eprescribing Adoption and Implications An E-Prescribing Case Study: Metrics to Inform Medicaid and State Pay-For-Performance Strategies

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1 eprescribing Adptin and Implicatins An E-Prescribing Case Study: Metrics t Infrm Medicaid and State Pay-Fr-Perfrmance Strategies Jnah Frhlich, Califrnia HealthCare Fundatin Timathie Leslie, Manatt Health Slutins February 28,

2 Airline and Healthcare Industries Cmpared Surces: Federal Aviatin Administratin. Merrill CT, Elixhauser A. Hspitalizatin in the United States, Agency fr Healthcare Research and Quality, HCUP Fact Bk N. 6. AHRQ Publicatin N Institute f Medicine, T Err is Human, Natinal Academy f Sciences CALIFORNIA HEALTHCARE FOUNDATION 2

3 Electrnic Prescribing (aka eprescribing r erx): Ptential Benefits: Significantly reduce medicatin errrs including: dispensing the wrng drug, rdering drugs that may interact with ther drugs patients are taking, r cause allergic reactins. CALIFORNIA HEALTHCARE FOUNDATION 3

4 Califrnia vs. Wal-Mart Surces: The Wrld Factbk (ISSN ; als knwn as the CIA Wrld Factbk). Wal-Mart 2006 Annual Reprt. CALIFORNIA HEALTHCARE FOUNDATION 4

5 Hw Are They Different? Wal-Mart knws when a 6 z. can f lw-sdium Campbell s tmat sup is sld in Fresn stre #1815; hw much the custmer paid fr it; hw many mre they have in stck; and can instantaneusly rder mre t replace it Califrnia can t accurately accunt fr the number f peple wh die r are sickened frm a prescribing errr: There is n reprting r detectin system There are n incentives (r penalties) assciated with gd (r bad) prescribing practices CALIFORNIA HEALTHCARE FOUNDATION 5

6 Hw Is This fr Efficiency? Cst f dispensing a drug fr a Medi-Cal beneficiary 1 : $13.18 per prescriptin Cmmunicatin between pharmacies and physician ffices accunt fr 2 : 25% f pharmacists time 20% f the wrklad f physician-ffice staff Meanwhile ver at Wal-Mart: Generics drugs are $4 (and they re making mney n it) Saved cnsumers >$750 millin Surces :1 Grant Thrntn, LLP, Natinal Study t Determine the Cst f Dispensing Prescriptins in Cmmunity Retail Pharmacies, January Jane Sarashn-Kahn & Matthew Hlt, The Prescriptin Infrastructure: Are We Ready fr eprescribing? Califrnia HealthCare Fundatin, January CALIFORNIA HEALTHCARE FOUNDATION 6

7 Quality and Safety Institute f Medicine, Reprt Brief, July 2006: Preventing Medicatin Errrs Rick Ratliff, COO Surescripts - NACDS Natinal Assciatin f Chain Drug Stres estimates Natinal Highway Traffic Safety Administratin, July 2007 Traffic Safety Facts, Federal Highway Administratin, US Department f Transprtatin (2002) A typical autmbile n the rad in 2002 had an average trip length f 4.0 miles CALIFORNIA HEALTHCARE FOUNDATION 7

8 CALIFORNIA HEALTHCARE FOUNDATION 8

9 e-prescribing: Slwly but Surely Infiltrating the Wrld f P4P Private Sectr Initiatives Federal Initiatives Medicare Physician Quality Reprting Initiative Medicare Physician Grup Practice Demnstratin Draft 2009 Medicare Drug Benefit Call Letter State-level Initiatives: Massachusetts, Flrida, Michigan and thers Mississippi: Saves the state abut $1.2 millin per mnth in medicatin csts by equipping 225 dctrs with handheld e- prescribing devices* eprescribing pilt prgram (nrthern CA and Medi-Cal) * Gvernment Health IT September 13, CALIFORNIA HEALTHCARE FOUNDATION 9

10 eprescribing: Frm Start t Finish CALIFORNIA HEALTHCARE FOUNDATION 10

11 A Cmprehensive erx Prgram Pharmacy Pre-authrizatin Refill request Fill histry Claim generatin PBM/Payr Claims Frmulary Patient Refill request Outreach and educatin Self-management Prvider Pre-authrizatin Refill apprval Decisin supprt Reminders Drug-drug checks CALIFORNIA HEALTHCARE FOUNDATION 11

12 NSRHN erx Prgram: A Pilt fr the State 9-cunty regin f rural nrthern Califrnia Nrthern Sierra Rural Health Netwrk Map Over 30% f patients are Medi-Cal beneficiaries Drug-seeking: tp issue identified by prviders in eight cmmunity meetings (2006) erx identified as #1 technlgy funding pririty CALIFORNIA HEALTHCARE FOUNDATION 12

13 Participant Overview Facility Plumas District Hspital Hill Cuntry Cmmunity Clinic Fairchild Medical Center McClud Clinic Mercy Mt. Shasta Shasta Cmmunity Health Center Siskiyu Family Health Care Cunty Plumas Shasta Siskiyu Siskiyu Siskiyu Shasta Siskiyu Sites FTEs Clinician FTEs Payr Detail/ Market Share Pharmacy Detail Pilt Prviders MD, 40% Medicare 30% Medi- Cal 20% Private 5% Self 5% Other Quincy Drug Rite Aid Cstc 1 DDS,1.6 MH 39% MediCal/CMSP 15% Medicare 18% Uninsured 25% Sliding Scale 3% Self-Pay Rite Aid Safeway Lngs Walgreen s TBD TBD 45% Medicare 20% Medi-Cal 25% Private 5% Self 5% Other Sctt Valley Drug Wal-Mart Rite Aid Raleys 55% Medicare/Me di-cal* 20% Private Rite Aid Medicare Medi-Cal Blue Crss Rite Aid Pharmacy Express Cuntry Drug Lngs Medicare Medi-Cal CMSP Rite Aid Pharmacy Express Cuntry Drug Lngs TBD Medicare Medi-Cal Blue Crss Sctt Valley Drug Wal-Mart Rite Aid Raleys CALIFORNIA HEALTHCARE FOUNDATION 13

14 What s in it fr the Prvider? Free access t Allscripts erxnow thrugh NEPSI erx wrkflw assessment and implementatin supprt thrugh prgram management (Illumisys and Manatt Health Slutins) NSRHN n-site and ad hc training, phne supprt Access t frmulary data thrugh Medi-Cal and ther plans (e.g. Wellpint) Imprved wrkflw e-refills Increased patient safety Alerts, e.g. drug-drug interactin Patient histry means f addressing drug-seeking behavir Pharmacy relatinship supprt thrugh SureScripts utreach and educatin CALIFORNIA HEALTHCARE FOUNDATION 14

15 Spring 2009: Sharing erx Prgram Findings Evaluatin perfrmed by U f A Pharmacy Impact n clinical utcmes Impact n peratinal csts, quality, and efficiencies t bth prviders and pharmacies Benefits t the Medi-Cal prgram NSRHN best practices fr sustaining and spreading mdel Initial rllut 6 prvider rganizatins Extensin f Medi-Cal data t additinal NSRHN prviders Recmmendatins fr extensin f Medi-Cal data t users f NEPSI and ther erx applicatins acrss state Recmmendatins fr effective pay-fr-perfrmance initiatives amng safety net prviders Recmmendatins fr state and natinal Medicaid pay-frperfrmance strategies CALIFORNIA HEALTHCARE FOUNDATION 15

16 Can E-Prescribing Help Medicaid Managed Care Plans/Prviders Measure Up? Type f Measure HEDIS/HEDIS-Like (fcus largely at the HMO-level nt the physician level) Infrmatin Technlgy Utilizatin Patient Safety Patient Satisfactin Pharmacy Operatinal Efficiency Measures Antidepressant medicatin management E-prescribing technlgy use % generic drug use abve market usage Utilizatin rates Overall spending levels Drug-drug interactins Never events Cnsumer Assessment f Health care Prviders and Systems Survey Time t fill, refill Rx Cmmunicatins/handffs CALIFORNIA HEALTHCARE FOUNDATION 16

17 Key Factrs in the Design f Successful Medicaid Physician P4P Prgrams Which incentive mdel is best suited t physicians? Which perfrmance measures and data shuld be used? What are the best ways t engage physicians? What regulatry issues are unique t physician P4P prgrams? Hw des e-prescribing address these issues? Surce: Center fr Health Care Strategies, Inc. Physician Pay-fr-Perfrmance in Medicaid: A Guide fr States, Funded by The Cmmnwealth Fund and the Rbert Wd Jhnsn Fundatin. March CALIFORNIA HEALTHCARE FOUNDATION 17

18 Discussin Questins? CALIFORNIA HEALTHCARE FOUNDATION 18

19 Fr mre infrmatin: Jnah Frhlich Senir Prgram Officer Califrnia HealthCare Fundatin Timathie Leslie Managing Directr Manatt Health Slutins