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Pharmacies ... offices and pharmacies to resolve issues ..

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Pharmacies ... offices and pharmacies to resolve issues ... Develop the required infrastructure, e.g. pharmacy connection, automated coverage information ... – PowerPoint PPT presentation

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Title: Pharmacies ... offices and pharmacies to resolve issues ..


1
  • Highlights of CAQH-MedStar-DrFirst-Safeway
  • Electronic Prescribing Pilot
  • November 2004

2
Sponsors
  • CAQH
  • Not-for-profit alliance of health plans and
    networks that promotes collaborative initiatives
    to
  • Share knowledge to improve quality of care
  • Make administration easier for physicians and
    their patients
  • Participating companies include 22 of Americas
    largest health plans and trade associations
    chairman is John W. Rowe, MD, who is Chairman and
    CEO of Aetna
  • MedStar Health
  • Not-for-profit, community-based healthcare
    organization that owns and operates seven major
    hospitals and other healthcare services in the
    Baltimore/Washington area the hospitals include
    both teaching and community facilities

3
Sponsors
  • DrFirst
  • DrFirsts Rcopia system is a leading electronic
    prescription management solution that was awarded
    Top Honors by the Medical Records Institute at
    TEPR 2004
  • DrFirsts clients include health plans, health
    systems, hospitals, IPAs, EMR/POMIS vendors, and
    individual physician practice groups
  • Safeway
  • Operates 1,815 stores with over 1,300 pharmacies
    across the United States and in Western Canada
    eastern division operates 178 stores, including
    124 pharmacies, in the metropolitan areas of
    Washington, Baltimore and Philadelphia

4
Pilot Parameters
  • Offered a 12-month free Rcopia subscription to
    MedStar providers
  • Participants provided their own hardware, with
    the software being available for either desk-top,
    web-based or hand-held technology
  • In addition to a free subscription, participants
    received free on-site training and on-going
    assistance additional incentives were not
    offered
  • Key functionality of Rcopia e-prescribing
    technology included
  • Clinical data (e.g., drug-to-drug interactions)
    sourced by First Data Bank
  • Option of entering patients allergies and
    receiving warnings
  • Option of checking patients formulary coverage
    (where available)
  • Ability to send prescriptions electronically or
    via Fax to the pharmacy, and ability to print or
    save prescriptions (could go to any chain or
    independent pharmacy)
  • Sponsors agreed to jointly review outcomes data
    and agree on key findings (data was analyzed in
    Summer 2004)
  • Outcomes data was generated from Rcopia system as
    well as through pre and post pilot participant
    surveys, phone interviews with providers/office
    managers and anecdotal feedback Rcopia staff
    received during participant training/assistance
  • All provider and patient-specific data was
    blinded

5
Provider Interest
  • Provider interest
  • 200 free, one-year subscriptions to e-prescribing
    tools were offered to 1,000 MedStar affiliated
    providers with no required renewal
  • 60 of available subscriptions were utilized by
    registered participants of these registered
    participants, 75 were active participants,
    who were defined as participants who sent at
    least 100 scripts
  • Registered participants gave the following
    reasons for low provider participation
  • Time constraints
  • Conflicting priorities
  • Non-reimbursable/lack of incentive for a time
    consuming activity
  • Existing ability to use the already tested,
    traditional handwritten system

6
Volumes and Interactions
  • Volume of prescriptions
  • Participants generated 126,758 prescriptions
  • Active participants generated an average of
    1,424 prescriptions over the 12 month period
    number of scripts sent were not more than in
    traditional system
  • The active participants became comfortable with
    the system over time, reverting to the
    handwritten method less frequently average
    number of prescriptions written per active
    participant increased by 30 between the 1st
    quarter and the 4th quarter of the pilot (no
    increase in overall of scripts)
  • Internal Medicine participants, who represented
    27 of the total registered participants,
    generated 54 of the total pilot prescriptions
  • Clinical interactions
  • 2 of the pilot prescriptions had an allergy
    warning 6 of these warnings were acted
    upon/cancelled
  • 8 of the pilot prescriptions had a drug
    interaction warning 3 were acted upon/cancelled
  • The pilot potentially avoided over 400 adverse
    reactions
  • The high percentage of warnings ignored is common
    and can be attributed to several explanations
    such as lack of clinical significance as
    determined by the prescriber

7
Formulary Use
  • Provider interest and use of formulary
  • 75 of the registered participants opted to have
    formulary enabled. The key reasons participants
    gave for not wanting formulary enabled were
  • Formulary is not the responsibility of the
    provider
  • Did not want the extra responsibility/activity
  • Did not want to have to do any manual entry
    (manual data entry of patient drug histories was
    required in some cases)
  • 22 of enabled users actually referenced
    formulary. The key reasons for the low usage rate
    were
  • Time needed for manual entry
  • Gaps in payer coverage, e.g. MAMSI did not
    participate
  • Time constraints /other priorities
  • Lack of know-how
  • Lack of interest

8
Formulary Impact
  • Impact of non-formulary warnings
  • 22 of the formulary references generated a
    non-formulary warning (507 warnings in total)
    participants acted upon 25 of these warnings
  • 15 of warnings resulted in a change of drug
  • 9 of warnings resulted in a cancellation of a
    drug
  • Between 1st and 4th quarters there was a 20
    increase in providers changing a drug vs.
    ignoring or canceling it after receiving a
    non-formulary warning

9
Pharmacy Connection
  • Pharmacy connection
  • 62 of the prescriptions were sent to the
    pharmacy (9 of these were also printed), 27
    were only printed and 11 were only saved
  • Saved prescriptions were a way in which
    prescribers could add to a patients medication
    history
  • Of the 62 of the prescriptions sent to the
    pharmacy, 40 were sent electronically and 60
    were sent by fax
  • There was a 270 increase in electronic
    prescriptions when comparing 1st to 4th quarter
    data. This was largely attributable to increased
    market activity by SureScripts and others
    responsible for developing electronic connections
    to pharmacies however, pharmacies reported that
    the existence of the pilot provided incentive for
    them to adopt the technology
  • Two national chains represented the majority of
    pharmacies receiving electronic prescriptions
    while a mix of independent and national chains
    received the faxes

10
Work Flow Impact
  • Impact on work flow
  • Provider offices
  • Reduced calls from pharmacies for clarification
    of prescriptions
  • Increase in number of legible prescriptions
  • Fewer benefit coverage issues
  • Reduced staff requests for provider assistance in
    locating medication lists
  • DrFirsts Rcopia system can save and print out
    patient medication lists that are legible and
    easy to find
  • Pharmacies
  • Significantly reduced time needed to read
    prescriptions due to legibility of
    computer-generated faxes or electronic
    prescriptions
  • Minimally reduced calls to resolve benefit
    coverage issues because of the availability of
    formulary information

Based upon qualitative survey of pilot
participants Based upon interviews of Safeway
pharmacists
11
Benefits
  • Clinical
  • Pilot supports concept that e-prescribing
    positively impacts patient safety by reducing
  • Drug errors that occur due to illegible
    handwriting
  • Potential adverse reactions
  • Administrative burdens, so providers can focus on
    patient care
  • Financial Indirect
  • Reduced call volume between provider offices and
    pharmacies to resolve issues
  • Pilot providers reluctant to quantify this into
    actual savings given size of pilot
  • Improved access to medication lists for provider
    office staff
  • Pilot providers reluctant to quantify this into
    actual savings given size of pilot

12
Benefits (contd)
  • Financial Direct
  • Members Copays
  • Reduced co-pays occurred because of adherence to
    formulary warnings
  • Savings increase as adherence increases
  • Reduction in initial prescription co-pays
    estimated at 2,500
  • Potential of 30,400 saved annually if
    on-formulary drug continued to be used monthly
  • Health plans Reduced hospitalization and
    increased formulary adherence
  • Reduction in hospitalizations/ER visits estimated
    at 100,000 saved identified savings occurred
    through reduction in hospitalizations/ER visits
    as a result of Rcopia communicating potential
    adverse drug reactions
  • Evaluated impact on health plan drug costs due to
    formulary switches, however, numbers are very
    small given size of pilot and low use of
    formulary
  • One plan noted a 35 net savings in health plan
    drug costs when a formulary warning is given,
    with an average savings of 29.21 per
    prescription for the initial prescription
  • Providers (see indirect benefits)
  • Applying the estimated benefits from the pilot to
    industry-wide adoption would correlate into
    enormous clinical and financial benefits for the
    US heath system

13
Industry-wide Implications
  • Comparison to other pilots
  • When compared to other recently published pilot
    findings, the total direct savings from this
    pilot were lower, however, the pilot sponsors
    believe this pilot is more representative of
    actual market challenges than previously
    conducted studies as it represents a real-world
    setting
  • Sponsors consisted of organizations with no
    history of working together on information
    technology and were located in a region not known
    for market interest in adopting new healthcare
    technology
  • Participants had no level of association
    to/vested interest in working with a specific
    health plan(s) and/or Pharmacy Benefit Manager
    (PBM)
  • Providers were given the software and training
    free of charge, but no additional incentives were
    offered

14
Industry-wide Implications (contd)
  • Requirements to achieve industry-wide adoption
  • Gain a multi-stakeholder focus on the same set of
    goals
  • Different participants are at different points in
    the e-prescribing life cycle for success, each
    stakeholder needs to agree on the goals upfront,
    understand their unique role and the activities
    they will need to undertake to achieve those
    goals
  • Resolve the technical barriers
  • Develop the required infrastructure, e.g.
    pharmacy connection, automated coverage
    information
  • Pre-populate medical and drug histories into
    e-prescribing tools
  • Agree and adopt basic standards for technical and
    outcome measures
  • Conduct large scale, multi-stakeholder studies to
    analyze, test and review outcomes, focusing on
    gaining agreement on
  • Financial and clinical benefits
  • Provider incentive models

15
Contacts
  • For detailed pilot findings, please contact any
    of the sponsors
  • CAQH
  • Gwendolyn Lohse (glohse_at_caqh.org or 202-778-1142)
  • MedStar Health
  • Peter Basch, MD (peter.basch_at_medstar.net or
    202-546-4504 x316)
  • DrFirst
  • John Bartos (jbartos_at_drfirst.com or 301-231-9510
    x109)
  • Safeway
  • David King (david.king_at_safeway.com or
    713-268-3440)
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