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Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Outcomes and Implications of Florida
Medicaid’s e-Prescribing Pilot Project
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Christopher B. Sullivan, Ph.D.
Agency for Health Care Administration
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Background to the Presentation
This presentation will cover three topics that relate
to the e-prescribing initiatives taken by Florida state
government.

A summary overview of the Florida Medicaid
e-Prescribing Pilot Project, including the outcomes of
fewer prescription claims and lower costs to Medicaid.

An overview of the Electronic Prescribing
Clearinghouse website developed by the Agency to
promote e-prescribing.

A description of the Medicaid e-Prescribing Adoption
Program to be proposed for legislation in FY 2009-10.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid e-Prescribing Pilot Project
 In 2003, the Florida Legislature directed AHCA to
develop a wireless handheld drug information
application for prescribers to use at point of care.
o AHCA developed a model in which clinical outcomes
and “over-prescribing” could be positively impacted at
the point of care.

The system was expected to provide:

Continuously updated clinical pharmacology
information for prescriber reference

Reference to the Florida Medicaid PDL

Individual Medicaid patient medication history
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Value of the e-Prescribing Pilot Project

Florida Medicaid e-Prescribing Pilot makes 100 days
of a patient’s prescription drug history available to
practitioners.

The medication history:

is available at the point of service;

permits immediate utilization and compliance
review;

provides information about coverage and
restrictions;

incorporates an e-prescribing function that permits
immediate transmission of prescription
authorization to the patient’s pharmacy.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Expected Outcomes from the e-Prescribing Pilot

The e-prescribing application contracted by Medicaid is
eMPOWERx. This program is expected to provide a drug
utilization review to the physician for purposes of:

Minimizing adverse drug reactions.

Detecting overuse or under use of drugs.

Detecting duplicate therapies.

Detecting potential allergic responses.

Screening for appropriate dosage.

Halting “doctor shopping” for medications
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
ePrescribing Provides a Medication History
Comprehensive
medication
history for well
informed
therapeutic
decisions
Drug Interactions
Identified
Therapeutic
duplications
flagged for
further review
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
e-Prescribing Pilot Drug Interaction Alerts


Medicaid e-prescribing is integrated with a clinical
information database, which includes screening tools
to reduce the potential for medication errors before
they occur.

Employs Clinical Pharmacology and clinical report
tools, empowering clinicians to screen a
prescription for adverse effects.

Alerts the provider to potential drug-drug or drugallergy interactions
The e-Prescribing component provides Medicaid
Preferred Drug List information and offers
recommendations for alternative medications.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Interaction Alerts From July 2007 to March 2008
Incidence of Drug Alerts in Medicaid e-PRescribing, June 2006 to March 2008
Low Risk of Drug
Interaction, 12%
(n=18,887)
Moderate Risk of
Drug Interaction,
66% (n=109,433)
Very High Risk of
Drug Interaction,
3% (n=4,564)
High Risk of Drug
Interaction, 19%
(n=30,221)
Very High Risk of Drug Interaction
High Risk of Drug Interaction
Moderate Risk of Drug Interaction
Low Risk of Drug Interaction
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid e-Prescribing Features

The Medicaid e-prescribing system is supported through a
Web-based, real-time prescribing system:


Allows providers to write prescriptions from a desktop
computer or a PDA with prompts for the patient’s last
pharmacy.
The desktop version of of the e-prescribing software
includes a data feed from SureScripts-RxHub.

Physicians can obtain a medication history from both
Medicaid and non-Medicaid sources using the desktop
version.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid e-Prescribing, January-June, 2008
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid ePrescribing Volumes, January to June 2008
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Floridaper
Center
for Health
Information
andePrescribing
Policy Analysis
Average Prescriptions
Patient, Comparing
Physicians
in the Medicaid
Pilot
versus All Other Medicaid Physicians, July 2006 to March 2008
Fewer Medicaid Prescription Claims per Patient
3.7
3.5
3.4
3.5
3.5
3.5
3.4
3.4
3.4
3.5
3.4
3.5
3.5
3.4
3.4
3.3
3.4
3.4
3.4
3.3
3.3
3.3
3.2
Average Prescriptions per Patient
Medicaid ePrescribing Pilot Physicians 2.7
All Other Medicaid Physicians
3.4
3.2
2.9
2.8
2.7
2.7
2.7
2.7
2.9
2.7
2.7
2.8
2.7
2.7
2.6
2.7
2.8
2.7
2.8
2.7
2.7
2.8
2.7
2.6
2.6
2.4
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun06
06
06
06
06
06
07
07
07
07
07
07
ePrescribing Pilot Physicians
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar07
07
07
07
07
07
08
08
08
All Other Physicians
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida
Center
for Health
Policy
Analysis
Average Cost of
Prescriptions
per Patient
ComparingInformation
Physiciansin the and
Medicaid
ePrescribing
Pilot versus All Other Medicaid Physicians, July 2006 to March 2008
$300
Greater Medicaid Cost Savings per Patient
$294
$296
$290
$290
$289
$284
$280
$281
$282
$286
$282
$272
$275
$275
$274
$275
$274
$274
$263
$258
Average Cost of Rx Per Patient
Medicaid ePrescribing Pilot Physicians $230
All Other Physicians
$278
$254
$265
$250
$243
$242
$240
$239
$230
$235
$229
$233
$225
$218
$222
$228
$225
$226
$241
$241
$243
$233
$228
$223
$216
$203
$200
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun06
06
06
06
06
06
07
07
07
07
07
07
Medicaid ePrescribing Pilot Physicians
Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar07
07
07
07
07
07
08
08
08
All Other Medicaid Physicians
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Outcomes of the Medicaid e-Prescribing Pilot Project

Prescribers in the Medicaid pilot write 25% fewer
prescriptions than physicians not using the system.

Prescribers in the Medicaid pilot save Medicaid an
average of $48 more per month per patient on
prescription claims.

Florida Medicaid reports $1.8 - $2 million in monthly
savings from physicians using e-prescribing.

During a 9 month period in 2007-08 e-prescribing
physicians received an average of 18,122 alerts per
month, for a projected savings of $208,933 each
month in claims.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Public Health Opportunities for Medicaid e-Prescribing
o Duval County Health Department is initiating a pilot
project using eMPOWERx.
o Florida Medicaid is working with the Duval County Health
Department to obtain extra wireless PDAs for the pilot.
o The eMPOWERx Desktop version has extra benefits with
its RxHub feed, but security is an important issue that
needs to be resolved.
o AHCA Medicaid is reaching out to make eMPOWERx
available to all County Health Departments in Florida
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
2007 Legislative Session – HB 1155
 Mandates information clearinghouse on electronic
prescribing (s. 408.0611 FS)

“To promote the implementation of electronic
prescribing by healthcare practitioners, healthcare
facilities, and pharmacies in order to prevent
prescription drug abuse, improve patient safety,
and reduce unnecessary prescriptions.”

“The agency shall work in collaboration with
private sector electronic prescribing initiatives and
relevant stakeholders to create a clearinghouse of
information of electronic prescribing for health
care practitioners, health care facilities, and
pharmacies.”
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis

E-Prescribing Clearinghouse Mandate
Provide information regarding the availability of
electronic prescribing products.

Regularly convene stakeholders to assess and
accelerate implementation of electronic
prescribing.

The Agency shall monitor the implementation of
electronic prescribing

The Agency shall annually report on the progress
of electronic prescribing implementation to the
Governor and Legislature – due January 31.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
17
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
E-Prescribing Clearinghouse –
www.fhin.net/eprescribe
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
18
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
E-Prescribing Initiatives Across the Country
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
19
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
E-Prescribing Vendor Clearinghouse
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
20
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Monitoring the Progress of E-Prescribing in
Florida
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
21
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid Electronic Prescribing Adoption
Program, FY 2009-2010
The Agency is considering developing an incentive
program to promote the adoption of electronic
prescribing among Medicaid providers.
o Offering financial incentives to Medicaid providers
benefits Florida Medicaid beneficiaries by:
• E-prescribing enhances quality patient care.
• Makes electronic medication records available at
the point of care.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid Electronic Prescribing Adoption
Program, FY 2009-2010
The proposed incentive payment would be continued
for a limited number of years and gradually be
decreased in subsequent years.
The Agency is NOT considering imposing a penalty
related to low utilization of electronic prescribing.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Expected Adoption Rates from the Incentives
The current level of adoption of e-prescribing by pilot
project providers is estimated at 19.5% of the physicians
using the eMPOWERx program, or an estimated 3.8% of
all Medicaid physicians.
46,866 electronic prescriptions were reported by Medicaid
in the second quarter of 2008.
The proposed program would fund incentives to achieve
5% level of adoption of electronic prescribing among
Medicaid physicians targeting 679,126 e-prescriptions in
fiscal year 2009-2010.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid e-Prescribing Adoption Program Issues
Metrics: The number of electronic prescriptions sent by
the Medicaid clinician relative to the number of
prescriptions generated by the Medicaid clinician during
the measurement period.
Qualifying Metric for Incentive Payment: The
qualifying metric should be set high enough to document
that the clinician is committed to electronic prescribing
and the qualifying metric should reward increased use of
electronic prescribing.
Data Sources: Use claims data to track e-prescribing;
avoid creating new reporting requirements if possible.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid e-Prescribing Adoption Program Issues
What e-prescribing tool standards are available?
o CCHIT certified EMRs
o ePrescribe America
The proposed method to implement program change:
o Amend the State Plan
o Adopt a rule amendment and incorporate changes in
the Florida Medicaid Provider Reimbursement
Handbook and Physician Services Coverage and
Limitations Handbook.
o Include proviso language in appropriations bill
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Medicaid e-Prescribing Incentives Program
Issues
Program funding:
The proposed source of funds for the first year would be
general revenue with federal match.
o The proposed source of funds for the second year is
prescription drug savings from year one.
o And subsequent years.
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
CMS Medicaid Policy for Promoting Adoption
of e-Prescribing
How will states be supported to establish incentive
programs?
What have we learned from Physician Quality Reporting
Initiative (PQRI)? What metrics will be most cost effective
to administer?
What program design would be most acceptable to
physicians and encourage Medicaid participation?
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008
Florida Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Carolyn H. Turner
Christopher B. Sullivan, Ph.D.
Agency for Health Care Administration
Florida Center for Health Information
and Policy Analysis
2727 Mahan Drive
Tallahassee, FL 32308
[email protected]
[email protected]
National e-Prescribing Conference Sponsored by CMS
and Industry Partners - October 6 & 7, 2008