03-23-05 august 2008 page 1 arkansas medicaid eprescribing project overview

03-23-05August 2008

page 1

Arkansas Medicaid ePrescribing Project OverviewArkansas Medicaid ePrescribing Project Overview


August 2008 page 2

ePrescribing Project Introductions and ePrescribing Project Introductions and ResponsibilityResponsibility

• HP - Program management and oversight for the ePrescribing implementation; Medicaid program data provider

• SureScripts-RxHub - Patient identification and information routing

• Point Of Care Partners - ePrescribing program consultants

• QSource/Buccaneer - Provider outreach and program evaluation


August 2008 page 3

HPHP

• Project and Program Management

• System Connectivity to SureScripts-RxHub

• Building transactions to provide program data

– Eligibility

– Medication History

– Drug Coverage Data


August 2008 page 4

SureScripts-RxHubSureScripts-RxHub

The ePrescribing Advantage


August 2008 page 5

SureScripts-RxHub FormationSureScripts-RxHub Formation

• SureScripts: industry owned LLC formed by the pharmacy associations representing nation’s 57,000 pharmacies

– Incorporated August 2001– Mission: improve the prescribing

process through a focus on Safety, Efficiency and Quality

• RxHub: formed and owned LLC by the 3 largest PBMs and now representing more than 200M covered lives

– Incorporated February 2001– Mission: improve patient safety

and reduce healthcare delivery costs

Together, SureScripts-RxHub provide physicians with secure access to 200 million covered lives and have connected over 95% of the nation’s pharmacies through proven industry transactional standards.


August 2008 page 6

SureScripts-RxHub BenefitSureScripts-RxHub Benefit

• The merger provides a single, nationwide network that enables more clear, accurate and efficient communications between prescribers, pharmacists, and payers.

• The merger makes available critical information that every physician should have in front of them when they prescribe and, in doing so, accelerate the country’s transition toward a paperless prescription process that will save billions of dollars and thousands of lives.

• Streamlining the individual processes of the legacy organizations will save the industry time and money and give physicians more information needed to provide quality care to their patients.


August 2008 page 7

SureScripts-RxHub AR Information SureScripts-RxHub AR Information

RxHub Certified Technology Partners offering services within the State as of first quarter 2008:

© SureScripts-RxHub, 2008Proprietary and Confidential

RxHub has a relationship with HP for the Fee-For-Service lives and e-Prescribing can beenabled. RxHub has access to some Medicaid Managed Care lives covered by PBMs and Payersconnected to the RxHub National Patient Health Information Network.


August 2008 page 8

Clinical Decision Support InformationClinical Decision Support Information

Payers provide real-time access to patient pharmacy eligibility, benefits & formulary, and medication history at the point of care for more than 200 million patient records.

Physicians utilize RxHub certified technology applications to review real-time decision support information and electronically transmit prescriptions to the patient’s choice of pharmacy.

Patients provide consent for use of their data for healthcare treatment and select pharmacies to fill prescriptions.

Pharmacists utilize RxHub certified technology applications to process electronic prescriptions and request refills directly from physicians offices which improves patient safety and processing time.

Healthcare Data Sources

Technology Applications

Patient Eligibility Data

Name, Address, Date of Birth, Gender, Cardholder, Group, Health Plan, Retail Benefit Status, Student Status

Patient Formulary Data

Formulary Status, Alternatives, Drug Coverage

Patient Medication History Data

Date Range, Drug Name, Oldest Fill Date, Most Recent Fill Date, Number of Fills, Days Supply, Quantity Dispensed, Pharmacies/Prescribers

70% of safety and savings advantages of e-Prescribing result from

Decision Support Information


August 2008 page 9

Informed ePrescribing ProcessInformed ePrescribing Process

Patient Uniquely

Identified in Master Person

Index

Patient Selects

Pharmacy

Patient 1

2

3 4

6

Collects Patient:

Consent Name Date of Birth Gender Zip

Certified Physician Applications

5

Electronic

Dr./Patient Information Validation

SureScripts-RxHub provides secure

access to more than 200 million patient records AND returns

patient clinical decision support

information in less than 2 seconds.

© SureScripts-RxHub, 2008Proprietary and Confidential

Certified Retail Networks Certified Payers

Provides Patient:

• Eligibility• Benefit • Formulary• Medication History


August 2008 page 10

SureScripts-RxHub ObjectivesSureScripts-RxHub Objectives

• Open to all ePrescribing stakeholders to ensure fastest route to widespread adoption and cost effective healthcare delivery

• Utilizes and develops industry transactional standards to securely communicate consenting patient information in real-time between e-Prescribing stakeholders (ASC X12, and NCPDP)

• Provides clinical decision support information - patient eligibility, benefits, formulary, and medication history - for more than 200 million patients to physicians at the point-of-care

• Delivers real-time, informed electronic prescriptions to pharmacists in the retail setting

• Does not alter clinician/patient relationships, or business relationships between payers, pharmacies, and technology vendors

• Operates as a Cost Recovery Model


August 2008 page 11

Physician Access to Real Time InformationPhysician Access to Real Time Information

• Person Index: Access to more than 200M members uniquely identified using demographic elements.

• Patient Eligibility: Patient eligibility, benefit and coverage, and formularies for authorized clinicians at the point of care. Patient eligibility is also available to pharmacists at the point of dispensing.

• Patient Medication History: Drug history for all patient coverages. Includes original prescription and refills. Data can indicate:

• Patient Prescriptions: Bi-directional electronic delivery of prescriptions between physicians and retail pharmacies.

Patient compliance with prescribed regimens

Therapeutic interventions

Drug-drug and drug-allergy interactions

Adverse drug reactions

Duplicate therapy


August 2008 page 12

ePrescribing ReadinessePrescribing Readiness

National infrastructure is secure and established

Transaction standards are approved and have been used for 6+ years

Technology partners are certified on transactions and data usage

Proven ability to improve patient safety and quality of care


August 2008 page 13

Point of Care Partners (POCP)Point of Care Partners (POCP)

ePrescribing Program Consultants


August 2008 page 14

Point of Care PartnersPoint of Care Partners

Who Are We?• Health Information Technology (HIT) strategy and management

consulting firm with active practices in:

– ePrescribing

– Chronic Care Management in the context of EHRs

• Focus is on subject matter, not stakeholder segment

• Boutique consulting firm regarded as experts in ePrescribing

What is Our Role?• Provide overall ePrescribing program advice and counsel

• Advise on PR, media and marketing components of the project

• Offer advice and direction on program parameters

• Provide program management assistance


August 2008 page 15

POCP Client ListPOCP Client List

Employers General Motors, Ford, Chrysler

Content Companies Thomson Healthcare

PDR

MICROMEDEX Wolters Kluwer Health MediMedia

Government Natl. Library Of Medicine Department of Defense AHRQ

PBMs Medco Express Scripts CVS Caremark MedImpact

Providers

Cleveland Clinic

Henry Ford Health System

Health Plans

BCBS Florida – Navigy

Group Health Inc. (GHI)

BCBS Michigan

Cigna

Connectivity Companies

Availity

RMD Networks

eRx Network

Technology Companies

AthenaHealth

Epocrates


August 2008 page 16

• Anthony J (Tony) Schueth, MS – CEO and Managing Partner, 17-year health care veteran, and nationally recognized expert in ePrescribing. Project manager for SEMI. Project lead for the RAND New Jersey ePrescribing Action Coalition, one of five MMA pilots. Previously at Merck-Medco, IMS MEDACOM, IU Medical Center and Baxter Healthcare.

Project Role: Executive Oversight and Overall Responsibility

• David S. Green – Senior a 20-year healthcare veteran. Most recently with the ePrescribing companies, Prematics and Zix, he spent 16 years prior to that with Express Scripts and AdvancePCS (now CVS Caremark) in ePrescribing-related roles. He has been involved in numerous ePrescribing initiatives in both business development and operational roles and has assessed many business opportunities and markets for his employers.

Project Role: Consulting Lead and Key Contact

• Other Executives – POCP has a portfolio of other consultants with whom we work on a case-by-case basis based on skills. They include: Kurt Andrews, PhD, epidemiologists and outcomes researcher; Connie Sinclair, RPh, clinical pharmacist and HIT strategist; Michael Solomon, HIT Strategist; Lynn Offenhartz, implementation and operations guru

Project Role: As Needed and Where Have Expertise

Experienced, Successful Team


August 2008 page 17

Recent ProjectsRecent Projects• Project manager for the Southeastern Michigan (SEMI) ePrescribing

Initiative funded by General Motors, Ford, DaimlerChrysler and BCBSM

• ePrescribing planning and feasibility study for the state of Vermont

• Subcontractor to the RAND corporation on:– the New Jersey ePrescribing Action Coalition, one of the four 2006 MMA eRx pilots

– The eRx Toolset, an AHRQ-funded program to build a toolset for ePrescribing based on best practices, lessons learned and critical success factors

– A pilot for Structured and Codified Sig, RxNorm

• AHRQ subcontractor leading the business case and standards development efforts around electronic prior authorization

• Assisted a large regional health plan to determine an ePrescribing strategy and level of investment using POCP’s proprietary ROI model

• Led initiative to analyze clinical decision support language for the Agency for Healthcare Research & Quality (AHRQ)

• Evaluation, analysis and recommendations for leading ePrescribing solutions for various clients


August 2008 page 18

QSOURCEQSOURCE

Provider Outreach and Program Evaluation


August 2008 page 19

Who We AreWho We Are

• QSource of Arkansas is a healthcare consulting firm

• Our parent company is headquartered in Memphis with a satellite office in Nashville

• QSource created a subsidiary organization in Little Rock called QSource of Arkansas in March 2008

Nancy Archer, QSource Executive Director


August 2008 page 20

Valuable PartnershipValuable Partnership

• QSource integrates partners into our work to maximize the skills & services available to our customers

• Buccaneer Computer Systems & Service, Inc. (BCSSI) is partnering with QSource in delivering superior information systems (IS) and analytical support. BCSSI is a national leader in IS design and implementation and is expert in claims analysis, data mining and reporting. Nena Sanchez will lead BCSSI’s work with QSource.


August 2008 page 21

QSource Project Role QSource Project Role

QSource will provide expertise in the technical aspects of adoption and use of electronic clinical information; specifically e-prescribing, such as:

• Facilitating and coordinating intra/inter office workflow redesign toward maximization of health information exchange among providers regarding continuity of treatment

• Quality Improvement and Patient Safety as it relates to e-prescribing


August 2008 page 22

A Hybrid ModelA Hybrid Model

• Existing Medicaid regional and statewide meetings and publications

• Academic detailing: onsite visits to participating physician practices


August 2008 page 23

Outreach TeamOutreach Team

Contact PCP sites and gauge their interest in pursuing assessment,

planning, and implementation of e-prescribing functionality by:

• Examining the technical specifications of any current product(s)

• Analyzing communication and transmission capabilities

• Identifying the pharmacies they routinely utilize on behalf of their patients


August 2008 page 24

Program EvaluationProgram Evaluation

Evaluation of the Arkansas Medicaid e-prescribing initiative will be

accomplished through 3 recommended methods based on the

principle objective of this initiative:

Facilitate adoption and utilization of e-prescribing among primary care physicians. Improve the quality, safety, and coordination of care provided to Arkansas Medicaid beneficiaries.


August 2008 page 25

Program Evaluation MethodsProgram Evaluation Methods

• Real time feedback from the stakeholder organizations and the providers

• Monthly reports of number of participants & status of adoption

• A provider survey of satisfaction with the e-prescribing initiative, including:

– Tools and resources available

– Usage estimates

– Recommendations for future Medicaid technology initiatives


August 2008 page 26

CommunicationCommunication

• Information sharing across provider associations

• Quarterly written updates for all stakeholders

• Regional and state wide meetings and publications will be used to introduce the initiative and offer ePrescribing assistance

• Exhibits and presentations at consumer, stakeholder and medical community events, such as professional provider organization conferences and coalition meetings

Because ePrescribing is a state wide effort and will involve many groups, associations, stakeholders, physicians, pharmacists, providers and more, communication is vital to project success. Some forms of

communication will include:


August 2008 page 27

CommunicationCommunication

• Arkansas Medicaid Website

• Provider newsletter

• Regional meeting presentations

• Journal articles and ads

• Project status reports, face to face meetings and teleconference calls between project team and core stakeholders


August 2008 page 28

THANK YOUTHANK YOU

QUESTIONS?

03-23-05 august 2008 page 1 arkansas medicaid eprescribing project overview

Documents

quality rxhub

confidential rxhub

eprescribing advantage

hp project

program evaluation slide

medicaid managed care

patient safety

covered lives incorporated