Unanticipated high out-of-pocket prescription costs negatively impact patient safety and may lead to increased healthcare spending later. According to the Truven Health Analytics-NPR Health Poll for Prescription Drugs (June 2017), the most cited reason by respondents who did not fill their prescription was cost (67%).

Prior-authorization is another hurdle, and when it’s required, according to today’s guest, medication adherence drops precipitously.

In general, medication treatment failures due to a variety of issues, including medication non-adherence and friction from prior-authorization are a big problem in U.S. healthcare. Patients don’t get the care they need and it costs the healthcare system an estimated $500-672 Billion each year (Note: It’s often said that medication non-adherence costs $300 Billion – and I referenced that number on the show, but that’s a bit hazy as this article explains).

The bottom line is this: administrative functions, high drugs prices, and increased out of pocket expenses for patients are creating friction between Americans and the care we need.

On this episode, Shahid Shah and I sit down with Surescripts CEO Tom Skelton, to discuss their Real-time Prescription Benefits and Electronic Prior Authorization services. When used together, they bring patient-specific medication prices and alternatives into the conversation between doctors and patients and reduce the friction between patients and the care they need.

We also talk about the many ways in which Surescripts has been a model for an industry seeking “interoperability”. Their use-case driven approach is very instructive.

Some of the highlights:

1:24 Today we’re talking about Medication Non-adherence and how it relates to the rising cost of prescription drugs.

3:09 Surescripts is a massive connector who digitized the medication management process and provides medication reconciliation at the point of care to provide patients with radical transparency for shared decision making.

6:14 One way we’re fighting non-adherence is to eliminate friction.

10:00 The two things Shahid wants you to learn from Surescripts’ example:

  1. If you care about interoperability, you can make it happen.
  2. Tie interoperability to a specific use case.

12:34 Physicians with inside knowledge of insurance still get burned by surprise costs when there is no transparency at the point of care. We need to start having discussions with providers about expenses.

14:50 Prior authorization causes a drop in adherence. A $10 increase in cost at the pharmacy has a significant impact on adherence. Physicians want instant answers to a patient’s financial options.

18:29 The steps necessary to make data available to the patient:

  1. Is the data available?
  2. Can it be connected to the EHR?
  3. Has the EHR presented the info at the time of care?
  4. Is the physician using the info to start a conversation?

The answers to criteria 3 and 4 are the pressing issues of the day.

22:30 The biggest threat to question 4 is uncompensated care. Doing more work for no pay is not a tech problem, it’s a business problem.

26:30 When medication reconciliation was taking extra time, it helped the patient so insurance companies paid doctors for their time with the coordination of care code. There should be another code for financial discussions to drive medication adherence!

28:20 With the many other use cases of the data Surescripts collects, how do your partners gain consent from patients to use their data?

32:10 The Surescripts Network Alliance is rallying for access and connectivity.

35:25 A look at what else Surescripts is doing beyond prescriptions: National Record Locator and Exchange Service, Medical History consolidation, Insights for population health, extracting value from interoperability for care management.

38:08 Interoperability is use case specific. If you speak generally it seems insurmountable. You get alignment behind the use case. Physician price transparency happened quickly because people wanted it but there is a cost to raising the adoption curve.

42:15 National Patient Identifier is not the biggest hindrance to interoperability. Don’t look for the reason why it can’t be done. Just solve the problem. Surescripts has been a catalyst for interoperability by focusing on the use case.

45:27 How do e-prior auths come into play with price transparency? Feedback in real time to see if you need prior auth for prescriptions. We make it more convenient for the patient so they don’t have to make two trips to the pharmacy.

Listen to the interview:

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About Tom Skelton

urescripts CEO Tom Skelton

Chief Executive Officer, Surescripts

Tom is amazed by the changes he’s seen over the course of more than 30 years working in healthcare technology. Before joining Surescripts in 2014, he served as Chief Executive Officer of Foundation Radiology Group, a private equity-backed diagnostic imaging services firm that grew substantially under his leadership. His many other career accomplishments include serving as Chief Executive Officer for Misys Healthcare Systems and as a member of Elcomp Systems’ founding team.

LinkedIn: https://www.linkedin.com/in/skeltontom/


About Surescripts

SurescriptsOur purpose is to serve the nation with the single most trusted and capable health information network, built to increase patient safety, lower costs, and ensure quality care. Since 2001, Surescripts has led the movement to turn data into actionable intelligence, and convened the Surescripts Network Alliance™ to enhance prescribing, inform care decisions, and advance the healthcare industry.

Website: https://surescripts.com/

Twitter: https://twitter.com/surescripts

LinkedIn: https://www.linkedin.com/company/395901/?trk=tyah&trkInfo=tas%3Asures%2Cidx%3A2-1-6

Blog: https://surescripts.com/news-center/intelligence-in-action/

YouTube: https://www.youtube.com/channel/UCVJajqk__-rDozGAPMXB-TQ

Related and/or Mentioned on the Show

2017 National Progress Report

Network Alliance video

How Surescripts is Accelerating Interoperability 

Solutions by Surescripts:

Enhance Prescribing – Collectively Enabling Safer and More Affordable Prescriptions

Inform Care Decision – Arming Healthcare Professionals with Actionable Patient Intelligence

Advance Healthcare – Convening, Informing, and Advocating for the Healthcare Industry

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