Good, better, best: A clear framework for specialty pharmacy

Most specialty pharmacy leaders know when their program is under strain. They can usually point to the pressure points: delayed prior authorizations, inconsistent reporting, manual handoffs, limited visibility into therapy start timelines, and quality teams concentrating their work around accreditation cycles. What is harder is determining whether those issues are isolated problems or signs that the operating model itself needs to mature.

For health systems evaluating specialty pharmacy performance, the question is not only whether the program is meeting accreditation requirements or internal targets. It is whether leaders can see, explain, and improve the operational drivers behind those results across adherence, time to therapy, quality, accreditation readiness, and patient experience.

Without a shared definition of performance, "good" means something different to every team.

Without a common framework, every organization, team, and individual defines "good" differently.

The Accelerate Pharmacy Solutions team created the Good, Better, Best framework to make specialty pharmacy performance easier to evaluate across the areas that shape program effectiveness: clinical outcomes, time to therapy, operational visibility, quality and accreditation readiness, and patient experience.

1. A Good specialty pharmacy program meets core expectations. The team maintains accreditation, tracks required metrics, and reports on performance when asked. But much of the work remains reactive: data lives in separate systems, teams invest manual effort in reporting, and improvement efforts focus on immediate issues rather than recurring patterns.
2. A Better program builds more consistency. Teams integrate data, establish benchmarks, and design workflows to reduce variation across sites. Leaders gain clearer visibility into performance, which helps them identify trends, communicate progress to stakeholders, and address issues before they grow into larger operational problems.
3. A Best-in-class program uses performance data as part of daily management. Leaders can see where work is moving smoothly, where patients are at risk of delay or nonadherence, and which interventions are improving outcomes. Leaders do not only measure performance after the fact; they manage it continuously through clear ownership, predictable workflows, and a shared understanding of what good looks like.

Many programs land closer to Good than their leaders expect. That does not mean performance is poor. It usually means the program relies on strong individual effort more than repeatable systems, integrated data, and a consistent rhythm for reviewing and acting on results.

A useful specialty pharmacy performance assessment does more than label a program as Good, Better, or Best. It helps leaders compare current operations against defined benchmarks, identify missing capabilities, and prioritize the changes most likely to improve outcomes, efficiency, and readiness for future growth.

• Moving from Good to Better means building the systems that make performance visible: standard workflows, integrated data, consistent reporting, and clear ownership for follow-up.
• Moving from Better to Best is about how teams use those systems. Data drives daily decisions. Teams build a rhythm around performance. Improvement never stops.
• Once the basics are in place, the strongest programs do not just ask whether performance is improving. They ask why it is improving, whether that improvement is repeatable, and what needs to happen next.

1. In adherence and clinical outcomes, programs shift from tracking performance to predicting risk -- moving from reporting adherence rates to identifying which interventions drive those results.
2. In time to therapy and operations, visibility is the differentiator. Good programs track timelines. Best-in-class programs explain exactly where delays occur and why.
3. In quality and accreditation, programs progress from periodic readiness to continuous readiness. At the highest level, teams embed quality in daily operations rather than concentrating it around audit cycles.
4. Patient experience often reveals the biggest gap. Collecting feedback is not enough. Leading programs incorporate patient input into care and operational decisions in real time.

Benchmark thresholds alone do not create differentiation. Many programs meet baseline targets. Fewer demonstrate how they achieve and sustain those outcomes.

That is what leadership teams evaluate: not just results, but control over those results.

Choose one domain where your team feels confident, then test that confidence with a more specific question: Can we explain how we achieve this performance, what factors influence the result, and what we would change if the number started moving in the wrong direction? If the answer is no, the next step is not another report. It is building the visibility and ownership needed to manage performance more deliberately.