A Gold Standard for Patients


The HOSP Alliance‘s Gary Kerr on adding another level of value to the packaging and delivery of dispensed drugs and modifying terminology

The Health System Owned Specialty Pharmacy Alliance (HOSP) is a nationwide, member-led organization of leading health systems, which aims to be “the face and voice of the integrated specialty pharmacy industry.” It promotes the message that the fully integrated health system specialty pharmacy model is “the optimal way to improve patient outcomes while reducing the total cost of care.”

Recently, HOSP has led the way in embracing the new term “gold bagging.” “Bagging” refers to the physical packaging of a dispensed drug and how it is delivered to the care setting for administration to a patient. The other bagging terms are:

  • Clear bagging—when a health system’s own specialty pharmacy delivers medication to the clinic, hospital suite or provider office for administration to a patient
  • White bagging—when the medication from a pharmacy, typically an outside specialty pharmacy, is shipped directly to and administered at the hospital, physician’s office, or clinic.
  • Brown bagging—when a patient acquires drugs through their pharmacy and brings them to a hospital to have the product prepared and administered on-site. (This practice has typically been banned at hospitals and health system.)

The term gold bagging, however, “represents the most holistic, patient-centric, and best practice approach because it is a more controlled process within a health system with fewer potential failure points,” says HOSP. Under this method, the health system typically controls the purchase, receipt, preparation, and delivery to the point of care within its own closed environment. Gold bagging acknowledges and represents “the essential pharmacist-added value to the medication use and delivery process, ensuring safe, efficient, timely, and accurate drug administration.”

Gary Kerr

Gary Kerr

Pharma Commerce sat down with Gary Kerr, president of HOSP and chief pharmacy officer at Baystate Health, to further explore gold bagging terminology and discuss why it is time for the concept to be more widely known .

Pharma Commerce: Can you tell us a bit more about what gold bagging means ?

Gary Kerr: It is terminology more than it is an actual event or process. We at HOSP are using the word “gold” to most firmly emphasize how, in preparing the product for the patient, the health system owned pharmacy (HSSP) brings a series of value-added steps that would not occur if the product were simply shipped in from another vendor or supplier. Many HSSPs have teams of clinical pharmacists and they can and do access the electronic medical record (EMR), which outside companies cannot do for privacy reasons. So, if I, for example, as a health system clinical pharmacist, go into the EMR, I know that the patient’s clinician is also looking into it also, and he/she is going to see when my appointments are, what my lab values are, etc. Essentially, it’s a tremendous safety net to wrap around the process; our pharmacists communicate with our clinicians face to face and inside of our EMR and we’re continually making sure that things are good. And if they’re not good, we make sure that they are made good for the employee or for the patient. This could include medication adherence, disease monitoring, lab monitoring and side effects.

We’re circulating the term gold bagging to draw more attention to the extra value that is added when our staff is involved in the care of the patient. It’s like me saying that here in Western Massachusetts, when our pharmacy is involved, we’re taking care of our community patients with local and regionalized care. It’s not about a widget that’s coming from Dallas or from Fort Lauderdale; it’s a widget that’s purchased into our health system and enhanced with robust clinical pharmacy services. We double-check it, we control the delivery, the preparation, the lab monitoring, etc. And if the drug is to be infused in one of our infusion suites, we’re the ones doing the sterile mixing and the labeling and we’re talking with the nursing staff about how to administer it. These are all steps that would not necessarily happen with a product coming from outside.

You have mentioned that you’re confident that the terminology will become firmly established within five years…

That’s wishful thinking to a degree, but many of the health systems in the United States are being held more and more responsible for the patient experience as well as patient outcomes. HOSP recently published a White Paper which, among other things, compares the Net Promoter Scores (NPS) of integrated HSSPs with other specialty pharmacies. The specialty pharmacies have an overall NPS of 59, some a lot lower, while the HSSPs typically score in the 80s, indicating excellent customer satisfaction. This is the result of face-to-face communications with clinicians, patients, and caregivers; genuine human connections with commitments to follow-through; and a true high-touch, white-glove service throughout each patient interaction. These scores are an endorsement of the gold bagging concept, and our mission is now to elevate it. There are probably other organizations in the country that are comfortable with the clear bagging terminology, which is when the hospital buys the drug and dispenses it. We’re saying, yes, clear bagging implies transparency, we get that, but there is so much more going on behind the scenes that’s not reimbursed and is not acknowledged, which is why we want to push the terminology harder.

Do you envision any resistance to this terminology change idea, from payers or PBMs, for example?

The short answer is no, but we believe some organizations or pharmacy trade associations will be opposed to us disrupting the status quo terminology here. They are comfortable with clear bagging because they’ve been using the term for a while. They may say we’re going to confuse the marketplace by introducing a new term. I’d say to them however that we are simply trying to bring recognition to the power of our clinical care model, which patients are experiencing on a day-to-day, hour-to-hour basis. Many downstream implications within the industry could be hypothesized.

Can you outline some of the waste reduction advantages that the concept of gold bagging would bring?

Our ability to work within the EMR and see and communicate things that are happening in real time is something that the long-distance, third-party drug supplier would not be able to do. One of our pharmacists may be in the EMR, looking at labs and progress notes by physicians, and could say, wait a minute, we’re not going to dispense a $15,000 drug to somebody who clearly has an infection, or clearly has something wrong with their red blood cell count, or has been missing appointments. But another supplier would ship this drug, and once it leaves their loading dock, there’s not much that can be done with respect to returning it. But we can manage real-time dosing or regimen changes and we can manage the yes or no decision at the point the patient is supposed to be treated. In some instances the health system already owns the financial and medical risk within their contracts.

What brought HOSP to the gold bagging concept at this point in time?

It’s a sub-plot of the larger message we’ve been pushing out, really. Our commitment as a trade association is to get the word out about the value of what we’re doing, because otherwise it’s taken for granted and it’s not public. There may be drug access and payor network access implications. At HOSP we are all profoundly committed to improving/enhancing patient care. We are a bona fide group of pharmacy professionals in leadership roles that believe firmly and deeply in this powerful yet unrecognized process. We’ve all been spun around by COVID and its lingering and unprecedented financial and social impact on patients and communities. For us it is all about the power of the patient story—the patient experience and the patient outcomes—that’s what drives and informs everything we do.

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