Copyright © 2008 Prematics, Inc. All rights reserved.

Accelerating E-PrescribingKevin Hutchinson, President and CEO

Presentation to the Wisconsin E-Health Initiative

June 12, 2008

The Building Momentum for E-Prescribing

A look back at the rapid progress of recent years and

A look at today’s building momentum

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Greater Value: Efficiency Cost-Savings Safety Patient Empowerment

Greater Connectedness: Medication Adherence Personal Health Record Payer-Based Health Record Patient-Centered Medical Home

Building Toward Transparent, Coordinated Care

TransparentTransparentCoordinatedCoordinated

CareCare

Physician ConnectivityPhysician Connectivity

Back-End InfrastructureBack-End Infrastructure

Technology Vendor CertificationTechnology Vendor Certification

Standards / Legislation / RegulationStandards / Legislation / Regulation

Standards Development

- 2003 - Medicare Modernization Act (MMA) standards

- HHS developed and adopted initial uniform standards for e-prescribing

- 2005 - CMS standards under Medicare Part D

- Adopted “foundational” e-prescribing standards under Medicare Part D

- NCPDP SCRIPT Standards V. 5.1

- Fax exemption

- 2007 – Additional rules for MMA

- Eliminated fax exemption

- NCPDP SCRIPT 8.1

- National Provider Identifier

Standards

Legislation and Regulation

- E-MEDS Legislation

- One-time physician bonus for e-prescribing

- Ongoing incentives under Medicare

- Eventual reduced reimbursement for physicians not e-prescribing

- Expected $3 billion Federal savings

- Sec. Leavitt: “Mandate e-Rx for Medicare patients”

- FDA regulations require tamper-resistant paper for all paper scripts for controlled substances

- DEA – rules for e-prescribing of controlled substances

- Committed to publish proposed rule before September 2008

LegislationRegulation

Legislation and Regulation

- Regulatory framework in all 50 states

- CA: E-Prescribing standards and requirements for all providers contracting with California Medicaid.

- MA: Proposes creating a change management toolkit to prepare practices to EHR and E-Rx.

- AZ: Gov. Napolitano Executive Order directs AZ’s regulatory agencies coordinate with Arizona Health-e Connection and EAzRx initiative. Also educates providers, payers and patients on e-Rx benefits.

- PA: Gov. Rendell’s Executive Order created Pennsylvania Health Information Exchange (PHIX). Support statewide use of e-prescribing.

LegislationRegulation

Creating Back-End Infrastructure and Certifications

Payers

RetailPharmacy

- SureScripts – Over 95% of retail pharmacies

- Increasing automation within pharmacy

- Consolidation of retail pharmacies

- 2007 – Over 35 million prescriptions

- RxHub – Major health plans and PBM’s

- Secure access to 200 million US covered lives

- Increase PBM consolidation, automation

- Emphasis on mail order

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Connecting the Physician PracticeONLY

2% OF ALL RXsARE

E-PRESCRIBED

National Progress Report on E-Prescribing. Dec. 2007.

Connecting the Physician PracticeONLY

6% OF ALL PRACTICES

E-PRESCRIBE

National Progress Report on E-Prescribing. Dec. 2007.

Opportunities for Accelerating E-Prescribing

Different Needs Across the Physician Landscape

A Comprehensive Approach to E-Prescribing

How Payers are Getting Involved

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The highest prescribers are concentrated in the smallest physician practices

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0

25,000

50,000

75,000

100,000

125,000

250,000

1–2 3–4 5–6 7–9Group Size

Num

ber o

f Phy

sici

ans

252,000

31,000 24,000 19,000

132,000150,000

5,3007,1007,100

28% 85% 59% 37% 4%High prescriber share:

70,000 70,000

26,30026,300 14,20014,20010+

High prescribers

Source: “Medical Group Practices in the U.S.,” AMA, 1999 edition; Major pharmaceutical company analysis

175,000

200,000

225,000PhysiciansPhysicians Script VolumeScript Volume

15% 50%

30% 83%

Source: SureScripts (2005)

29.2% of physicians (est. 150,000) use some form of an EMR with 12.4% having some access to e-prescribing functions

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Percentage of office-based physicians using electronic medical records and using comprehensive electronic medical record systems: United States, 2001–2006

Percentage of physicians using electronic medical records and using comprehensive electronic medical record systems by practice size: United States, 2006

Electronic Medical Record Use by Office-Based Physicians and Their Practices: United States, 2006, Esther S. Hing, et al, Division of Health Care Statistics, CDC

Different Practices. Different Needs.

Lagging in IT adoption

Process Automation

Limited $$ for HIT Adoption

No In-House IT Staff

Little to No Connectivity or

Infrastructure

Large Practices

Small Practices

High EMR adoption

Chart Pull Efficiencies

Group-Based $$ Power

Full-Time IT Staff

Connectivity and

Infrastructure

E-Prescribing Is a Multi-Stakeholder Relationship

Pharmacy

PatientPhysician

Payer

• Rx History Access• Clinical Alerts• Practice Efficiency• Safety and quality• Med adherence

• No transcription• Share Rx history• Increase 1st fill rate

• Less wait • Safer Rx• Med Record• Doctor Relationship

• Better Outcomes• Point of Care

Benefit Design• Safety / ADEs• Efficient Care

Pharmacy preferencesPatient education

Update PHR

Eligibility / formularyAdjudication

Payer Rx history Eligibility / formulary

Retail history to PHR Reminders

Refills

Member portalsUpdate PHR

New scriptsRenewalsChanges

Retail history

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Electronic Prescribing Is A Complete Toolkit

Bundled Technology

Service and Support

Installation

Training

Tech Support

Hardware

Software

Connectivity

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How Payers are Accelerating E-Prescribing

- Investing in e-prescribing that delivers value in a number of categories

- Initiatives limiting payer risk - Initiatives tied to / generating ROIs- Part of pay-for-performance strategies

that create a “win-win” for all stakeholders

Payers favor programs with:- Focus on prescriber utilization- Low or no provider costs- High-touch ongoing support- Ability to coordinate with existing

clinical programs- Ability to message physicians/patients- Insights into prescriber behavior

16Electronic Prescribing: Becoming Mainstream Practice. eHealth Initiative and the Center for Improving Medicaion Management. June 11, 2008.

Value CategoryValue Category Value ContributorValue ContributorPatient-physician relationship

Patient-pharmacist relationship

Improves individual’s self-efficacy and intrinsic motivation relative to medication therapies

Lowers individual’s out of pocket costs

Increases patient satisfaction with the healthcare experience (e.g., shorter pharmacy waits)

Improves clinical outcomes

Improves patient safety

Improves functional outcomes (e.g., absenteeism / presenteeism)

Improves medication adherence

Streamlined/transparent care process

Increases availability of an individual’s pharmacy benefit at the point of care

Decreases therapy duplication or unnecessary therapies (e.g., prior authorization, step therapy)

Improves Individual

Empowerment and Satisfaction

Improves Health

Outcomes

Improves Efficiency

and/or Lowers Costs

How E-Prescribing fits into larger HIT trends

An on-ramp to the journey of patient-centered care

for smaller practices

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Major industry initiatives are informed by electronic prescribing

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PhysicianPractice

RetailPharmacy

Patient

Payer

- Patient-centered medical home

- Payer-based health record

- Personal health record

- Medication adherence and care management

Patient-centered medical home

- Addressing the fragmentation of care into silos of "organologists“

- Focusing on the patient; bringing all care into a transparent model

- Incentivizing primary care physicians to manage the electronic patient record

- Organize around care teams; current med list is key

- Leading the charge

- TransforMed (AAFP)

- Patient-Centered Primary Care

Collaborative (ERIC)

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- Personal physician- Physician directed medical

practice- Whole person orientation- Care is coordinated and/or

integrated- Quality and safety- Enhanced access to care- Payment appropriately

recognizes added value

Founding Principles

Payer-based health record

- Leveraging the information assets of employers, health plans and PBMs

- Applying business and clinical rules to patient data to identify opportunities for best care

- Communicate to physicians and patients about gaps in care, clinical alerts, diagnostic screening, medication adherence, etc.

- Promote the use of PHRs; clinical decision support

- Effective medication management is key

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Personal Personal Health Health RecordRecord

Predictive Predictive ModelsModels

MedicalMedicalClaimsClaims

MedicalMedicalClaimsClaims PBMPBM

Rx DataRx Data

PBMPBMRx DataRx Data

Clinical Clinical Decision Decision SupportSupport

PatientPhysician

Payer

GuidelinesGuidelines Care Mgmt.Care Mgmt.

Personal health record

- Modern platforms from major players are bringing energy to the PHR market

- Once tethered solutions from health plans are now positioning as interoperable and patient-controlled

- Physician practice solutions, such as electronic prescribing, can connect to patients through standardized protocols such as the Continuum of Care Record (CCR)

- Making prescription information transparent across providers can help with medication safety and adherence

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Medication adherence and care management

- Electronic prescribing can be an on ramp to medication adherence and care management

- Medication history information from retail pharmacies and PBMs can be used to calculate adherence

- Physicians using electronic prescribing can be alerted when the patient is in the office

- Patient PHRs can be synched with prescribing databases to confirm a current med list

- Benefits information and interaction checking can create additional alerts

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ElectronicPrescribing

PersonalHealthRecord

Rx HistoryClinicsMTM

Rx HistoryFormulary

HRA

Perspectives from AHIC

Advancing Patient-Focused Health Care

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Health Information Technology Deployment Coordination

Health Care Industry

Biosurveillance Consumer Empowerment

Chronic Care Electronic HealthRecords

Breakthroughs

Consumer Value

Ind

ust

ry T

ran

sfo

rmat

ion

Coordination of Policies, Resources, and Priorities

Office of the National Coordinator -Health IT Policy Council

-Federal Health Arch.

AHIC-Workgroups

Standards Harmonization (HITSP)

ComplianceCertification (CCHIT)

NHIN

Privacy / Security

Health ITAdoption

Infr

astr

uct

ure

Tec

hn

olo

gy

Ind

ust

ry

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AHIC Workgroups

Workgroups initially formed to pursue breakthroughs in four areas:

- Consumer Empowerment

- Electronic Health Record

- Population Health

- Chronic Care

Three additional workgroups have been formed:

- Confidentiality, Privacy & Security

- Quality

- Personalized Healthcare

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AHIC Transition

- Plans are now underway to transition the AHIC to a public-private partnership.

- The AHIC successor will be an independent and sustainable public-private partnership.

- The proposed scope for the AHIC successor includes:

- Accelerate and coordinate current AHIC interoperability initiatives

- Prioritize stakeholder requirements for nationwide health IT interoperability

- Advance the harmonization of technology standards and policies

- Oversee and facilitate the Nationwide Health Information Network

- Advance the certification of products, network participants, and/or operations

- The AHIC successor will be designed and ready for initial operation by Spring 2008.

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Q & A