EFFECTIVE PRIOR AUTHORIZATION: RIGHT DRUG, RIGHT PATIENT

Transcription

1 EFFECTIVE PRIOR AUTHORIZATION: RIGHT DRUG, RIGHT PATIENT HOW SURESCRIPTS USES ANALYTICS TO IMPROVE THE PA PROCESS LUKE FORSTER-BROTEN October 12, Copyright 2017 by by Surescripts, LLC. All All rights reserved.

2 THERE IS A NEED FOR ACTIONABLE PATIENT-SPECIFIC INFORMATION AT CRITICAL POINTS IN CARE. The computer helps me know about their health and their healthcare. The hard part is figuring out how to help care teams access and add to this information and still stay present with patients in the room. Dr. Neda Ratanawongsa Associate Chief Health Informatics Officer for Ambulatory Services San Francisco Health Network 2 Copyright 2017 by by Surescripts, LLC. All All rights reserved. Source: JAMA Intern Med. 2016;176(1): doi: /jamainternmed

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4 WE GIVE PROVIDERS CRITICAL INFORMATION ON PATIENT S MEDICATIONS IN REAL-TIME MEDICATION HISTORY RESULTS 13-month view of patient medication history delivered electronically Up to 67% increased identification of significant medications Walsh, Andrew, Report from MediCenter Pilot Study, Health Monitoring Systems, Study demonstrated that using Medication History identified these drug types at rates greater than the average rates at which they are reported using the patient interview process only.

5 It is very handy to have that list...for many of the patients who come in and aren t able to give you any useful information because of their condition. Even if we haven t been able to confirm with the patient, it at least gives us a tool we can work with. CMIO Rideout Health 5 Copyright 2017 by by Surescripts, LLC. All All rights reserved.

6 MANUAL PRIOR AUTHORIZATION IS HUGELY INEFFICIENT Physician Pharmacy Patients PBM/ Health Plan 1. Medication nonadherence: a national epidemic among America's seniors. Geriatrics (April 2007) 2. Enhancing Prescription Medicine Adherence: A National Action Plan. National Council on Patient Information and Education (August 2007) 6

7 PROSPECTIVE EPA WITHIN IN THE EMR IS THE IDEAL WORKFLOW Physician Pharmacy Patients - Real-time eligibility transaction identifies patient s pharmacy coverage - Real-time benefit check identifies formulary status, alternatives, and coverage details for the target drug 7

8 PROSPECTIVE EPA WITHIN IN THE EMR IS THE IDEAL WORKFLOW Physician Pharmacy Patients - EMR holds the prescription and initiates epa - PBM returns in seconds the exact criteria needed to adjudicate the PA 8

9 PROSPECTIVE EPA WITHIN IN THE EMR IS THE IDEAL WORKFLOW Physician Pharmacy Patients - Provider sends the completed question set - PBM returns an approval/denial in minutes 9

10 COMPLETEPA USES REAL TIME BENEFIT INFORMATION TO AUTOMATICALLY POPULATE PARTS OF THE FORM Med Rx: Crestor 20 MG Drug: Crestor 20 MG With a direct connection to the PBM/payer, patient information is automatically pre-populated from the provider s EHR. Next step is automating extraction of test results, diagnoses, etc. using coded references

11 WE STREAMLINE PRIOR AUTHORIZATIONS SO PRESCRIPTIONS CAN BE DISPENSED TIMELY COMPLETEPA RESULTS Pre-populated question sets with patient and plan specific information within EHR At least1% increase in first fill adherence for all drugs Walsh, Andrew, Report from MediCenter Pilot Study, Health Monitoring Systems, Study demonstrated that using Medication History identified these drug types at rates greater than the average rates at which they are reported using the patient interview process only.

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