How Do We Get to the
Tipping Point?
Electronic
Prescribing:
Sponsored by:
AHIP Business Forum – November 19, 20081
Making the Case For
Electronic Prescribing
2
Electronic Prescribing
Prescribe Transmit
Traditional view3
Medication Management Process
Prescribe Transmit Dispense Administer Monitor
Modern view4
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. 60–70.
Doug Bell,
RAND and UCLA5
Payer Messaging LensePayer Messaging Lens
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 care6
Importance of E-Prescribing
• It is safer
• It saves time and money
- Pharmacies
- Plans
- Physician practices
- Patients
• It improves the quality of
healthcare
7
Lowers health plan drug costs
• 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
Return
On Investment
+1% generic utilization = $4 - $12 PMPY*
*Industry estimates by payer e-health consulting firm. 8
Lowers health plan medical costs
• 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
Return
On Investment
+$1 drug spend = $4 - $7 lower medical costs*
*Medco, 2005 (study on increased adherence for diabetes, hypertension and other conditions). 9
Increases provider and member
satisfaction
• 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
Return
On Investment
Reduces staff time by hours per day in smaller practices*
*SureScripts-RxHub 10
Electronic Prescribing
Across Stakeholder Environments
11
Physician adoption
Large and smaller practices are different markets
Niche stand-alone
Full EMR
12%
Use EMR
w/o ERx
17%
Use EMR
With ERx
5%
Use ERx
Stand-alone
66% Not Automated
EMR ERx
DeRoche, N Engl J Med 2008;359:50-60; CDC (2008), SureScripts-RxHub (2008) 12
Physician utilization
Do we have the tools to succeed?
Niche stand-alone
Full EMR
• Commitment
• Practice leadership
• Training
• Workflow
• Total system support
ERx within an EMR
13
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
Government: Medicare Incentives
2009 2010 2011 2012 2013 2014
+2%
+1%
+.5%
+2%
-1%
-1.5%
-2%
Will payers continue to invest or move to the sidelines?
15
Consumer Experience
Safety, Convenience, Outcomes
• Call pharmacies for refills
• Refill reminders
• Prescription receipt
-Administrative messages
-Care messages
• Focus on adherence
• Physician-patient
relationship
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Pharmaceutical Manufacturers
Focus on patient education and medication adherence
• Formulary positioning
• Medication adherence
• First fill alerting
• Closed loop prior auth
• Communications links
-Market surveys
-Drug information
• Practice efficiency
17
Electronic Prescribing:
The Health Plan Experience
18
Successful Models
• Free or near free to high prescribers
• Activation and monthly services fees to solution providers
• MA ERx Collab.
• SEMI
• ePrescribe FL
• CareFirst
• Horizon
• BCBSNC
• Capital
• BCBSAL
• Sierra
• BCBSLA
• BCBSIL
• Medicaid FL
• BCBSRI
• Aetna
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Top Standalone Suppliers
Business models remain a challenge
• Allscripts
• DrFirst
• iScribe
• MedPlus
• Prematics
• RelayHealth
• RxNT
• ZixCorp
20
Part of a payer toolset
Supports clinical messaging to providers and members
• Physician EMR
• Member PHR
• Disease management
• Pay for performance
• Patient-centered
medical home
Electronic
Prescribing
21
Multi-payer projects
Collaboration upfront or joining mid-process
Free riders?
Business Model?
• First movers
• Competitors
• Nationals
• Niches
• CMS
22
ePrescribe FL
AHIP
RIQI
Availity
CAQH
????
S.E.M.I.
SureScripts-RxHub
eRx Collaborative
Collaborative models
Ownership? Breadth of Coalition? Org structure?23
Open Discussion:
The Way Forward
24
Force Field Analysis
Ideal State
Today
Obstacles and Challenges
Driving Forces
The Payer Environment for Electronic Prescribing25
Force Field Analysis
Ideal State
Today
Obstacles and Challenges
Driving Forces
The Payer Environment for Electronic Prescribing
Free
Riding
Medicare
Incentive
Physician
IT Support
Vendor
Biz Model
Payer
Silos
Payer
ROI
Pharmacy
InterOp
26
From the payer point of view
Key Questions for the Group
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?
???
27
Thank you.
Michael Lake
President
Circle Square Inc.
San Francisco, CA
www.michaellake.com
28
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