EHR-integrated Benefit Design

Jake Halpert, Clinical Programs

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Solution Overview

High Level Solution Description:• SampleRX lets healthcare payers provide virtual sample

closets for physicians at the point of care. The health plan

decides what drugs can be trialed for its members, and these

are displayed in the physician’s EHR during patient exam.

Medications are e-prescribed to retail or mail-order with a $0

patient copay during trial period (typically a 30-day supply).

Healthcare/Business problem addressed:• Rising pharmaceutical costs (for insurers and patients)

The application developed addresses the following

category: Innovative approaches to addressing value-based care

imperatives.

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Improvements in Care

Quality of Care Treatment initiation is smoother,

easing the patient’s financial and psychological

commitment to a new prescription while drug

effectiveness and tolerance is being established

Cost-Efficacy The most value-based medication

options are promoted at the point of care, reducing

drug expenditures for both the patient and the payer

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Usability and Design

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Provider Workflow

1—The provider is in the patient’s EHR chart documenting a new

diagnosis and deciding on treatment options.

2—In the Sample Closet tab (integrated into the EHR), the provider can

view medications—generic and brand—sponsored by the health plan.

Samples are sorted according to condition.

3—The provider can select one or multiple medications, which are e-

prescribed to retail or mail-order with a proprietary insurer voucher

code automatically attached on the backend for $0 patient copay.

4—The e-prescription is saved automatically to the EHR, and the

provider returns to the native EHR.

Usability and Design

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Figure 1. Provider-facing drug selection screen

Usability and Design

In the separate payer-facing portal, the plan’s

formulary administrators have controls to:

1) update what medications are sponsored to trial for plan

members

2) target specific medication promotions to certain patient

segments based on demographic and diagnostic criteria

3) analyze physician-usage metrics in real-time

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Integration Description

SampleRX operates as a web-based application. For

integration with the Allscripts Enterprise EHR, a UAI

Command button (“Sample Closet”) is created on the

Clinical Desktop that links to the application. To give the

physician flexibility within his prescription workflow,

additional hooks can be placed in EEHR medication-

related views according to client specifications as

allowable by the Allscripts integration API.

Web service calls utilized:GetPatientFull, GetPatientPharmacies, GetPatientProblems,

GetRXFavs, GetUserID, SaveRX, SaveSimpleRX, SearchPharmacy

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Development Stage

The product is currently in the prototype phase, with

sponsored partnerships with HMOs and ACOs rolling

out in late 2013.

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Go to Market Plans

Our pricing for healthcare payers is based on a

$PMPM model. We target a 3-4% reduction in

pharmaceutical spend per client from value-based

drug promotion and take a 30% share of savings.

The product is being rolled out in large integrated

payer-provider systems, starting with HMOs and

ACOs.

• Next, we are approaching PPOs and large third-party insurers

with network providers. We sell to large organizations with at

least 1000 physicians and 100,000 members due to the fixed per-

group implementation costs necessary for secure EMR

integration and admin setup.

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Video Demonstration

Short demo video

This video illustrates the points of integration with

Allscripts, sample selection process, and sample

formulary administration.

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Recap

EHR-integrated value-based benefit design

SampleRX encourages physicians and other providers to

select medications based on value, as opposed to drug

sampling promotion strategies around expensive or recent

brand-name drugs. This saves money for both the patient

and the insurance plan and leads to better patient

adherence with the drug regimen, further improving overall

care. This has earned SampleRX the following moniker

from the director of one of the largest ACOs in the U.S. –

“the white knight of drug promotion.”

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Thank you for your time.

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