Section 10.5: Measuring Hub Performance and Patient Experience

10.5.1 The “Why”: “What Gets Measured, Gets Managed”

In the complex, multi-stakeholder ecosystem of specialty pharmacy, simply doing the work is not enough. The Hub can process PAs, your pharmacy can dispense drugs, but are these activities achieving the ultimate goals? Are patients getting therapy quickly? Are they staying on therapy? Are they satisfied with the complex process they just endured? Without measurement, these critical questions remain unanswered.

The adage “What gets measured, gets managed” is the fundamental principle driving this section. Pharmaceutical manufacturers invest tens or hundreds of millions of dollars annually into their Hub programs and specialty pharmacy networks. They demand objective proof that this investment is yielding results. This proof comes in the form of rigorously defined, consistently tracked Key Performance Indicators (KPIs).

KPIs are the vital signs of the patient access journey. They transform complex processes into quantifiable metrics that allow manufacturers, Hubs, and pharmacies to:

• Assess Effectiveness: Is the program actually achieving its goals (e.g., reducing TTT, improving adherence)?
• Identify Bottlenecks: Where are the delays and friction points occurring in the process?
• Benchmark Performance: How does this Hub compare to others? How does your pharmacy compare to others in the network?
• Drive Continuous Quality Improvement (CQI): What specific changes can be made to improve the metrics and, ultimately, the patient experience?
• Demonstrate Value: How can the Hub and SP network prove their worth to the manufacturer?

As an advanced specialty pharmacist, you are no longer just a participant in this system; you are a critical generator and interpreter of these metrics. The data flowing from your pharmacy system (as discussed in 10.4) is the primary source for many of the most important KPIs. Understanding these metrics—how they are calculated, what they mean, and how your actions impact them—is essential for demonstrating your value and contributing to the optimization of patient care.

10.5.2 The Dashboard: Key Performance Indicators (KPIs) Defined

KPIs are the core metrics displayed on the “dashboard” used by manufacturers and Hubs to monitor program health. While dozens of metrics can be tracked, a standard set of primary KPIs forms the basis of performance evaluation. Understanding the precise definition, calculation method, and typical benchmark for each is critical.

KPI Deep Dive: Time-to-Therapy (TTT)

This is often considered the single most important KPI in specialty access. It measures the total duration of the patient’s onboarding journey.

Aspect	Definition & Nuance
Precise Definition	Total time (usually in calendar days) from the date the Hub receives the complete initial referral packet from the prescriber to the date the patient receives their first dose (ship/delivery date).
Calculation	(Date of First Dispense/Delivery) - (Date of Complete Referral Intake)
Benchmark	Highly variable by therapy area and payer mix. Can range from < 7 days for drugs with simple PAs to > 30 days for complex medical benefit drugs requiring multiple appeals.
Interpretation	Directly measures the speed and efficiency of the entire access process (Hub + SP). Longer TTT means delays in care, potential disease progression, and patient/prescriber frustration.
Pharmacist’s Impact	Your pharmacy directly owns the latter portion of TTT: the time from AOR to Dispense (TTD). Efficient intake, clinical review, patient scheduling, and fulfillment are critical. Accurate status reporting (including “clock stops”) is essential to ensure TTT is calculated fairly.

KPI Deep Dive: Conversion Rate (Referral to Dispense)

This KPI measures the percentage of patients referred to the program who actually end up receiving the medication.

Aspect	Definition & Nuance
Precise Definition	The number of patients who received at least one dispense, divided by the total number of “clean” (non-duplicate, actionable) referrals received by the Hub, over a specific time period.
Calculation	$$ \text{Conversion Rate} = \frac{\text{Number of Patients Dispensed}}{\text{Total Clean Referrals Received}} \times 100\% $$
Benchmark	Highly variable. Can range from 60% to 90%+ depending on the drug’s access challenges (e.g., payer restrictions, affordability).
Interpretation	Measures the overall effectiveness of the Hub and SP network in overcoming access barriers. A low conversion rate indicates significant drop-off somewhere in the process.
Pharmacist’s Impact	Your pharmacy plays a role through efficient processing and patient engagement. However, the primary drivers of low conversion are often outside your control (PA denials, unaffordable copays even *with* aid, patient clinical ineligibility, patient/prescriber changing their mind). Accurate reporting of cancellation reason codes is crucial for identifying *why* patients aren’t converting.

KPI Deep Dive: Abandonment Rate

This is the inverse of the Conversion Rate, focusing specifically on why patients “fall out” of the process *after* being approved and handed off to the pharmacy.

Aspect	Definition & Nuance
Precise Definition	The number of patients whose referrals were successfully processed by the Hub (PA approved, financials clear) and sent to the SP, but who never received a dispense, divided by the total number of referrals sent to the SP network.
Calculation	$$ \text{Abandonment Rate} = \frac{\text{Number of Approved Referrals Never Dispensed}}{\text{Total Referrals Sent to SPs}} \times 100\% $$
Benchmark	Ideally < 5-10%. Higher rates indicate significant problems post-Hub.
Interpretation	High abandonment rates often point to issues at the SP level (poor patient outreach, scheduling difficulties) or patient-level factors (unaffordable final copay despite aid, patient changed mind, clinical change making drug inappropriate).
Pharmacist’s Impact	This KPI directly reflects on SP performance. Your team’s ability to successfully contact patients, explain their final cost, schedule delivery efficiently, and perform empathetic clinical onboarding is critical. Meticulous documentation of outreach attempts and reasons for patient refusal (“Patient declined due to perceived side effects,” “Patient unable to meet remaining $50 copay”) is essential for root cause analysis.

KPI Deep Dive: Patient Satisfaction (e.g., NPS)

Modern Hub programs recognize that speed is not the only measure of success. The experience of navigating this complex process matters immensely to patients who are often already dealing with a difficult diagnosis.

Aspect	Definition & Nuance
Precise Definition	Measures the patient’s overall satisfaction with the support program services provided by the Hub and/or the Specialty Pharmacy. Often measured using the Net Promoter Score (NPS) methodology.
Calculation (NPS)	Patients are asked (via email, text, or IVR survey): “On a scale of 0-10, how likely are you to recommend the [Drug Name] Support Program/Specialty Pharmacy to a friend or colleague?” – Scores 9-10 = Promoters – Scores 7-8 = Passives – Scores 0-6 = Detractors $$ \text{NPS} = (\% \text{ Promoters}) – (\% \text{ Detractors}) $$ (Result is a score from -100 to +100).
Benchmark	Varies widely. NPS > 0 is considered “Good,” > +50 is “Excellent,” > +70 is “World Class.” Healthcare typically scores lower than other industries.
Interpretation	Directly measures the patient’s perception of the service quality, empathy, and effectiveness of the support team (Hub and SP). Low scores indicate poor communication, long wait times, unresolved issues, or lack of empathy.
Pharmacist’s Impact	Your pharmacy team has a MASSIVE impact on patient satisfaction. Every interaction—the initial welcome call, clinical counseling, refill reminders, handling delivery issues—contributes to the patient’s perception. Empathy, clear communication, first-call resolution, and proactive problem-solving by your pharmacists and technicians directly drive higher satisfaction scores. Many programs survey patients *after* their interaction with the SP.

KPI Deep Dive: Adherence Rate (PDC/MPR)

Getting the patient their first fill is only the beginning. Keeping them on therapy is critical for clinical outcomes and is a major focus for manufacturers.

Aspect	Definition & Nuance
Precise Definition	Measures how consistently a patient is taking their medication over a defined period. Typically measured using Proportion of Days Covered (PDC) or Medication Possession Ratio (MPR).
Calculation (PDC – Preferred)	PDC measures the percentage of days within a specific time interval (e.g., 90 days, 1 year) for which the patient had medication available. It accounts for overlapping fills better than MPR. $$ \text{PDC} = \frac{\text{Number of Days Covered by Fills}}{\text{Number of Days in Interval}} \times 100\% $$
Benchmark	Often benchmarked at > 80%, as this threshold is commonly linked to achieving clinical efficacy in many chronic diseases.
Interpretation	Low adherence rates indicate potential issues with side effects, cost, lack of perceived efficacy, forgetfulness, or complex regimens. Poor adherence leads to poor clinical outcomes.
Pharmacist’s Impact	Adherence is a primary clinical responsibility of the SP pharmacist. Your clinical counseling, side effect management, refill reminder calls, coordination with prescribers for dose adjustments, and barrier assessment directly impact PDC. Manufacturers rely heavily on SPs to drive adherence through high-touch clinical management programs. Your dispense data is the *source* for calculating this metric.

10.5.3 The Pharmacy’s Role: More Than Just Dispensing Data

As the previous section highlighted, your specialty pharmacy is the source of truth for many critical KPIs. However, your role extends beyond simply transmitting raw dispense data. You are the “eyes and ears on the ground,” providing qualitative context and actionable feedback that raw numbers alone cannot convey.

Providing Context Through Status & Reason Codes

Your pharmacy system’s status codes and cancellation reason codes are invaluable for understanding the “why” behind the KPIs. Simply reporting a “Canceled” status is useless. Reporting “Canceled – Reason Code 05: Patient Unable to Afford Remaining Copay” tells the manufacturer their copay card program may not be generous enough. Reporting “Canceled – Reason Code 08: Patient Reported Intolerable Side Effect” provides critical clinical feedback.

Participating in Quarterly Business Reviews (QBRs)

High-performing specialty pharmacies are invited to participate in QBRs with the Hub and Manufacturer teams. These are formal meetings where the KPIs are reviewed in detail. This is your opportunity to:

• Showcase Your Performance: Present your pharmacy’s excellent SLA adherence and patient satisfaction scores.
• Provide Qualitative Feedback: Share insights that the numbers don’t show. “We’re seeing many PA denials for off-label use X; perhaps the Hub needs better clinical documentation guidance for prescribers.” Or, “Patients consistently complain about confusion between the Hub nurse call and our pharmacist call; can we coordinate better?”
• Identify Systemic Issues: Use data to highlight recurring problems. “Your Hub’s Time-to-Handoff has increased by 3 days this quarter, significantly impacting our TTT. Can we investigate the root cause?”
• Collaborate on Solutions: Work *with* the Hub and Manufacturer to propose workflow improvements, communication enhancements, or technology changes.

Your participation in QBRs elevates you from a simple dispenser to a strategic partner.

Sharing Best Practices & Identifying Friction Points

As an advanced pharmacist on the front lines, you see the process failures firsthand. You hear the patient’s frustrations. You see the prescriber’s confusion. Your role includes proactively identifying these friction points and communicating them constructively to the Hub/Manufacturer.

Example: You notice that referrals for a specific drug consistently arrive from the Hub missing the patient’s weight, which is required for dosing. This forces your team to make an extra call on every referral, delaying TTT.
Your Action: Don’t just complain. Escalate appropriately (Level 2 or 3). Provide data (“30% of referrals last month were missing weight”). Propose a solution (“Can the Hub update their intake form to make patient weight a required field, or train their case managers to proactively obtain it during the Welcome Call?”).

This proactive, solution-oriented feedback is invaluable for optimizing the entire patient journey.

10.5.4 Optimizing the Patient Journey: Continuous Quality Improvement (CQI)

KPIs and data reporting are not just about grading performance; they are the fuel for Continuous Quality Improvement (CQI). The goal is to use data to identify weaknesses in the system and implement targeted changes to make the process faster, more efficient, and more patient-centric.

This is an ongoing cycle involving all stakeholders:

The Rise of Patient-Reported Outcomes (PROs)

Beyond operational metrics (TTT, Conversion) and satisfaction (NPS), there is a growing focus on measuring the clinical impact of the therapy and the support program through Patient-Reported Outcomes (PROs). These are data points collected directly from the patient (often via surveys or apps) about their symptoms, quality of life, side effects, and functional status.

Examples of PROs relevant to specialty pharmacy:

• Symptom Scores: e.g., Pain score (0-10), HAQ-DI for Rheumatoid Arthritis, EDSS for Multiple Sclerosis.
• Quality of Life Surveys: e.g., SF-36, disease-specific QoL questionnaires.
• Side Effect Monitoring: Patients self-reporting frequency and severity of side effects.

Your Role: Your clinical pharmacists are often responsible for collecting PROs during their counseling calls or through integrated digital platforms. This data provides invaluable real-world evidence of the drug’s effectiveness and the value of your clinical interventions in managing side effects and improving quality of life. Reporting PROs back to the manufacturer is becoming an increasingly important part of the SP value proposition.

10.5.5 Your Mandate as a CASP Pharmacist: Driving Data-Driven Care

Measuring Hub performance and the patient experience is not a passive activity observed from the sidelines. As a Certified Advanced Specialty Pharmacist, you are an active participant and a leader in this process. Your mandate is to:

• Understand the Metrics: Know the definition, calculation, and importance of every key SLA and KPI discussed.
• Ensure Data Accuracy: Champion internal workflows and training that guarantee the timeliness and accuracy of the data your pharmacy reports. Recognize that “Garbage In, Garbage Out.”
• Interpret the Data: Look beyond the raw numbers. Understand the story the data is telling about the patient journey, identifying both successes and opportunities for improvement.
• Provide Actionable Feedback: Use the established communication and escalation pathways to share insights, report friction points, and propose solutions to your Hub and Manufacturer partners.
• Focus on the Patient Experience: Remember that behind every data point is a patient. Use KPIs not just to meet contractual obligations, but as tools to genuinely improve the speed, affordability, and quality of the patient’s experience.

By mastering the art and science of performance measurement, you transition from being solely a clinical expert to becoming a vital operational partner, contributing directly to the efficiency, effectiveness, and patient-centricity of the entire specialty pharmacy ecosystem.