Electronic Prescribing:

Transcription

1 Sponsored by: Electronic Prescribing: How Do We Get to the Tipping Point? AHIP Business Forum November 19,

2 Making the Case For Electronic Prescribing 2

3 Electronic Prescribing Prescribe Transmit Traditional view 3

4 Medication Management Process Prescribe Transmit Dispense Administer Monitor Modern view 4

5 Medication Management Process Prescribe Transmit Dispense Administer Monitor Bell Douglas S, Cretin S, Marken RS, and Landman AB, A Conceptual Framework for Evaluating Outpatient Electronic Prescribing Systems Based on Their Functional Capabilities, Journal of the American Medical Informatics Association, Vol. 11, No. 1, January/February 2004, pp Doug Bell, RAND and UCLA 5

6 Payer Messaging Lense Provider Member Formulary alerts Patient safety alerts Medication adherence alerts Gaps in care alerts Condition & therapy education Medication adherence education Mail order instructions Care reminders Communication at the point of care 6

7 Importance of E-Prescribing It is safer It saves time and money - Pharmacies - Plans - Physician practices - Patients It improves the quality of healthcare 7

8 Lowers health plan drug costs Return On Investment Increases prescribing of generic medications Increases prescribing of lower cost alternative medications Decreases amount of inappropriate medication therapy - Prior authorizations - Step therapies Increases use of mail order for chronic medications +1% generic utilization = $4 - $12 PMPY* *Industry estimates by payer e-health consulting firm. 8

9 Lowers health plan medical costs Return On Investment Reduced ADEs - More accurate drug dosing - Increased legibility - Drug interaction checking Patient adherence - Increased first fill percentage - Increased persistence through availability of medication history - Prescribing of affordable, on formulary medications +$1 drug spend = $4 - $7 lower medical costs* *Medco, 2005 (study on increased adherence for diabetes, hypertension and other conditions). 9

10 Increases provider and member satisfaction Return On Investment Provider satisfaction - Practice efficiencies including less phone/fax through automated renewals - Availability of medication history information across providers - Availability of electronic prescription records outside the practice - Improved quality of care Member satisfaction - Less wait in the pharmacy - Perception of more modern care Reduces staff time by hours per day in smaller practices* *SureScripts-RxHub 10

11 Electronic Prescribing Across Stakeholder Environments 11

12 Physician adoption EMR ERx Niche stand-alone 12% Use EMR w/o ERx 17% Use EMR With ERx 5% Use ERx Stand-alone 66% Not Automated Full EMR Large and smaller practices are different markets DeRoche, N Engl J Med 2008;359:50-60; CDC (2008), SureScripts-RxHub (2008) 12

13 Physician utilization ERx within an EMR Niche stand-alone Commitment Practice leadership Training Workflow Total system support Full EMR Do we have the tools to succeed? 13

14 Community pharmacies Over 40,000 stores active 80% are chains Sharing Rx history - NCPDP with physicians - Google / Microsoft PHRs In-store clinics (CCR) Pharmacist care mgmt 14

15 Government: Medicare Incentives +2% +2% +1% +.5% % -1.5% -2% Will payers continue to invest or move to the sidelines? 15

16 Consumer Experience Call pharmacies for refills Refill reminders Prescription receipt - Administrative messages - Care messages Focus on adherence Physician-patient relationship Safety, Convenience, Outcomes 16

17 Pharmaceutical Manufacturers Formulary positioning Medication adherence First fill alerting Closed loop prior auth Communications links - Market surveys - Drug information Practice efficiency Focus on patient education and medication adherence 17

18 Electronic Prescribing: The Health Plan Experience 18

19 Successful Models MA ERx Collab. SEMI eprescribe FL CareFirst Horizon BCBSNC Capital BCBSAL Sierra BCBSLA BCBSIL Medicaid FL BCBSRI Aetna Free or near free to high prescribers Activation and monthly services fees to solution providers 19

20 Top Standalone Suppliers Allscripts DrFirst iscribe MedPlus Prematics RelayHealth RxNT ZixCorp Business models remain a challenge 20

21 Part of a payer toolset Electronic Prescribing Physician EMR Member PHR Disease management Pay for performance Patient-centered medical home Supports clinical messaging to providers and members 21

22 Multi-payer projects First movers Competitors Nationals Niches CMS Free riders? Business Model? Collaboration upfront or joining mid-process 22

23 Collaborative models AHIP CAQH RIQI???? SureScripts-RxHub Availity erx Collaborative S.E.M.I. eprescribe FL Ownership? Breadth of Coalition? Org structure? 23

24 Open Discussion: The Way Forward 24

25 Force Field Analysis Ideal State Obstacles and Challenges Today Driving Forces The Payer Environment for Electronic Prescribing 25

26 Force Field Analysis Ideal State Physician IT Support Obstacles and Challenges Free Riding Vendor Biz Model Payer Silos Today Medicare Incentive Payer ROI Pharmacy InterOp Driving Forces The Payer Environment for Electronic Prescribing 26

27 From the payer point of view 1. What are our primary obstacles to progress in e-prescribing? 2. What can each organization do to move e-prescribing ahead? 3. What help and support do we need from others? 4. What are our immediate priorities to work on together???? Key Questions for the Group 27

28 Thank you. Michael Lake President Circle Square Inc. San Francisco, CA 28