Vermont ePrescribing Program

1
Vermont ePrescribing Program

• Initial Kick-Off Meeting
• March 12, 2009

2
Agenda

• Why ePrescribing?
• ePrescribing Value Proposition
• Feasibility Study Results
• Project Overview
• Goals Objectives
• Success Measures
• Incentive Payments
• Discussion
• Next Steps
• Appendix

3
Purpose of Todays Kickoff Meeting

• Determine project scope and objectives
• Identify success measures
• Discuss the incentive plan
• Review draft outline the Action Plan

4
Why ePrescribing?
5
Health Information Technology
E-Prescribing
6
ePrescribing Components Value
Cost Efficiency
Quality Safety
7
1st Generation ePrescribing
Physician Practice
Retail or Mail Pharmacy
Faxes Rx or Prints Hands to patient
Medical Benefit Information
Practice Manage- mentSystem
A
Rx
Ambulatory EMR
Pharmacy Dispensing System
Rx
Formulary Database (e.g. MediMeida)
8
2nd Generation ePrescribing
9
ePrescribing Market Drivers
ePrescribing
Pressures for Change
10
ePrescribing Value Proposition
11
Benefits Prescribers
Reduce Cost

• Reduce phone calls chart pulls
• Streamline PA process
• Low impact to existing workflow

• Easy access to medication history
• Decreases potential medication errors due to
  illegible prescriptions
• Avoid potential adverse drug events

Improve quality of care
Improve patient satisfaction

• Reduced waiting time at pharmacy
• Aura of high tech

12
Benefits Payers/PBMs
Improve quality of care

• Decreases potential medication errors due to
  illegible prescriptions
• Facilitates improved care management

Reduce cost

• Reduced phone calls administrative costs
• Better utilization of generics and cost-effective
  alternatives
• Reduced medication errors

Improve customer satisfaction

• Employers lower premium growth due to reduced
  drug spend
• Prescribers Fewer hassles over coverage and
  benefit details
• Consumer Reduced wait time at pharmacy

13
Benefits Patients
Improve quality of care

• Decreases potential medication errors due to
  illegible prescriptions
• Facilitates improved medication compliance

Reduce cost

• Reduced out of pocket costs
• Better utilization of cost-effective alternatives

Improve customer satisfaction

• Reduces pharmacy wait times
• More predictable co-payment
• Aura of quality modernity

14
Benefits Pharmacy

• Reduces potential medication errors due to
  illegible prescriptions
• Allows for more patient consultation time
• Less delay in getting prescription
  approved/adjudicated

Improve quality of care
Reduce cost

• Less clarification phone calls to the prescriber
• More efficient use of time
• Less reversals

Improve customer satisfaction

• Reduces pharmacy wait times
• More predictable co-payment

15
Vermont ePrescribing Feasibility Study Findings
16
E-Prescribing Rankings
NOTE Vermont Ranks 31st
17
ePrescribing in Vermont

• 155 active prescribers (7 of VT)
• 9 vendors
• EHR products predominate
• Minimal e-rx functionality
• Often e-rx not turned on
• Medication History and Formulary and Benefit
  Information available on 509,090 covered lives
  ( 82 of state)
• Fewer than 1 of prescriptions transmitted
  electronically
• VT ranks 31st in Nation

18
Vermont Physicians
Data Source VITL 2008
19
Vermont Pharmacies

• 146 total pharmacies
• 102 chain pharmacies
• 44 independent community pharmacies
• 95 pharmacies connected for ePrescribing (mostly
  chain pharmacies)

Source SureScripts-RxHub
20
Vermont ePrescribing Opportunity

• 1 of all VT prescriptions written electronically
• 81 of Vermonters have available eligibility,
  drug history and formulary
• Only 15 of 44 independent community pharmacies
  connected for eRx
• The many rural communities creates challenges and
  opportunities for eRx

21
Project Overview
22
Build on Progress and Momentum

• Build on the feasibility and analysis study
  completed 12/08
• Take advantage of federal ePrescribing incentives
• Provide on-ramp for certain physicians towards
  EHR and HIE

23
Proposed Program Governance

• VITL will provide program sponsorship
• POCP will provide program management
• VT healthcare stakeholder/providers will provide
  advice and direction
• A Steering Committee will provide program
  guidance and insight

24
Advisory Groups

• Three Advisory Groups will be formed to guide the
  program
• Prescriber Advisory Group
• Physicians, NPs and PAs
• Pharmacy
• Chain Independent
• Hospital
• Small large
• One member of each Advisory Group will
  participate on the Steering Committee
• Meet as needed

25
Steering Committee

• Steering Committee proposed membership
• One member of each Advisory Group
• Health plan representation
• State representation
• POCP (non-voting)
• VITL
• Meet monthly
• Provide program guidance
• and direction

26
Approach (Draft)

• Initially contact physicians with EHR/EMRs that
  arent ePrescribing
• Then target non-hospital based non-EHR using
  physicians
• Be a physician advocate for appropriate IT
  change.
• Explain available programs
• Identify independent pharmacies in most need of
  assistance
• Partner with QIOs and PROs

27
Goals and Objectives
28
Potential Project Goals Objectives

• Reduce barriers to state-wide ePrescribing
  adoption
• Reduce the cost of ePrescribing
• Enable physicians to qualify for CMS
  ePrescribing program incentives
• Encourage pharmacy participation
• Support Vermonts healthcare reform efforts
• Make medication history more widely available to
  Vermont physicians

29
Project at a Glance
Progress to Date
30
Success Measures
31
Success Measures

• Success Measures
• Measures must be identified with success
• Sources identified very early
• Must be able to determine if goals
• and objectives are met
• Must be
• Agreed to
• Measurable
• Available
• Practical
• Comparable (with other initiatives)

32
Success Measures Examples

• Safety Examples
• Drug-drug alerts vs drug changes
• Drug-allergy alerts vs drug changes
• DUR alert frequency at the pharmacy
• ADE related ER visits frequency
• Cost Savings Examples
• Generic Dispensing Rate (GDR)
• On-Formulary Rate
• Other
• Total Physicians in program
• Total Pharmacies in program
• Total eRxs

33
SEMI An Unqualified Success StoryGrowing
Physicians, eRx Volume
Phase 1
After a flattening of enrollment, Phase 2 3
spurred growth accelerated it
Phase 3
Phase 2
eRxs have steadily increased, with additional
increases observed as Phase 2 and 3 physicians
started prescribing
34
SEMI Financial Savings
Total Number of Mail Rxs written by SEMI
Prescribers during analysis period
219,133 Total Mail Spend 32,718,061 Estimated
Savings for Mail Rxs during this analysis period
1,630,349 (4.75 savings) Estimate Retail
Savings 2.11 Consolidated Savings
4.78 Assume 82 average days Supply _at_Mail 24
days _at_Retail
35
POCP Client in SE
February of 2009 is extrapolated based on
transactions through the 11th based on a 28 day
month
36
POCP Client in SE
2009 is a projection based on current activity
and assumes a constant 9 month on month increase
in volume
37
Incentive Payments
38
Incentive Payments

• Determine if existing infrastructure exists to
  piggyback program payments
• Possible separate structure for physicians and
  pharmacists
• Database needed for tracking payments and
  ePrescribing usage
• Payments tied to usage/adoption
• Split payments (implementation/usage level)
  require database

39
Example of Piggyback Incentive Payments
Physicians
Pharmacies
40
Discussion
41
Next Steps
42
Next Steps

• Finalize Success Measures
• Draft Vendor participation criteria
• Define Incentive Payment process
• Construct Detailed Action Plan

43
Action Plan

• Develop Action Plan based on Kickoff Meeting
  subsequent decisions
• Goals Objectives
• Incentive payment infrastructure
• Success measures
• Vendor Assessment
• Draft criteria
• Evaluate demonstrations
• Contract with selected vendors
• Incentive payment process
• Determine if we can piggyback on existing
  physician or pharmacy payments
• Develop database for tracking usage and payments
• Program Launch
• Execute communications plan
• Execute marketing plan

44

• Thank you!
• Tony Schueth tonys_at_pocp.com
• David Green david.green_at_pocp.com

45
Appendix
46
MIPPA System Requirements

• MIPPA incentives based on use of qualified
  systems
• Need to use the technical standards required for
  use under Medicare Part D to the extent
  practicable
• Need to meet requirements of PQRI measure 125
• Generating a complete active med list
• Selecting medications
• Printing prescriptions
• Electronically transmitting prescriptions
• Conducting safety checks
• Providing information on lower-cost alternatives
• Providing information on formulary or tiers

47

Published Research Practice Efficiency
48

Published Research Practice Quality Safety
49
Unpublished Research
50

Published Studies ROI to Health Plan
51
Milliman/RxHub Study

• Objective
• Estimate financial impact of eRx on drug spend of
  Medicare providers and the implications for
  physician incentives
• Summary of findings
• More than 70 of potential drug spend is
  controlled by PCPs
• ePrescribing has the potential to
• Reduce a payers drug spend inflation by 1 per
  year
• Mitigate patient customer service issues on up to
  32 of prescriptions under a highly restrictive
  formulary
• ePrescribing has the potential to significantly
  lower drug spend on Medicare beneficiaries
• Up to 15 of total drug spend on minimally
  restrictive formulary
• Up to 8 of total drug spend under moderately
  restrictive formulary

Source Potential Impact of Electronic
Prescribing on Medicare Prescription Drug Spend,
October 25, 2005, Milliman, courtesy of RxHub
52
Outcome of Prescribers use of e-Prescribing
Technology (in-depth analysis of selected pilots)
53

Published Research Patient Satisfaction