Shields Clinical Outcomes Report 2025
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DIsease States
Shields Care Model
Future Outlook
Overview
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Health System Partners
75+
Quick Facts
At Shields, we are more than just a provider of solutions—we are subject matter experts and pioneers in specialty pharmacy integration.
By partnering with the industry’s foremost leaders and employing an integrated care model founded on innovation and compassion, we work side by side with our partners to accelerate the success of their specialty pharmacy programs.
Our Company
At Shields Health Solutions, we know that managing complex conditions requires more than just medication—it demands a seamless, patient-centered approach to care. Our integrated specialty pharmacy care model removes barriers that often disrupt or fragment patient care, ensuring that individuals receive the specialty medications they need without unnecessary delays.
By leveraging a dedicated team of clinical pharmacists, liaisons, and patient support advocates, we engage directly with patients and their families to provide education, coordinate care, and navigate challenges. This high-touch, collaborative model not only drives better clinical outcomes but also enhances system-wide performance for our health system partners.
Complex Care, Simplified
02 Shields Care Model
It starts with our people—some of the most experienced, hardworking, and dedicated professionals in the industry. But what truly sets us apart is how we harness data.
At Shields, we leverage advanced analytics across a vast spectrum of clinical data, setting new benchmarks for healthcare insights. Our approach integrates data from multiple sources—including electronic health records, patient-reported outcomes, and pharmacy dispensing records—into a unified platform designed exclusively for Shields. This powerful data infrastructure allows us to develop robust clinical outcome measures that not only meet but exceed industry quality standards.
But having data is just the beginning—it's how we use it that makes the difference. Our customizable reports and real-time dashboards empower healthcare professionals to pinpoint areas for improvement, track performance trends, and make informed, data-driven decisions that enhance patient care. From clinicians to operations leaders, every team member has the tools to uncover opportunities, monitor progress, and refine healthcare delivery—focusing on key metrics that drive quality and optimize patient outcomes.
This is why not all outcomes reports are created equal—because not all specialty pharmacy accelerators are built like Shields.
What Makes the Shields Care Model So Unique?
Discover how our integrated and comprehensive offerings improve therapy management and care coordination for patients with chronic and complex diseases.
Achieving Quality Clinical Outcomes
03 Disease States
05 future Outlook
Fill out the form to get in touch with our clinical outcomes team to learn more about driving better clinical outcomes.
When You're Ready for More
06 Get In Touch
Hospitals & Clinics
1,000+
Patients Served
2M+
Payer Access Secured
~90%
Drug Access Secured
~90%
in Financial Assistance Secured 2025
~2B
in Cost Avoidance
>$200M
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Tracking Universal Outcomes
Treatment effectiveness & clinical response
Healthcare resource utilization
Medication adherence & management
Patient-reported outcomes
Clinical interventions & lab results
Quality of life
We Provide Specialized Monitoring for the Following Disease-specific Analytics
Autoimmune Conditions
Rare Diseases
Oncology
Neurology
Hematology
And 40+ More Therapeutic Areas
Reduction in Total Cost of Care
13%
Shields
Care Model
Coordinate
Enhance
Renew
Intervene
Engage
Engage
Our team engages with patients at the clinic and through telephonic appointments to educate them on the importance of therapy adherence and completing routine lab work.
>1.5M
FAs/PAs Completed
Intervene
<2 days
Average Time to Therapy
Clinical pharmacists provide side effect mitigation tactics, monitor for drug interactions, and analyze lab results to optimize medication therapy.
Coordinate
~$2B
Financial Assistance Secured in 2025
Our team investigates patient insurance benefits, completes prior authorizations, and identifies financial assistance opportunities so patients and providers can focus on their health, not paperwork.
Renew
91%
Average Provider Score
Ongoing interactions beyond refills; our experts provide ongoing education, proactively identify opportunities to monitor and improve patient care and outcomes at each touchpoint.
Enhance
93%
Average Medication Adherence
Through pharmacist, liaison and other interventions, our team can enhance patient care, provide emotional support, and help educate and coordinate care.
Click each section to explore how our dedicated clinical team of pharmacists, liaisons, and patient support advocates work to eliminate disruptions that derail or fragment patient care, driving superior outcomes and elevating system-wide performance.
At Shields, we take immense pride in delivering exceptional patient care through our strategic partnerships with health systems. Today, we have the privilege of caring for more patients than ever, at more health systems than ever, while continuing to meet and exceed quality benchmarks.
Our goal is to ensure that every patient achieves the best possible outcomes from their medication therapy. Our innovative integrated care model is powered by a state-of-the-art data analytics engine that helps us gain the insights necessary to continuously refine our approach and engage swiftly with the most vulnerable patients.
The success of our model is built on collaboration. Our clinicians work closely with both providers and patients. By integrating pharmacists as vital members of the healthcare team, we foster meaningful relationships that allow us to intervene early, optimizing patient outcomes and enhancing the overall healthcare experience.
Looking to the future, it’s clear that specialty pharmacy is entering a new frontier in machine learning capabilities. At Shields, we view this as a means for pharmacists to garner more clinical insights, reduce administrative burden, and connect with more patients. Continued innovation enables and empowers us to more accurately anticipate patient needs and implement proactive interventions that drive improved outcomes.
Ultimately, however, positive patient outcomes depend on our people, who show compassion and build relationships that allow patients to trust us with their care. We understand that achieving optimal patient outcomes requires a personalized approach—one that addresses the unique challenges of diverse patient populations while promoting accessibility and inclusion.
At the heart of our mission is a simple but powerful belief: patients are our "why." Every individual deserves personalized, equitable care tailored to their unique needs. In partnership with our healthcare providers and the broader community, we are dedicated to raising the standard of specialty pharmacy and ensuring that every interaction contributes to better health outcomes today and lays the foundation for a healthier tomorrow.
Vice President of Clinical Services
Our Company
Our History
Our Team
Our History
Our Team
Founded in 2012, Shields was born from a vision to transform specialty pharmacy care through collaboration with hospitals and health systems. Established by a team of healthcare experts, we refined the integrated care model by combining clinical pharmacy services with health system operations. Over the years, we have grown significantly, forming strategic partnerships with leading health systems across the country.
Our history
The Clinical Outcomes Team at Shields Health Solutions is integral to demonstrating the value of our integrated care model through the development, implementation, analysis, and validation of patient outcomes. Comprising clinical specialists with deep expertise in specialty pharmacy, this team employs a data-driven approach to evaluate metrics that highlight the effectiveness of our care strategies. Their efforts focus on actionable insights regarding medication adherence, treatment efficacy, and patient satisfaction, ultimately informing patient care pathways and strategic decision-making.
Our team
Multiple Sclerosis (MS)
Reducing the number of flares over time can delay the progression of disability and neurologic dysfunction.2 If a patient reports a relapse, our pharmacists will evaluate the electronic medical record to determine if the event could be due to medication-related concerns, such as non-adherence. Pharmacists can intervene with the patient and provider to resolve any medication issues and coordinate care to address the relapse. Measuring absenteeism and adherence is crucial in identifying gaps in care, ensuring timely interventions, and improving overall health outcomes.
Why It Matters
We track universal and disease-specific metrics to enhance patient care and support data-driven decision-making. By focusing on quality improvement, value-based care, population health management, and cost optimization, we leverage advanced data capabilities to provide real-time analytics, custom reporting, risk stratification, and population health insights for continuous improvement.
Download PDF
What We Measure
Patient Reported Treatment Efficacy
Adherence**
Of patients receive and take medications on time
Of patients report feeling very well or well about how their specialty medication is working
93%
Benchmark12
**Average number of patients reported flares in one year
Optimal Annualized Relapse Rate (ARR)**
91.2%
0
0.1
0.2
0.3
0.4
Optimal ARR
Shields Health Solutions
MS is a chronic, autoimmune disease of the central nervous system, affecting the communication between the brain and other parts of the body. While there is currently no cure for MS, establishing and following a treatment plan is the best way to manage the disease and enhance quality of life.
Treatment plans often include medications to prevent the number of relapses and help treat symptoms.1
0.16
View MS References
Many specialty pharmacy medications are costly, have high copayments, limited insurance coverage, and involve multiple prior authorization steps. Additionally, patients facing high out-of-pocket expenses are more likely to discontinue therapy.
Common Barriers to Treatment
Financial Burden
Coordination of care between patients and multiple providers is often insufficient. Many treatment regimens involve medications with significant side effects and necessitate frequent monitoring, making seamless care coordination essential but frequently lacking.
Inadequate Care Coordination
Patients may experience social isolation or inadequate support from family and friends, which can impact their ability to cope with and adhere to treatment plans.
Social Isolation & Lack of Support
Explore our latest insights
The goal of treatment is to prevent the progression of the disease and to achieve SVR, a marker of the cure for Hepatitis C, meaning that the virus is no longer detectable in the blood 12 weeks after the patient completed treatment. Completing the full HCV treatment course is critical to cure the infection, eliminate the potential for transmission, improve quality of life, and avoid serious liver damage or even death. If SVR response is not achieved, getting the patient on the optimal therapy is key to preventing complications.2 Measuring absenteeism and adherence is crucial in identifying gaps in care, ensuring timely interventions, and improving overall health outcomes.
Why It Matters
Adherence**
Of patients receive and take medications on time
95%
Treatment Completion Rate
0
100%
Shields Network
98%
≥95%3,4,8
What We Measure
View Hep C References
Download PDF
Hepatitis C is a liver infection caused by the hepatitis C virus (HCV) and is spread through contact with the blood of an infected person. HCV infection is treated with medications intended to clear the virus from the body. These antiviral medications are highly effective and cure on average 95% of patients after 8-12 weeks of treatment.1, 2
Hepatitis C
Sustained Virologic Response Rate
Patients managing complex conditions often face significant barriers that delay or disrupt their treatment. These challenges not only impact adherence but also lead to worsening health outcomes. Addressing these obstacles requires an integrated approach that streamlines care, reduces delays, and ensures patients receive the right medication at the right time.
A lack of understanding regarding the progression of their condition can prevent patients from fully engaging in or adhering to their prescribed treatment plans.
Limited Understanding of Disease Progression
Patients often struggle with adhering to complex medication regimens, which is critical to preventing complications and maintaining treatment efficacy.
Challenges with Medication Adherence
Geographic constraints, financial limitations, inadequate insurance coverage, high copayments, and limited availability of specialized providers and facilities can make accessing essential care and medications difficult.
Barriers to Accessing Specialized Care
Emotional and mental health challenges, including stress, anxiety, and depression, can obstruct treatment adherence and overall disease management. Patients with robust support systems tend to achieve better outcomes, highlighting the importance of emotional and social support throughout the treatment journey.
Psychosocial Challenges
Learn more
Benchmark9-11
Benchmark
85%
Benchmark
3-7
98%
Shields
Measuring disease activity and patient response enables healthcare teams to evaluate the success of RA treatments and identify needed changes. These scores support a collaborative effort among the patient care team, facilitating shared decisions to improve patient health outcomes. Tools like RAPID3, supplemented by patient-reported outcomes (PROs), provide valuable insights into disease management from patients’ perspectives. This contributes to a holistic understanding of patient experiences, ensuring optimal patient care and enhancing patient outcomes. Measuring absenteeism and adherence is crucial in identifying gaps in care, ensuring timely interventions, and improving overall health outcomes.
Why It Matters
Of patients receive and take medications on time
80%
Benchmark3-6
93%
Adherence**
Of patients reported no missed days of planned activity, school, or work
92%
No Absenteeism
What We Measure
View RA References
Download PDF
Rheumatoid Arthritis (RA) is an autoimmune and inflammatory disease in which the immune system attacks healthy cells, causing inflammation and painful swelling in the affected parts of the body.1
Management of RA includes a combination of clinical exams, laboratory work, and various combinations of medications that help slow disease progression and prevent joint deformity. This management approach plays a vital role in determining disease severity and achieving low disease activity or near remission with few or no RA symptoms, which is the goal of therapy.1
Rheumatoid
Arthritis (RA)
Disease Control
95%
of patients reported their condition has improved or has been stable since onboarded with Shields
Disease Activity
61%
Keeping a patient's viral load low is essential in helping them live longer, healthier lives while also reducing their chances of transmitting the virus to others. To maintain a low viral load, patients must adhere to ART and keep up with routine appointments. Nonadherence to ART may reduce treatment response, increase drug resistance and morbidity, and even result in death.10 Assessment of viral load suppression on an annual basis is a core performance measurement for patient qualification in the Ryan White & Global HIV/AIDS Program.11 Measuring absenteeism and adherence is crucial in identifying gaps in care, ensuring timely interventions, and improving overall health outcomes.
Why It Matters
Of patients receive and take medications on time
Benchmark7-9
93%
Adherence**
Of patients report feeling very well or well about how their specialty medication is working
94.4%
Patient Reported Treatment Efficacy
Average % of patients
who reach viral supression
67.2%
What We Measure
View HIV References
Download PDF
Human immunodeficiency virus (HIV) is a virus spread through contact with certain fluids of an infected person, attacking the immune system and affecting the body's ability to fight infections and certain cancers. HIV is incurable and can progress to the most advanced disease stage if left untreated, known as Acquired Immunodeficiency Syndrome (AIDS).1 With proper medical care and a potent combination of antiretroviral therapy (ART), HIV has become a manageable chronic condition. ART therapy has proven to reduce health complications associated with the disease, increase life expectancy and prevent transmission.2
HIV
of HIV Viral Load Labs
completed on time
89.3%
93.9%
SHIELDS
National Average3
≥90.6%
Ryan White HIV/AIDS4-6
>89K
Clinical
Interventions
Average Patient Copay
$10
Patient Net Promoter Score
83
Even though corticosteroids are an effective induction treatment for IBD, they should not be used as a maintenance therapy due to the risk of dependency and many established side effects. Steroids may be used to stop flares, a systemic inflammation that may lead to progressive and irreversible intestinal damage. In children, persistent inflammation is associated with impairment of growth and pubertal development, risking permanent loss of height.4 IBD presents a significant burden on daily life activities and is associated with absence from work or school (absenteeism).5 In addition to corticosteroids and flares, measuring absenteeism and adherence is crucial to identifying gaps in care, ensuring timely interventions, and improving overall health outcomes.
Why It Matters
Of patients receive and take medications on time
≥80%
Benchmark2,3
95%
Adherence**
Of patients reported no missed days of planned activity, school, or work
91%
No Absenteeism
of patients reported using corticosteroids at follow-up
8.2%
Corticosteroid Use
of patients do
not report flares
70%
Disease Flares
What We Measure
View IBD References
Download PDF
Inflammatory bowel disease (IBD) is a chronic, progressive disease caused by an abnormal mucosal immune response against intestinal microorganisms in genetically predisposed hosts. IBD is an umbrella term for Crohn's disease and ulcerative colitis. Treatment is based on the disease severity, and goals include eliminating symptoms, preventing surgery and other complications, minimizing the adverse effects of medications, and restoring quality of life.1
Inflammatory Bowel Disease
Of patients report feeling very well or well about how their specialty medication is working
93%
Patient Reported Treatment Efficacy
Why It Matters
Of patients receive and take medications on time
≥90%
Benchmark7-10
92%
Adherence**
Of patients reported no missed days of planned activity, school, or work
97%
No Absenteeism
Of patients report feeling very well or well about how their specialty medication is working
95%
Patient Reported Treatment Efficacy
What We Measure
View Transplant References
Download PDF
A transplant is a surgical procedure that transfers an organ, tissue, or cells from a donor to a recipient to replace damaged or failing body parts and restore health. Shields primarily follows patients with kidney, liver, heart, lung, pancreas, stem cell, and bone marrow transplants. One of the treatments after the transplant is immunosuppression. Multiple immunosuppression agents are used in di erent doses and variations based on the type of transplant, patients’ rejection risk, comorbidities, and side e ects. Lifelong immunosuppression is vital after the transplant to prevent rejection.1
Transplant
Hospitalizations and Emergency Room (ER) Utilization
Percent of patients reporting unplanned ER visits or hospital stays
0
10%
20%
30%
50%
Benchmark
≤50%2-6
Shields
5.9%
40%
Pulmonary exacerbations are closely related to IV antibiotic use and hospitalizations and are a significant measure of disease severity. Acute pulmonary exacerbations are associated with rapid lung function decline, permanent loss of lung function, diminished quality of life, reduced survival, and increased healthcare costs.12 Decreasing the number of pulmonary exacerbations is a target in the care of patients with CF. Measuring absenteeism and adherence is also crucial in identifying gaps in care, ensuring timely interventions, and improving overall health outcomes.
Why It Matters
Of patients receive and take medications on time
≥80%
Benchmark9-11
Adherence**
Of patients reported no missed days of planned activity, school, or work
97%
No Absenteeism
Of patients report feeling very well or well about how their specialty medication is working
94%
Patient Reported Treatment Efficacy
What We Measure
View CF References
Download PDF
Cystic fibrosis (CF) is a genetic progressive disorder caused by mutations in the chloride ion channel cystic fibrosis transmembrane conductance regulator (CFTR), which helps to maintain the balance of salt and water on many surfaces in the body.
Many pharmacological treatments on the market address pulmonary manifestations of CF. However, oral CFTR protein modulators transformed the management of CF in the last decade.1 They are highly effective in most patients with CF with eligible genotypes. CFTR modulators decrease pulmonary exacerbations, improve pulmonary function (ppFEV1), nutritional status, and respiratory health-related quality of life.2, 3
Cystic Fibrosis
Pulmonary Exacerbations
Pediatric
<18 y/o
3.9%
Hospital and ER Utilization
Unplanned ER and hospital visits are common in patients with cancer due to disease or drug complications, driving up care costs. Close clinical monitoring of patients on oral oncolytic therapy, especially early on, can help prevent these events by identifying adverse events, medication issues, and adherence barriers. Tracking absenteeism and adherence is key to addressing care gaps, enabling timely interventions, and improving health outcomes.
Why It Matters
Of patients receive and take medications on time
Benchmark6-9
92%
Adherence**
Of patients reported no missed days of planned activity, school, or work
94%
No Absenteeism
See our proactive approach to the management of patients on complex oncology medications.
Shields Oncology
Patient Journey
SHIELDS:
Percent of patients reporting hospital and ER utilization due to oncology related symptoms
What We Measure
View Oncology References
Download PDF
Cancer, a genetic disease in which some of the body's cells grow uncontrollably and spread to other parts of the body, is caused by changes to genes that control the way our cells function.1 The goals of cancer treatment include eradicating known tumors, preventing the recurrence or spread of the primary cancer, and relieving symptoms.2
Oncology
Adult
≥18 y/o
4.3%
Of patients require ER visits or inpatient hospital stays fo CF
Shields Network
Benchmark4-8
0
20%
10%
20%
30%
6.7%
<20%
<25%
Pediatric
<18 y/o
Adult
≥18 y/o
3.6%
NATIONAL NETWORK
GROUP: ≤20%2-5
0%
10%
20%
View Patient Journey
Shields uses a proactive approach to the management of patients on complex oncology medications with a carefully designed cadence of clinical pharmacist assessments. Patients receive at least two clinical pharmacist touchpoints within the first week of therapy. Clinical reassessments depend on patient factors and medication risk; however overall, patients receive an average of three to 14 touchpoints annually, starting one week after therapy begins.
Shields Oncology Patient Journey
2
1
7
3
4
5
6
9
8
One week after starting medication
Before Starting Medication
Clinical reassessment every month to every
6 months depending
on the patient and medication factors
Months
Phamacist & Liaison Touchpoint
Liaison Touchpoint
PATIENT JOURNEY KEY
Integrated Disease States
50+
Jennifer L. Donovan, PharmD
Authentic, compassionate connections drive shared success, ensuring every patient and partner thrives. We go beyond innovation—delivering real, measurable outcomes that improve patient health and reduce costs. More than just a continuum of care, we seamlessly guide health systems with expertise and empathy—because better care begins with genuine connections.
This report underscores the profound impact of our integrated specialty pharmacy model, all while maintaining exceptional care outcomes. Our ability to scale without compromising quality reinforces the strength of our collaborative approach, setting new benchmarks for excellence in specialty pharmacy.
Driven by Unbeatable Clinical Outcomes
01 OVERVIEW
For the fifth consecutive year, we are excited to share our industry-leading outcomes across our expansive network of health system partners. At Shields, we are committed to empowering patients and health systems, transforming challenges into boundless opportunities.
Transplant
Cystic
Fibrosis
Inflammatory
Bowel Disease
HIV
Oncology
Rheumatoid
Arthritis
Hepatitis C
Multiple Sclerosis
“Multiple Sclerosis FAQ." National Multiple Sclerosis Society, https://www.nationalmssociety.org/What-is-MS/MS-FAQ-s#question-Can-MS-be-cured Accessed December 5, 2024.
Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(17):777-788. doi:10.1212/WNL.0000000000005347.
Rae-Grant A, Day GS, Marrie RA, et al. Comprehensive systematic review summary: Disease-modifying therapies for adults with multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(17):789-800. doi:10.1212/WNL.0000000000005345.
National Institute for Health and Care Excellence. Multiple sclerosis in adults: management. Published October 19, 2022. Accessed November 2023. Available at: https://www.nice.org.uk/guidance/ng220.
Montalban X, Gold R, Thompson AJ, et al. ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler. 2018;24(2):96-120. doi:10.1177/1352458517751049.
O'Connor P, Wolinsky JS, Confavreux C, et al. Randomized trial of oral teriflunomide for relapsing multiple sclerosis. N Engl J Med. 2011;365(14):1293-1303. doi:10.1056/NEJMoa1014656.
Confavreux C, O'Connor P, Comi G, et al. Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(3):247-256. doi:10.1016/S1474-4422(13)70308-9.
Calabresi PA, Radue EW, Goodin D, et al. Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Neurol. 2014;13(6):545-556. doi:10.1016/S1474-4422(14)70049-3
Li J, Hutton GJ, Varisco TJ, Lin Y, Essien EJ, Aparasu RR. Comparative effectiveness of high-efficacy and moderate efficacy disease-modifying agents in reducing the annualized relapse rates among multiple sclerosis patients in the United States. Prev Med. 2025;190:108180. doi:10.1016/j.ypmed.2024.108180
Kalincik T, Brown JWL, Robertson N, et al. Treatment effectiveness of alemtuzumab compared with natalizumab, fingolimod, and interferon beta in relapsing-remitting multiple sclerosis: a cohort study. Lancet Neurol. 2017;16(4):271-281. doi:10.1016/S1474-4422(17)30007-8
Olek MJ, Mowry EM. Initial disease modifying therapy for relapsing-remitting multiple sclerosis in adults. UpToDate. https://www.uptodate.com. Accessed November 24, 2025
PQA measure overview. Pharmacy Quality Alliance. Published 2024. Accessed October 21, 2024. Available at: https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf.
Multiple Sclerosis References
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Hepatitis C Information. Centers for Disease Control and Prevention. Updated July 28, 2020. Accessed December 18, 2025. https://www.cdc.gov/hepatitis/hcv/index.htm
Hepatitis C. The World Health Organization. Updated July 27, 2020. Accessed December 18, 2025 https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
AASLD-IDSA. Treatment Guidelines. 2023 Update. Available at: https://www.hcvguidelines.org. Accessed April 25, 2025.
Bolduc C, McCall K 3rd, Stickney K, Gelinas A, Levesque E. Applicability of a new specialty pharmacy-reported measure describing completion of therapy for hepatitis C. J Manag Care Spec Pharm. 2021;27(2):263-267. doi:10.18553/jmcp.2021.27.2.263. PMID: 33506724; PMCID: PMC10391126.
URAC. Pharmacy Benefit Management: Performance Measurement Aggregate Summary Performance Report. 2024. Accessed December 11, 2025. https://2297879.fs1.hubspotusercontent-na1.net/hubfs/2297879/URAC_PBM_Aggregate%20Summary%20Report_2024_FINAL.pdf
Zuckerman A, Douglas A, Nwosu S, Choi L, Chastain C. Increasing success and evolving barriers in the hepatitis C cascade of care during the direct-acting antiviral era. PLoS One. 2018;13(6):e0199174. Published June 18, 2018. doi:10.1371/journal.pone.0199174. Accessed October 21, 2025.
Lasser K, Heinz A, Battisti L, et al. A hepatitis C treatment program based in a safety-net hospital patient-centered medical home. Ann Fam Med. 2017;15(2):202-203. doi:10.1370/afm.2069. Epub December 30, 2016. Accessed October 21, 2019.
World Health Organization. Global Hepatitis Report 2024: Action for Access in Low- and Middle-Income Countries. Geneva, Switzerland: World Health Organization; April 9, 2024. Accessed April 25, 2025.
PQA measure overview. Pharmacy Quality Alliance. https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf. Published 2024. Accessed October 21, 2025. https://www.pqaalliance.org/measures-overview#pdc-dr
Yamamoto H, Hiroaki Ikesue, Ikemura M, et al. Evaluation of pharmaceutical intervention in direct-acting antiviral agents for hepatitis C virus infected patients in an ambulatory setting: a retrospective analysis. Journal of Pharmaceutical Health Care and Sciences. 2018;4(1). doi:https://doi.org/10.1186/s40780-018-0113-3
Younossi ZM, Stepanova M, Henry L, et al. Adherence to treatment of chronic hepatitis C: from interferon containing regimens to interferon and ribavirin free regimens. Medicine. 2016;95(28):e4151. doi: 10.1097/MD.0000000000004151.
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Hepatitis C References
Rheumatoid Arthritis (RA) | Arthritis | CDC Accessed 12/14/24
Gwinnutt JM, Leggett S, Lunt M, et al; RAMS and BRAGGSS co-investigators. Predictors of presenteeism, absenteeism, and job loss in patients commencing methotrexate or biologic therapy for rheumatoid arthritis. Rheumatology (Oxford). 2020;59(10):2908-2919. doi:10.1093/rheumatology/keaa027.
Jin Y, Chen SK, Lee H, Landon JE, Merola JF, Kim SC. Patient characteristics associated with use of TNF vs interleukin inhibitors as first-line biologic treatment for psoriatic arthritis. J Manag Care Spec Pharm. 2021;27(8):1106-1117. doi:10.18553/jmcp.2021.27.8.1106.
Zuckerman AD, Whelchel K, Kozlicki M, et al. Health-system specialty pharmacy role and outcomes: A review of current literature. Am J Health Syst Pharm. 2022;79(21):1906-1918. doi:10.1093/ajhp/zxac212.
Zuckerman AD, DeClercq J, Choi L, et al. Adherence to self-administered biologic disease-modifying antirheumatic drugs across health-system specialty pharmacies. Am J Health Syst Pharm. Published online August 18, 2021. doi:10.1093/ajhp/zxab342.
PQA measure overview. Pharmacy Quality Alliance. Published 2024. Accessed October 21, 2024. Available at: https://www.pqaalliance.org/ assets/Measures/PQA_Measures_Overview.pdf.
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Rheumatoid Arthritis References
National Cancer Institute https://www.cancer.gov/about-cancer/understanding/what-is-cancer Updated May 5, 2021. Accessed December 14, 2024
Lash RS, Bell JF, Reed SC, et al. A systematic review of emergency department use among cancer patients. Cancer Nurs. 2017;40(2):135-144. doi:10.1097/NCC.0000000000000360.
Rivera DR, Gallicchio L, Brown J, et al. Trends in adult cancer-related emergency department utilization: An analysis of data from the Nationwide Emergency Department Sample. JAMA Oncol. 2017;3(10):e172450. doi:10.1001/jamaoncol.2017.2450.
Li S, Peng Y, Liu J, et al. Variations in hospitalization and emergency department/observation stays using the oncology care model methodology in Medicare data. Curr Med Res Opin. 2020;36(9):1519-1527. doi:10.1080/03007995.2020.1801403
Behan E, Veenstra DL, Bansal A. Health care resource utilization and costs of Medicare-enrolled patients with HR+/HER2- metastatic breast cancer treated with a CDK4/6i in the first-line setting. J Manag Care Spec Pharm. 2025;31(1):6-14. doi:10.18553/jmcp.2025.31.1.6
PQA measure overview. Pharmacy Quality Alliance. https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf. Published 2024. Accessed October 21, 2024. https://www.pqaalliance.org/measures-overview#pdc-dr
Academia EC, Mejías-De Jesús CM, Stevens JS, Jia LY, Yankama T, Patel C, Lee J. Adherence to oral oncolytics filled through an internal health-system specialty pharmacy compared with external specialty pharmacies. J Manag Care Spec Pharm. 2021 Oct;27(10):1438-1446. doi: 10.18553/jmcp.2021.27.10.1438. PMID: 34595953; PMCID: PMC10390949.
Doshi JA, Jahnke J, Raman S, Puckett JT, Brown VT, Ward MA, Li P, Manz CR. Treatment utilization patterns of newly initiated oral anticancer agents in a national sample of Medicare beneficiaries. J Manag Care Spec Pharm. 2021 Oct;27(10):1457-1468. doi: 10.18553/jmcp.2021.27.10.1457. PMID: 34595957; PMCID: PMC10391122.
Zuckerman AD, Whelchel K, Kozlicki M, Simonyan AR, Donovan JL, Gazda NP, Mourani J, Smith AM, Young L, Ortega M, Kelley TN. Health-system specialty pharmacy role and outcomes: A review of current literature. Am J Health Syst Pharm. 2022 Oct 21;79(21):1906-1918. doi: 10.1093/ajhp/zxac212. PMID: 35916907.
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Oncology References
About HIV/AIDS | HIV Basics | HIV/AIDS | CDC Accessed 06.08.23 What Are HIV and AIDS? | HIV.gov Accessed 01.27.24
AdultandAdolescentGL.pdf (hiv.gov) Accessed 01.27.24 Treatment | Living with HIV | HIV Basics | HIV/AIDS | CDC Accessed 12.07.25
Centers for Disease Control and Prevention. National HIV Prevention and Care Objectives: 2025 Update. CDC. https://www.cdc.gov/hiv-data/nhss/national-hiv-prevention-and-care-objectives-2025.html Accessed September 17, 2025
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. National Office on AIDS Policy. Published September 2024. Accessed December 4, 2025. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/whats-new
Health Resources and Services Administration. Ryan White HIV/AIDS Program Annual Data Report 2023. Published December 2024. Updated June 2025. Accessed September 17, 2025. https://ryanwhite.hrsa.gov/data/reports
Salomon-Escoto K, Stutsky M, Reed G, Hinestroza Jordan MY, Kay J, Wessolossky M. Greater HIV Viral Load Suppression in Patients Using an Integrated Health System Specialty Pharmacy. J Pharm Pract. Published online September 4, 2025. doi:10.1177/08971900251376796
PQA measure overview. Pharmacy Quality Alliance. https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf. Published 2024. Accessed October 21, 2025. https://www.pqaalliance.org/measures-overview#pdc-dr
Komandt M, Canfield S, Lengel M, Gilmore V, Kilcrease C. Correlation between medication adherence using proportion of days covered and achieving viral suppression in patients living with HIV. Journal of managed care & specialty pharmacy. 2023;29(10):1129-1137. doi:https://doi.org/10.18553/jmcp.2023.29.10.1129
URAC. 2023 PBM Measures at a Glance. URAC. Published December 2022. Accessed October 4, 2024. https://www.urac.org/wp-content/uploads/2022/12/2023_PBM_Measures-at-a-Glance.pdf
HIV/AIDS Treatment Guidelines. Clinicalinfo.HIV.gov. https://clinicalinfo.hiv.gov/en/guidelines. Accessed January 18, 2026
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
HIV References
Le Berre C, Ricciuto A, Peyrin-Biroulet L, Turner D. Evolving Short- and Long-Term Goals of Management of Inflammatory Bowel Diseases: Getting It Right, Making It Last. Gastroenterology. 2022;162(5):
Zuckerman AD, Whelchel K, Kozlicki M, et al. Health-system specialty pharmacy role and outcomes: A review of current literature. Am J Health Syst Pharm. 2022;79(21):1906-1918. doi:10.1093/ajhp/zxac212.
PQA measure overview. Pharmacy Quality Alliance. Published 2024. Accessed October 21, 2024. Available at: https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf.
Agrawal M, Spencer EA, Colombel JF, Ungaro RC. Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User's Guide for Adult and Pediatric Gastroenterologists. Gastroenterology. 2021 Jul;161(1):47-65. doi: 10.1053/j.gastro.2021.04.063. Epub 2021 April 30. PMID: 33940007; PMCID: PMC8640961.
Youssef M, Hossein-Javaheri N, Hoxha T, et. al. Work Productivity Impairment in Persons with Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis. J Crohns Colitis. 2024 Sep 3;18(9):1486-1504. doi: 10.1093/ecco-jcc/jjae057. PMID: 38647194; PMCID: PMC11369077.
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Inflammatory Bowel Disease References
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Pediatric: < 18 years old Adult: ≥ 18 years old
Cystic Fibrosis References
Nelson J, Alvey N, Bowman L, et al. Consensus recommendations for use of maintenance immunosuppression in solid organ transplantation: Endorsed by the American College of Clinical Pharmacy, American Society of Transplantation, and the International Society for Heart and Lung Transplantation. Pharmacotherapy. 2022;42(8):599-633. doi:10.1002/phar.2716. PMID: 36032031.
Cserna J, Baumann CK, Lobmeyr E, et al. Emergency department utilization following allogeneic hematopoietic stem cell transplantation: a single-center retrospective longitudinal analysis of 557 patients. Transplant Cell Ther. 2023;29(5):321.e1-321.e9. doi:10.1016/j.jtct.2023.02.018.
Pothuru S, Chan WC, Goyal A, et al. Emergency department use and hospital admissions among adult orthotopic heart transplant patients. J Am Coll Emerg Physicians Open. 2022;3(3):e12718. doi:10.1002/emp2.12718.
Oliver MM, Meng Q, Hageman L, et al. Health care utilization by long-term survivors of blood or marrow transplantation: A Bone Marrow Transplant Survivor Study report. Cancer. 2024;130(5):803-815. doi:10.1002/cncr.35076.
Holzhauser L, Reza N, Edwards JJ, et al. Emergency department use and hospital mortality among heart transplant recipients in the United States. J Am Heart Assoc. 2024;13(5):e032676. doi:10.1161/JAHA.123.032676
Lovasik B, Zhang R, Schrager J, Pastan S, Adams A, Patzer R. Emergency department utilization among kidney transplant recipients in the United States [abstract]. Am J Transplant. 2017;17(suppl 3). Available at: https://atcmeetingabstracts.com/abstract/emergency-department-utilization-among-kidney-transplant-recipients-in-the-united-states
Chisholm-Burns M, Spivey C, Tolley E, Kaplan E. Medication therapy management and adherence among US renal transplant recipients. Patient Preference and Adherence. Published online April 2016:703. doi:https://doi.org/10.2147/ppa.s104646
Nevins TE, Nickerson PW, Dew MA. Understanding Medication Nonadherence after Kidney Transplant. Journal of the American Society of Nephrology. 2017;28(8):2290-2301. doi:https://doi.org/10.1681/asn.2017020216
Safia Boghani, Kirkham H, Witt EA, et al. Medication adherence and graft survival among heart transplant recipients. Journal of Drug Assessment. 2019;8(sup1):7-7. doi:https://doi.org/10.1080/21556660.2019.1658329
PQA measure overview. Pharmacy Quality Alliance. https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf. Published 2024. Accessed October 21, 2024. https://www.pqaalliance.org/measures-overview#pdc-dr
Velleca A, Shullo MA, Dhital K, et al. The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2023;42(5):e1-e141. doi:10.1016/j.healun.2022.10.015. Epub December 20, 2022. PMID: 37080658.
Gandolfini I, Palmisano A, Fiaccadori E, Cravedi P, Maggiore U. Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation. Clin Kidney J. 2022;15(7):1253-1274. doi:10.1093/ckj/sfac017. PMID: 35756738; PMCID: PMC9217626
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Transplant References
% OF PATIENTS
2025
Hyperlipidemia
Obesity
Diabetes
Why It Matters
Patients receive and take medications on time.
≥80%
Average PDC7-10
92%
Adherence**
What We Measure
View Obesity References
Download PDF
Overweight and obesity are chronic health conditions that affect nearly 75% of adults aged 20 and older in the United States.1 One of the most common tools for assessing weight status is the Body Mass Index (BMI), where a BMI between 25.0 and 29.9 is classified as overweight, and a BMI of 30.0 or higher indicates obesity.2 Several factors may contribute to the development of overweight and obesity, including unhealthy eating patterns, limited physical activity, certain medications, and family history or genetics. Obesity results from an increase in the size and number of fat cells, which can lead to a range of long-term health complications. Excess body weight can significantly reduce energy levels, limit physical activity, and impair overall quality of life, making it more difficult to stay active and perform daily tasks comfortably. It is also strongly associated with several cardiovascular risk factors, including hypertension, high cholesterol, and diabetes. In particular, Class III obesity (BMI ≥ 40) is linked to a substantially higher risk of total mortality, primarily due to heart disease, when compared to individuals with a normal BMI.3 Our goal is to support patients holistically in their pursuit of better health and well-being. Weight reduction has been shown to produce meaningful improvements in blood pressure and cholesterol levels, contributing to a lower overall cardiovascular risk.4,5
Obesity
Centers for Disease Control and Prevention. Obesity and Overweight. National Center for Health Statistics. Updated May 17, 2024. Accessed August 7, 2025. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm.
World Health Organization. Obesity. Accessed August 7, 2025. https://www.who.int/health-topics/obesity.
Kitahara CM, Flint AJ, Berrington de Gonzalez A, et al. Association between class III obesity (BMI of 40–59 kg/m²) and mortality: a pooled analysis of 20 prospective studies. PLoS Med. 2014;11(7):e1001673. doi:10.1371/journal.pmed.1001673.
Harsha DW, Bray GA. Weight loss and blood pressure control (Pro). Hypertension. 2008;51(6):1420–1425. doi:10.1161/HYPERTENSIONAHA.107.094011.
Brown JD, Buscemi J, Milsom V, Malcolm R, O’Neil PM. Effects on cardiovascular risk factors of weight losses limited to 5–10%. Transl Behav Med. 2016;6(3):339–346. doi:10.1007/s13142-015-0356-9.
Jastrebo_ AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038.
Johnson KM, Zhou H, Lin F, Ko JJ, Herrera V. Real-world adherence and persistence to oral disease-modifying therapies in multiple sclerosis patients over 1 year. J Manag Care Spec Pharm. 2017;23(8):844-852. doi:10.18553/jmcp.2017.23.8.844.
Pardo G, Pineda ED, Ng CD, Bawa KK, Sheinson D, Bonine NG. Adherence to and persistence with disease-modifying therapies for multiple sclerosis over 24 months: a retrospective claims analysis. Neurol Ther. Published online January 12, 2022. doi:10.1007/s40120-021-00319-3.
Halpern R, Agarwal S, Dembek C, Borton L. Comparison of adherence andpersistence among multiple sclerosis patients treated with disease-modifyingtherapies: a retrospective administrative claims analysis. Patient Prefer Adherence. 2011;5:73-84. doi:10.2147/ppa.s15702.
PQA measure overview. Pharmacy Quality Alliance. Published 2024. Accessed October 21, 2024. Available at:https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf.
Linco_ AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389 (24):2221-2232. doi:10.1056/NEJMoa2307563
Malhotra A, Grunstein RR, Fietze I, et al; SURMOUNT-OSA Investigators. Tirzepatide for the treatment of obstructive sleep apnea and obesity. N Engl J Med. 2024;391(13):1193-1205. doi:10.1056/NEJMoa2404881.
Weiss T, Carr RD, Pal S, et al. Real-World Adherence and Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists Therapy in Type 2 Diabetes Mellitus Patients in the United States. Patient Prefer Adherence. 2020;14:2337-2345. Published 2020 Nov 27. doi:10.2147/PPA.S277676.
Thorpe KE, Joski PJ. Estimated Reduction in Health Care Spending Associated With Weight Loss in Adults. JAMA Netw Open. 2024;7(12):e2449200. Published 2024 Dec 2. doi:10.1001/jamanetworkopen.2024.49200.
Malhotra A, Grunstein RR, Fietze I, et al; SURMOUNT-OSA Investigators. Tirzepatide for the treatment of obstructive sleep apnea and obesity. N Engl J Med. 2024;391(13):1193-1205. doi:10.1056/NEJMoa2404881".
Gleason PP, Urick BY, Marshall LZ, et al. Real-world persistence and adherence to glucagon-like peptide-1 receptor agonists among obese commercially insured adults without diabetes. J Manag Care Spec Pharm. 2024;30(8):860-867.
Rodriguez P, Zhang V, Gratzl S, et al. Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists among US adults with overweight or obesity. JAMA Netw Open. 2025;8(1)e2457349. doi: 10.1001/jamanetworkopen.2024.57349.
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Obesity References
Effective management of hyperlipidemia with appropriate therapy and optimal adherence lowers the risk of serious cardiovascular events by 22%17, all-cause mortality by 15%18, and hospital utilization by 30%.19 An integrated care model optimizes patient adherence to evidence-based therapy and maximizes patient outcomes by fostering collaboration across care teams and streamlining patient support. This coordinated approach not only improves individual patient outcomes but also strengthens the value of a health system integrated care model in cardiovascular medicine.
Why It Matters
What We Measure
View Hyperlipidemia References
Download PDF
Hyperlipidemia (HLD) is defined by abnormal levels of lipids. Low-density lipoprotein (LDL) is the primary marker of HLD; it promotes plaque buildup and significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD), heart attack, and stroke. Causes include genetics, metabolic conditions, and lifestyle factors such as poor diet, inactivity, and smoking.1 According to the American Heart Association, 25.5% of US adults have high LDL.2 First-line interventions include lifestyle modifications, a healthy diet, exercise, weight control, and smoking cessation. When medications are required, the primary goal is to reduce LDL, lower triglycerides, and increase high-density lipoprotein (HDL). Statins, ezetimibe, and PCSK9 inhibitors are well-established therapies that effectively reduce LDL and cardiovascular risk. LDL targets vary by strategy: primary prevention aims to reduce the risk of developing ASCVD, while secondary prevention focuses on avoiding recurrent events in patients with established ASCVD.3
Hyperlipidemia
Centers for Disease Control and Prevention. About cholesterol. CDC. Published May 15, 2024. Updated May 15, 2024. Accessed September 2, 2025. https://www.cdc.gov/cholesterol/about/index.html
Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024;149(8):e347-e913. doi:10.1161/CIR.0000000000001209
Patel SB, Wyne KL, Afreen S, et al. American Association of Clinical Endocrinology clinical practice guideline on pharmacologic management of adults with dyslipidemia. Endocr Pract. 2025;31(2):236-262. doi:10.1016/j.eprac.2024.09.016
Canadian Cardiovascular Society, European Association for the Study of Diabetes, Latin American Academy for the Study of Lipids and Cardiometabolic Risk, Patel SB, Belalcazar LM, et al. American Association of Clinical Endocrinology consensus statement: algorithm for management of adults with dyslipidemia—2025 update. Endocr Pract. Published online September 14, 2025. doi:10.1016/j.eprac.2025.07.014
Pignone M, Cannon CP. Low-density lipoprotein cholesterol-lowering therapy in the primary prevention of cardiovascular disease. UpToDate. Updated August 2025. Accessed September 23, 2025. https://www.uptodate.com
Roth EM, Moriarty PM, Bergeron J, et al. A phase III randomized trial evaluating alirocumab 300 mg every 4 weeks as monotherapy or add-on to statin: ODYSSEY CHOICE I. Atherosclerosis. 2016;254:254-262. doi:10.1016/j.atherosclerosis.2016.08.043
Eloso J, Awad A, Zhao X, et al. PCSK9 inhibitor use and outcomes using concomitant lipid-lowering therapies in the Veterans Health Administration. Am J Med Open. 2023;9:100035. doi:10.1016/j.ajmo.2023.100035
Svensson MK, James S, Ravn-Fischer A, et al. A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels. Ups J Med Sci. 2024;129. doi:10.48101/ujms.v129.9618
Ray KK, Dhalwani N, Sibartie M, et al. Low-density lipoprotein cholesterol levels exceed the recommended European threshold for PCSK9i initiation: lessons from the HEYMANS study. Eur Heart J Qual Care Clin Outcomes. 2022;8(4):447-460. doi:10.1093/ehjqcco/qcac009
Gargiulo P, Basile C, Cesaro A, et al. Efficacy, safety, adherence and persistence of PCSK9 inhibitors in clinical practice: a single country, multicenter, observational study (AT-TARGET-IT). Atherosclerosis. 2023;366:32-39. doi:10.1016/j.atherosclerosis.2023.01.001
Zafrir B, Jubran A. Lipid-lowering therapy with PCSK9-inhibitors in the real-world setting: two-year experience of a regional lipid clinic. Cardiovasc Ther. 2018;36(5):e12439. doi:10.1111/1755-5922.12439.
Farnier M, Hovingh GK, Langslet G, et al. Long-term safety and efficacy of alirocumab in patients with heterozygous familial hypercholesterolemia: an open-label extension of the ODYSSEY program. Atherosclerosis. 2018;278:307-314. doi:10.1016/j.atherosclerosis.2018.08.036
Pharmacy Quality Alliance. PQA measure overview. Published 2024. Accessed October 21, 2024. https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf
Kazi DS, Elkind MSV, Deutsch A, et al. Forecasting the economic burden of cardiovascular disease and stroke in the United States through 2050: a presidential advisory from the American Heart Association. Circulation. 2024;150(4):e89-e101. doi:10.1161/CIR.0000000000001258
De Vera MA, Bhole V, Burns LC, Lacaille D. Impact of statin adherence on cardiovascular disease and mortality outcomes: a systematic review. Br J Clin Pharmacol. 2014;78(4):684-698. doi:10.1111/bcp.12339
Andersson T, Nåtman J, Mourtzinis G, et al. The effect of statins on mortality and cardiovascular disease in primary care hypertensive patients without other cardiovascular disease or diabetes. Eur J Prev Cardiol. 2023;30(17):1883-1894. doi:10.1093/eurjpc/zwad212
Huang CH, Wang SI, Fan FS, Lu HJ, Wei JC. Association of PCSK9 inhibitors with mortality: insights from a retrospective cohort analysis. Eur Heart J Cardiovasc Pharmacother. 2024;10(6):505-514. doi:10.1093/ehjcvp/pvae05
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Hyperlipidemia References
Why It Matters
Average A1C
What We Measure
View Diabetes References
Download PDF
Diabetes occurs either when the pancreas does not produce enough insulin or when the body becomes resistant to insulin,leading to an increase in blood sugar levels and other complications. Patients are considered to have prediabetes when their hemoglobin A1C is 5.7-6.4%, and diabetes is diagnosed when the A1C is ≥ 6.5%.1 Poorly controlled diabetes can lead to serious complications such as cardiovascular disease, retinopathy, kidney disease, and nerve damage, increasing both direct and indirect healthcare costs, which exceeded $412 billion in the U.S. in 2022.2 Treatment plans for diabetes often include a combination of both lifestyle modifications and oral or injectable medications. Weight loss and a balanced diet can lower the risk of complications by improving insulin sensitivity and lowering blood sugar levels.3 First-line treatment options for type 2 diabetes, such as Glucagon-Like Peptide-1 (GLP-1) agonists and Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors, have proven to be effective in lowering blood sugar and in assisting with weight loss.3 In addition to blood sugar lowering benefits, SGLT2 inhibitors and GLP-1s have been shown to significantly reduce cardiovascular events, slow the progression of kidney disease, and reduce cardiovascular mortality.4,5,6
Diabetes
American Diabetes Association. Understanding A1C. American Diabetes Association. Published 2023. https://diabetes.org/about-diabetes/a1c
Parker ED, Lin J, Mahoney T, et al. Economic costs of diabetes in the U.S. in 2022. Diabetes Care. 2024;47(1):26-43. https://doi.org/10.2337/dci23-0085
American Heart Association. Diabetes complications and risks. American Heart Association. Published April 2, 2024. https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks
Neuen BL, Heerspink H, Vart P, et al. Estimated lifetime cardiovascular, kidney, and mortality benefits of combination treatment with SLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal MRA compared with conventional care in patients with type 2 diabetes and albuminuria. Circulation. 2024;149(6):450-462. doi: 10.1161/CIRCULATIONAHA.123.067584.
Nuffield Department of Population Health Renal Studies Group; SGLT2 inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. Lancet. 2022;400:1788–1801. doi: 10.1016/S0140-6736(22)02074-8
Sattar N, Lee MM, Kristensen SL, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials. Lancet Diabetes Endocrinol. 2021;9:653–662. doi: 10.1016/S2213-8587(21)00203-5
American Diabetes Association Professional Practice Committee. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S128-S145. doi:10.2337/dc25-S006
PQA measure overview. Pharmacy Quality Alliance. https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf. Published 2024. Accessed October 21, 2024. https://www.pqaalliance.org/measures-overview#pdc-dr
Quach J, Midlam C, Sell C, Levin-Scherz J. Out-of-pocket costs for diabetes medications in employer-sponsored health insurance plans. Am J Manag Care. 2024;30(3):107-108. doi:10.37765/ajmc.2024.89510
Do D, Lee T, Peasah SK, Good CB, Inneh A, Patel U. GLP-1 Receptor Agonist Discontinuation Among Patients With Obesity and/or Type 2 Diabetes. JAMA Netw Open. 2024;7(5):e2413172. Published 2024 May 1. doi:10.1001/jamanetworkopen.2024.13172
Rodriguez PJ, Zhang V, Gratzl S, et al. Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults With Overweight or Obesity. JAMA Netw Open. 2025;8(1):e2457349. Published 2025 Jan 2. doi:10.1001/jamanetworkopen.2024.57349
https://shieldshealthsolutions.com/content/uploads/2026/01/Shields-ADA-2025-Care-Coach-Poster_FINAL.pdf
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2024
**Adherence is measured by the proportion of days covered (PDC)
Diabetes References
View our
MS White Paper
View our Diabetes White Paper
View our Pediatric Diabetes White Paper
View our Cystic Fibrosis White Paper
Of patients receive and take medications on time
≥80%
Benchmark15
93%
Adherence**
Of patients report feeling very well or well about how their specialty medication is working
93%
Patient Reported Treatment Efficacy
Primary prevention:
Percent of patients with LDL < 100 mg/dL
Secondary prevention:
Percent of patients with LDL < 70 mg/dL
Shields
Benchmark4-8
25%
50%
75%
100%
75%
80%
0%
Benchmark9-15
Shields
25%
0%
50%
75%
100%
55%
68%
Hear directly from specialty pharmacy leaders who’ve grown with us—and see the care model in action.
Partner Voices, Proven Results
04 Partner Testimonials
In this video, Phoenix Children’s Hospital shares how their specialty pharmacy program has evolved to meet the complex needs of pediatric patients. Hear from their team about the clinical integration, patient engagement strategies, and measurable outcomes that have positioned their program as a leader in pediatric specialty care. The testimonial highlights their commitment to innovation, collaboration, and improving lives through pharmacy excellence.
Phoenix Children's Hospital
Partner testimonial
In this video, leaders from Tampa General Hospital share how their specialty pharmacy program has grown into a high-performing, patient-centered service. Learn how they achieved measurable improvements in patient outcomes, streamlined operations, and built a scalable model for complex care. The testimonial highlights their strategic approach, clinical integration, and the results that set their program apart.
Tampa General Hospital
Partner testimonial
Albany Med shares how their specialty pharmacy program has become a vital part of their patient care strategy. In this video, hear from their team about the clinical integration, operational improvements, and patient-centered outcomes that have driven their success. The testimonial highlights their commitment to delivering high-touch care and building a sustainable model for specialty pharmacy excellence.
Albany Medical Center
Partner testimonial
06
06
Partnerships
9.8%
SHIELDS
≥ 5%
Benchmark6
Percent Weight
Loss within ≥6 Months
Spartanburg Regional Healthcare System (SRHS), one of South Carolina’s largest healthcare providers, set out to enhance care for patients with complex conditions by expanding its specialty pharmacy services. Recognizing the power of a high-touch, integrated model, SRHS set out to elevate their pharmacy operations, aiming for accreditation, increased prescription volume, and broader support across disease states. With embedded liaisons in clinics including oncology, HIV, and hepatitis C, SRHS delivered personalized care while driving measurable improvements in patient satisfaction. Annual surveys, including Net Promoter Score (NPS) tracking, became a cornerstone of quality assurance and continuous improvement.
Spartanburg Regional Healthcare System
Partner testimonial
View Case Study
View Case Study
In this case study, CHRISTUS Health shares how it revolutionized diabetes care by implementing a Health System Specialty Pharmacy (HSSP) model. Confronted with medication non-adherence and low patient satisfaction in a traditional pharmacy settings, CHRISTUS seized the opportunity to redesign its approach, delivering more personalized, integrated support to a rapidly growing diabetes population
CHRISTUS Health
Partner testimonial
Discontinuation Rate
Percent of patients who discontinued their GLP-1 therapy at 1 year
Managing GLP-1 side effects and guiding dose adjustments helps patients stay on therapy —cutting discontinuation rates and improving outcomes. Even a 5% BMI drop can lower healthcare costs.14,15
A Specialty Care Team Can Make the Difference
Shields
46.5%
19.7%
64.5%
With Type 2 DM17
Without Type 2 DM17
Weight management has been shown to improve obesity-related medical conditions significantly. It can reduce the incidence of major adverse cardiovascular events (MACE) by 1.5 percentage points, representing a 20% relative risk reduction, and improve obstructive sleep apnea (OSA) severity by 20 to 23.8 fewer apnea–hypopnea events per hour.11,12 Nonadherence to weight loss medications may impact weight loss goals and hinder the improvement of MACE and OSA. Gastrointestinal side effects of GLP-1RAs, such as nausea, vomiting, diarrhea, or constipation, can contribute to patient nonadherence or discontinuation of the medication.13 Clinical pharmacists offer strategies to manage side effects, support adherence, and guide patients through missed doses or treatment adjustments. Beyond health, obesity also carries a financial burden. People living with obesity may face up to three times higher medical costs than those at a healthy weight. Measuring weight loss and medication adherence is crucial in identifying gaps in care, ensuring timely interventions, improving overall health outcomes, and potentially lowering healthcare costs.
Cardiovascular
disease and stroke
are leading causes of
morbidity and mortality in the U.S. and represent a major driver of healthcare spending, accounting for approximately
$251
Billion
IN DIRECT COST IN 201916
To deepen the clinical impact of its care model, in 2021, Shields launched its Care Coach program, which offers an enhanced set of services to at-risk patients with diabetes. The program targets patients with a sustained A1C above 9% and, in addition to offering specialty pharmacy services, provides a range of additional services such as nutritional and lifestyle counseling, goal setting, motivation coaching, Social Determinants of Health (SDOH) support, and mental health referrals. The program is designed to re-engage patients in their diabetes self-management by pairing them with a clinical pharmacist coach who provides continuous support.
Our Unique Approach to Complex Diabetes Care: The Care Coach Program
Hear directly from one of our Care Coach Patients:
Watch Here
0%
10%
6 months
Post-Enrollment
1%
0%
2%
1.7%
1.9%
12 months
Post-Enrollment
Patients can afford their medications, enabling consistent access and adherence to therapy
Benchmark9
$29
Average Copay
Discontinuation Rate at 12 months
Low discontinuation reflects sustained patient engagement and treatment stability
Of patients receive and take medications on time
>80%
Benchmark7
94%
Adherence**
Martha Stutsky, PharmD; Carolkim Huynh, PharmD; Tatyana Cohen, PharmD; Kate Smullen, PharmD; Kerry Mello‑Parker, PharmD; Shreevidya Periyasamy, MS HIA; Diana Miller; Chris Barr; Ashley Struble; Laura Rice; Nicholas Bull, PharmD; Bill McElnea; Jennifer Casey; Avia Shemesh, PharmD; Sharon Zhu, PharmD; Mallory Telese, PharmD; Kyle Wojciechowski, PharmD; Jillian Augusthy, PharmD; Rachel Quinn, PharmD.
Contributors list:
Rare Diseases
Reducing bleeding in this population is essential because each episode can cause cumulative, often irreversible damage to joints, muscles, and other tissues, leading to chronic pain and long-term disability. Pharmacists educate patients and caregivers, help optimize dosing and adherence, and monitor breakthrough bleeding patterns through proactive clinical management and coordination with care teams. Bleed prevention helps preserve joint health and physical functioning, supports independence, and reduces ER visits and hospitalizations.
Why It Matters
Variance between the ordered dose and the dispensed dose to minimize medication waste
+/-10%
Benchmark9
0.4%
Mean Variance
Of patients reported no missed days of planned activity, school, or work
96%
No Absenteeism
What We Measure (Bleeding Disorders)
View Rare Diseases References
Read the case study
The term “rare diseases” first appeared in medical literature in the late 1960s. It gained formal recognition with the passing of the Orphan Drug Act in 1983.1 Since then, research and innovation in this space have grown tremendously, alongside the number of identified rare conditions.2 While rare diseases are still defined as those affecting fewer than 200,000 people in the U.S., new terms like ultra-rare (fewer than 1 in 50,000) and hyper-rare (fewer than 1 in 100 million) help us discuss rarity more precisely.3 In 2024, more than half of all newly approved medications were developed to treat rare diseases. Of those drugs, 15.4% targeted hyper-rare conditions, 61.5% focused on ultra-rare, and 23.1% addressed rare diseases, reflecting a shift toward highly specialized medicine.4
For patients living with rare, ultra-rare, and hyper-rare conditions, access to therapy, high treatment costs, and navigating complex insurance and financial assistance pathways remain significant barriers. At Shields, we partner with health systems to close these gaps—leveraging deep clinical expertise, integrated specialty pharmacy support, and hands-on guidance through insurance and FA programs to ensure patients can start and stay on therapy. Our innovative, data-driven, high-touch platform allows us to monitor progress and assess outcomes, providing the personalized support these patients need while centering compassionate care.
In this report, we focus specifically on bleeding disorders, a subset of rare conditions that exemplify many of the challenges and innovations shaping this space.
Rare Diseases
Huyard, C. (2009), How did uncommon disorders become ‘rare diseases’? History of a boundary object. Sociology of Health & Illness, 31: 463-477. https://doi.org/10.1111/j.1467-9566.2008.01143.
GlobalGenes.org. https://globalgenes.org/blog/rare-ultra-rare-hyper-rare-a-search-for-paths-forward-2024-next-report/
Smith, C.I. Edvard et al.; Estimating the number of diseases – the concept of rare, ultra-rare, and hyper-rare; iScience, August 18, 2022, https://linkinghub.elsevier.com/retrieve/pii/ S2589004222009701
Casper B. Commercialization Considerations for Orphan/Rare, Cell & Gene, and Precision Medicine. Presented at: Asembia Summit; May 2025; Las Vegas, NV
World Federation of Hemophilia. World Bleeding Disorders Registry 2023 Data Report. Montréal (QC): World Federation of Hemophilia; March 2024. Available from: https://www1.wfh.org/publications/files/pdf-2452.pdf. Accessed December 1, 2025.
World Federation of Hemophilia. World Bleeding Disorders Registry 2023 Data Report. Montréal (QC): World Federation of Hemophilia; March 2024. Available from: https://www1.wfh.org/publications/files/pdf-2452.pdf. Accessed December 1, 2025.
Cutter S, Molter D, Dunn S, et al. Impact of mild to severe hemophilia on education and work by US men, women, and caregivers of children with hemophilia B: The Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) study. Eur J Haematol. 2017;98 Suppl 86:18-24. doi:10.1111/ejh.12851
Van Balen EC, Hassan S, Smit C, et al. Socioeconomic participation of persons with hemophilia: Results from the sixth hemophilia in the Netherlands study. Res Pract Thromb Haemost. 2022;6(6):e12741. Published 2022 Aug 26. doi:10.1002/rth2.12741
National Hemophilia Foundation, Medical and Scientific Advisory Council (MASAC). MASAC Recommendations Regarding Standards of Service for Pharmacy Providers of Clotting Factor Concentrates for Home Use to Patients with Bleeding Disorders (MASAC Document #188). Published 2008. Accessed February 4, 2026. https://www.bleeding.org/sites/default/files/document/files/masac188.pdf
* Shields Health Solutions Network includes data from a collective of member health systems that partner with Shields to elevate an integrated specialty pharmacy model.
* All metrics are reflective of data collected in 2025
**Adherence is measured by the proportion of days covered (PDC)
Rare Disease References
of RA patients IMPROVED their RAPID3 score, resulting in positive treatment outcomes
≥
90%
≥
80%
≥
80%
≥
90%
≥
86%
≥
>$38
≤0.372-11
5%
<40%
Benchmark10,11
Average A1C Reduction
at 6 and 12 Months
Total Medical Expense Reduction
$2,649
Average TME reduction per patient with A1C > 9% during the program’s first year (number reflects only patients managed by the Care Coach program).12
Learn more here
6.9%
SHIELDS
0%
9%
<7%
Benchmark7
Annualized Bleeding Rate
10%
Benchmark
<
0%
Shields
Unplanned ER Visits/Hospitalizations
Patients who experienced a hospitalization/ER visit related to bleeding disorder
The ABR Benchmark is the Shields annualized bleeding rate goal for patients receiving factor replacement product for either prophylaxis or on-demand dosing.5
1.5
>40%
Benchmark7,8
Bleeds per year
Shields
Bleeds per year
Benchmark5
<4
6
Intro to CF. Cystic Fibrosis Foundation. https://www.cff.org/intro-cf#overview-of-cf. Accessed September 25, 2025.
Bell SC, Mall MA, Gutierrez H, et al. The future of cystic fibrosis care: a global perspective. Lancet Respir Med. 2020;8(1):65-124. doi:10.1016/S2213-2600(19)30337-6.
Ramos KJ, Pilewski JM, Taylor-Cousar JL. Challenges in the use of highly effective modulator treatment for cystic fibrosis. J Cyst Fibros. 2021 May;20(3):381-387. doi: 10.1016/j.jcf.2021.01.007. Epub 2021 January 30. PMID: 33531206; PMCID: PMC8192344.
Cystic Fibrosis Foundation Patient Registry. 2024 Annual Data Report Bethesda, Maryland ©2025 Cystic Fibrosis Foundation
Cystic Fibrosis Foundation. Patient Registry 2022 Annual Data Report, 48. Bethesda, Maryland, 2023
P.G. Middleton, M.A. Mall, P. Dřevínek, L.C. et al. Elexacaftor–Tezacaftor–Ivacaftor for Cystic Fibrosis with a Single Phe508del Allele. N Engl J Med 2019;381:1809-19. DOI: 10.1056/NEJMoa1908639
Wainwright CE, Elborn JS, Ramsey BW et al. Lumacaftor-Ivacaftor in Patients with Cystic Fibrosis Homozygous for Phe508del CFTR. N Engl J Med 2015;373:220-31
Taylor-Cousar JL, Munck A, McKone E, et al. Tezacaftor-Ivacaftor in Patients with Cystic Fibrosis Homozygous for Phe508del. N Engl J Med 2017;377:2013-23
Hansen CME, Breukelman AJ, van den Bemt PMLA, Zwitserloot AM, van Dijk L, van Boven JFM. Medication adherence to CFTR modulators in patients with cystic fibrosis: a systematic review. Eur Respir Rev. 2024 Aug 14;33(173):240060. doi: 10.1183/16000617.0060-2024. PMID: 39142708; PMCID: PMC11322823.
Olivereau L, Nave V, Garcia S, Perceval M, Rabilloud M, Durieu I, Reynaud Q. Adherence to lumacaftor-ivacaftor therapy in patients with cystic fibrosis in France. J Cyst Fibros. 2020 May;19(3):402-406. doi: 10.1016/j.jcf.2019.09.018. Epub 2020 Jan 3. PMID: 31902692.
PQA measure overview. Pharmacy Quality Alliance. https://www.pqaalliance.org/assets/Measures/PQA_Measures_Overview.pdf. Published 2024. Accessed October 21, 2024. https://www.pqaalliance.org/measures-overview#pdc-dr
Goss CH. Acute Pulmonary Exacerbations in Cystic Fibrosis. Semin Respir Crit Care Med. 2019 Dec;40(6):792-803. doi: 10.1055/s-0039-1697975. Epub 2019 October 28. PMID: 31659730; PMCID: PMC7528649.
Transplant patients frequently require hospitalization or ER due to comorbidities, rejection, infections from post-transplant immunosuppressant medications, and inadequate coordination between transplant centers and emergency providers. Regular follow-up, monitoring by clinicians, and adherence to anti-rejection medications can prevent some transplant-related hospitalizations and ER utilization. Monitoring hospital utilization provides insight into potential unmet healthcare needs and approaches to lower the total cost of medical care.11,12 Comprehensive care requires a thorough understanding of disease management. Absenteeism and adherence measurements are vital in providing insights into disease burden and quality of life effects, leading to enhanced care, improved quality of life, and reduced costs.
With proper support, patients can gain confidence in managing their condition, improve their quality of life, and reduce the risk of long-term health issues. In patients with type 2 diabetes, lowering A1C by 1% has been associated with reductions in all-cause and diabetes-related total healthcare costs, resulting in annual cost savings of $429 and $736, respectively.8 Pharmacists play a vital role in managing chronic conditions. By monitoring drug interactions, identifying contraindications, and providing personalized counseling, they help patients stay on track with their therapy, avoid or manage side effects, and achieve better outcomes.9
Benchmark2
50%
≤
