline migraines, we
track their progress once they’ve started therapies to confirm treatment is effective and
migraine days are decreasing each month,” explains Canup. If there isn’t improvement
after three months, the pharmacist works closely with the neurologist to adjust and
optimize therapy. “And when an office visit is required for further evaluation, we can
typically get patients seen faster so they are able to adjust therapies as needed in a more
timely fashion.”
Working with the rheumatology clinic, the specialty pharmacy team also conducted
a study to determine if self-administered subcutaneous injections could be a more
affordable and convenient option for patients with autoimmune diseases being treated
with intravenous (IV) therapies. The catalyst for the study was related to the cost of IV
therapies, which were becoming unaffordable for many patients, even with financial
assistance, as well as the time and expense spent traveling to a medical facility for
treatment. Self-administered medications were delivered to the homes of patients who
agreed to participate. Union Health specialty pharmacists then interviewed participants
using a standardized six-question survey to measure patient satisfaction, ease and
convenience of use, and confidence in the self-administered medication. Overall, 87% of
participants said the self-administered medication was either
extremely convenient or very convenient. With this, the specialty
pharmacy team began working with rheumatology patients to
We’ve found that
having a local
Terre Haute
patient talking
to a Terre Haute-
based pharmacist
or liaison has
made a difference
in building trust
and helping them
understand we
have a specialty
pharmacy right
here onsite.”
Zel Skrtic
Senior Vice President of
Onsite Operations
~ CPS Solutions
CASE STUDY
www.cps.com
“
educate them on at-home treatments — helping them transition from IV therapies and
secure financial assistance to cover more of the medication costs.
THE BOTTOM LINE — FOR PATIENTS, PROVIDERS, AND
UNION HEALTH
“What we do on a daily basis is very rewarding,” says Canup. “Patients are constantly
thanking us for making a complex and scary situation more manageable.” That includes
helping them get access to the specialty medications they need, as well as the financial
assistance to make treatment more affordable. She also notes that being in the clinics
helps doctors and nurses understand exactly what the specialty pharmacy team can
do for them. “The CPS team frees clinicians up to do what they are trained to do — build
relationships with and care for their patients,” says Skrtic. “That’s why we’ll continue looking
for more opportunities to help other specialty providers increase patient satisfaction.”
From Cleveland’s perspective, he believes many directors of pharmacy in smaller hospitals
might not think they can embed a specialty pharmacy. “That’s just not the case. I had
no idea what opportunity was waiting for us until we decided to establish a specialty
pharmacy.” As a result of adding specialty pharmacy services, Union Health’s pharmacy
department continues to exceed its operational margin goal. “I think any hospital with
340B access that offers specialty services should explore what is possible working with a
partner like CPS.”
For more information on Union Health, please visit their website at www.union.health.
For more information about CPS Solutions, LLC, please visit their
website at www.cps.com.
The specialty
pharmacy
maintains a
96.7% prior
authorization
approval
rate and has
saved patients
over $2.6M
in financial
assistance.”
Overall, how would you rate
the convenience of receiving
your medication with the
autoinjector?
Extremely Convenient
Moderately Convenient
Very Convenient
Kathy Canup, PharmD
Clinical Operations Manager
~ CPS Solutions, LLC/
Union Health
2023 RESULTS AT-A-GLANCE AND FUTURE GROWTH
• 80% increase in Rx volume.
• 50% growth in the number of patients serviced.
• 92% patient adherence.
• $2.6 million in financial assistance secured.
• 94% provider satisfaction.
13%
27%
60%