Transcript Impact of ePrescribing (PPT File - 3 Mb)

Florida Medicaid
Program: Impact of ePrescribing
Christopher B. Sullivan, Ph.D. - AHCA
Kathy Mosbaugh, Exec V.P. - Informed Decisions, LLC
Tad Davis, PharmD - AHCA
1
Florida Medicaid
Wireless Handheld Clinical Pharmacology
Drug Information Database and E-Prescribing
Christopher B. Sullivan, Ph.D.
Agency for Health Care Administration
www.ePrescribeFlorida.com
2
Wireless Handheld PDA - the Opportunity for Change
 In 2003, the Agency for Health Care Administration was
authorized to implement its wireless handheld PDA
program in the Pharmacy program.
 AHCA developed a model in which clinical outcomes
and Medicaid “over-prescribing” could be positively
impacted at the point of care.
 Florida, under the direction of AHCA, is at the forefront in
using healthcare technology.
www.ePrescribeFlorida.com
3
Wireless Handheld PDA - About the Program
 Florida uses wireless technology to make 100 days of
our recipients’ prescription drug history available to
practitioners.
 This 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.
www.ePrescribeFlorida.com
4
Wireless Handheld PDA - About the Program
 The prescription program allows physician participation
in prospective drug utilization review to:
 Minimize
adverse drug reactions.
 Detect
overuse or under use of drugs.
 Detect
duplicate therapies.
 Detect
potential allergic responses.
 Screen
www.ePrescribeFlorida.com
for appropriate dosage.
5
Wireless Handheld PDA - About the Program
 Phase 1:
 1000
high-volume participating Medicaid providers
 Medicaid preferred drug list (PDL)
 60-day patient specific prescription drug history
 Drug utilization reports (i.e. interaction alerts, etc.)
 Phase 2:
 Expanded
to 3000 total participating Medicaid
providers
 100-day patient specific prescription drug history
 Included
www.ePrescribeFlorida.com
electronic prescribing (e-prescribing)
6
Wireless Handheld PDA - About the Program

Wireless Handheld PDA
Three
Components
of the Wireless
Handheld
Factors
to Optimizing
Utilization
PDA Program:
 Drug Information
 Patient Information
 Fraud and Abuse Detection
www.ePrescribeFlorida.com
7
Wireless Handheld PDA - About the Program
 The PDA program provides clinical benefits by alerting
the provider to potential drug-drug interactions and
providing electronic prescribing to avoid costly
medication errors.
 This Prescribing System provides:
 comprehensive recipient drug histories,
 PDL status information,
 clinical drug information,
 drug-drug and drug-food interaction alerts and
 recommendations for alternative medications.
www.ePrescribeFlorida.com
8
Wireless Handheld PDA - About the Program
Ideal Electronic Prescription
 Available for any patient group
 Not an e-mail from electronic medical record
 NCPDP 5.1 compatible transmission
 Only requires pharmacist to:
 Confirm NDC selection
 Confirm the patient’s payor information
 Includes Controlled Substances, CIII - CV
www.ePrescribeFlorida.com
9
E-Prescribing - General Overview
 The system is supported through a Web-based, real-time
prescribing system:
 Allows providers to “write” prescriptions from a
desktop computer or PDA – prompts for patient’s last
pharmacy.
 Allows electronic prescription submission to any
pharmacy for dispensing and adjudication.
 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.
www.ePrescribeFlorida.com
10
E-Prescribing - General Overview
 The Prescribing System is capable of tracking:
 who wrote the prescription,
 for which recipient,
 what was ordered,
 when it was ordered,
 where it was sent and
 what time it was filled.
 If the recipient does not pick up the prescription, the
Prescribing System is capable of notifying the doctor.
www.ePrescribeFlorida.com
11
E-Prescribing - Data Tracking Capabilities
 Doctors can:
 Track individual patients.
 Track prescription status – compliance, fraud and
abuse.
 Pharmacies can:
 Track patient’s drug profiles – clinical review, fraud
and abuse monitoring.
 Track incoming prescription – improve workflow,
minimize wait times.
www.ePrescribeFlorida.com
12
E-Prescribing - Data Tracking Capabilities
 AHCA can:
 Track prescriptions at the recipient, doctor,
pharmacy or NDC level.
 Monitor outcomes resulting from drug therapy.
www.ePrescribeFlorida.com
13
Medicaid
Provider
Desktop PC
1
Wireless
Wireless
PDA
Handheld PDA
Project
Approach
GSM’s User Interface
100-day Manifest
PDL, Clinical PA, Drug
Information
Prescription Writing
and Tracking
5
2
ACS
4
3
14
www.ePrescribeFlorida.com
14
E-Prescribing
Results
 Florida providers have sent 361,586 electronic
prescriptions since the inception of the e-prescribing
system.
 Anecdotal feedback from users continues to be positive.
www.ePrescribeFlorida.com
15
Medicaid Cost Per Member Per Month
 Impact of e-Prescribing – Number of Claims
www.ePrescribeFlorida.com
16
Medicaid Cost Per Member Per Month
 Impact of e-Prescribing - Savings
Average Monthly Cost per Patient
$300.00
$200.00
$100.00
$0.00
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
$204.10
$209.16
$219.72
$208.27
$217.10
$216.70
$215.74
$217.68
$203.16
$221.52
$230.01
$227.98
NonPDA $241.41
$236.73
$246.50
$245.61
$258.50
$262.42
$258.29
$262.68
$254.10
$272.34
$275.38
$281.31
PDA
PDA NonPDA
www.ePrescribeFlorida.com
17
Integrated Drug Data Technologies
For Florida Medicaid Service Providers
Kathy Mosbaugh, Exec Vice President
Informed Decisions, LLC
www.ePrescribeFlorida.com
18
The History of Rx History
 ProDUR Possible with Point of Sale Claims in 1993
 Pharmacies Got the Message / Physicians In the Dark
 Prescribers
 No
would help if they had the information
“Real time connection” was available
 Internet
connections were rare in physician offices
 Medicaid Fiscal Agent Website with Rx History – 2000
 Did
not have DUR / Pharmacology information
 Unpredictable
www.ePrescribeFlorida.com
Access
19
Prescriber Needs at the Point of Care
 Reference to Florida Medicaid PDL
 Constantly updated clinical pharmacology information
 Reference to best practice guidelines
 Specific, up-to-date patient medication history
 Elimination of errors in the prescribing/dispensing
process due to:
 Legibility
 Lost
issues
paper prescriptions
 Patient
non-compliance
 Assignment
of prescription claim to incorrect
prescriber
www.ePrescribeFlorida.com
20
Application of Health Information
 In 2002, Florida Legislature directed Agency to develop
wireless handheld drug information application for
prescribers to use at point of care
 The system was to provide:
 Continuously
updated clinical pharmacology
information for prescriber reference
 Reference
 Individual
 Ongoing
www.ePrescribeFlorida.com
to the Florida Medicaid PDL
Medicaid patient medication history
education and support for prescribers
21
Impacting Utilization Through Technology
 The wireless handheld drug information
application was developed with
expectations of creating value-added
services by:
 Applying
Patient Information
 Improving
 Saving
www.ePrescribeFlorida.com
Outcomes
Money
22
eMPOWERx
 Point of care clinical decision
support
 Coupling Clinical Pharmacology
with real time patient data
 Delivering data for use on a
variety of platforms
 Received National awards
www.ePrescribeFlorida.com
23
Impacting the Delivery System
 Accurate medication history
 Coordination
 Record
of care – identify duplications
of therapeutic failure
 Formulary verification
 Avoid
formulary disruption
 Therapeutic fulfillment
 Impact
on silent disease
 Legible & complete prescriptions
www.ePrescribeFlorida.com
24
Overall Impact for Florida Medicaid

Savings calculations- prescription utilization and cost
avoidance

5:1 Return on Investment

2006 PEW Report noted $50 million savings for
Florida in previous two years

AHCA currently reports $1.8 - $2 million in monthly
savings

$4 million in savings quarterly by avoiding severe
drug interactions
www.ePrescribeFlorida.com
25
Overall Impact for Florida Medicaid

Savings realized by eliminating waste and reducing
medication errors

Minimize duplication of therapy - Inefficiencies of a
disconnected system

Minimize fraud and abuse - Real-time, proactive
identification

Reduce medication errors – Preventing severe drug
interactions
www.ePrescribeFlorida.com
26
Overall Impact for Florida Medicaid
Drug Interaction Alerts by Severity Ranking
July-September 2006
www.ePrescribeFlorida.com
27
About the Program - Florida
 Launched (2003):
 1000
high volume Medicaid providers
 Providee
Medicaid PDL
 Providee
60-day patient specific Rx history
 Drug
utilization reports (interaction reports, etc.)
 Expanded (2004):
 Expanded
to 3000 total providers
 Provided
100-day patient specific Rx history
 Included
electronic prescribing
www.ePrescribeFlorida.com
28
About the Program - Florida
 Currently:
 Renewal
 Open
of service for providers using PDAs
online access for all Medicaid providers
 Increase
ePrescribing
 eMPOWERx
www.ePrescribeFlorida.com
Office
29
CMS Acknowledgement
www.ePrescribeFlorida.com
30
Independent Review
www.ePrescribeFlorida.com
31
The eMPOWERx Program
and the Provider
www.ePrescribeFlorida.com
32
Proof is in the Pudding
“…I also use it as a teaching tool to let patients know
how computers can make our lives easier and teach
them and myself about medication side effects. Once
they see the whole list of medications they are on,
many of them realize they may be overmedicated
by too many prescribing physicians.”
Dr. Pedro Carballo
www.ePrescribeFlorida.com
33
Patient Specific Information
100 Day Medication History List
ME0xxxx25
RISPERDAL 3MG TABLET
10/27/2003
60
30
ME0xxxx61
ZYPREXA 10MG TABLET
10/27/2003
60
30
ME0xxxx90
KU-ZYME CAPSULE
10/29/2003
90
30
ME0xxxx90
ZITHROMAX 250MG Z-PAK TAB
10/29/2003
6
4
ME0xxxx90
IBUPROFEN 800MG TABLET
10/29/2003
30
15
ME0xxxx90
ALBUTEROL 90MCG INHALER
10/29/2003
17
30
ME0xxxx47
CEFTIN 500MG TABLET
10/31/2003
20
10
ME0xxxx60
SEROQUEL 300MG TABLET
10/31/2003
60
30
ME0xxxx47
ADVAIR 500/50 DISKUS
10/31/2003
60
30
ME0xxxx47
VIOXX 50MG TABLET
10/31/2003
30
30
www.ePrescribeFlorida.com
34
Duplications of Therapy
Medication History List Identifies Duplicate Drugs
ME0xxxx25
RISPERDAL 3MG TABLET
10/27/2003
60
30
ME0xxxx61
ZYPREXA 10MG TABLET
10/27/2003
60
30
ME0xxxx90
KU-ZYME CAPSULE
10/29/2003
90
30
ME0xxxx90
ZITHROMAX 250MG Z-PAK TAB
10/29/2003
6
4
ME0xxxx90
IBUPROFEN 800MG TABLET
10/29/2003
30
15
ME0xxxx90
ALBUTEROL 90MCG INHALER
10/29/2003
17
30
ME0xxxx47
CEFTIN 500MG TABLET
10/31/2003
20
10
ME0xxxx60
SEROQUEL 300MG TABLET
10/31/2003
60
30
ME0xxxx47
ADVAIR 500/50 DISKUS
10/31/2003
60
30
ME0xxxx47
VIOXX 50MG TABLET
10/31/2003
30
30
www.ePrescribeFlorida.com
35
Duplications of Therapy
Medication History List Identifies Duplicate Drugs
ME0xxxx25
RISPERDAL 3MG TABLET
10/27/2003
60
30
ME0xxxx61
ZYPREXA 10MG TABLET
10/27/2003
60
30
ME0xxxx90
KU-ZYME CAPSULE
10/29/2003
90
30
ME0xxxx90
ZITHROMAX 250MG Z-PAK TAB
10/29/2003
6
4
ME0xxxx90
IBUPROFEN 800MG TABLET
10/29/2003
30
15
ME0xxxx90
ALBUTEROL 90MCG INHALER
10/29/2003
17
30
ME0xxxx47
CEFTIN 500MG TABLET
10/31/2003
20
10
ME0xxxx60
SEROQUEL 300MG TABLET
10/31/2003
60
30
ME0xxxx47
ADVAIR 500/50 DISKUS
10/31/2003
60
30
ME0xxxx47
VIOXX 50MG TABLET
10/31/2003
30
30
www.ePrescribeFlorida.com
36
Duplications of Therapy
Medication History List Identifies Duplicate Drugs
ME0xxxx25
RISPERDAL 3MG TABLET
10/27/2003
60
30
ME0xxxx61
ZYPREXA 10MG TABLET
10/27/2003
60
30
ME0xxxx90
KU-ZYME CAPSULE
10/29/2003
90
30
ME0xxxx90
ZITHROMAX 250MG Z-PAK TAB
10/29/2003
6
4
ME0xxxx90
IBUPROFEN 800MG TABLET
10/29/2003
30
15
ME0xxxx90
ALBUTEROL 90MCG INHALER
10/29/2003
17
30
ME0xxxx47
CEFTIN 500MG TABLET
10/31/2003
20
10
ME0xxxx60
SEROQUEL 300MG TABLET
10/31/2003
60
30
ME0xxxx47
ADVAIR 500/50 DISKUS
10/31/2003
60
30
ME0xxxx47
VIOXX 50MG TABLET
10/31/2003
30
30
www.ePrescribeFlorida.com
37
Duplications of Therapy
Medication History List Identifies Duplicate Drugs
ME0xxxx25
RISPERDAL 3MG TABLET
10/27/2003
60
30
ME0xxxx61
ZYPREXA 10MG TABLET
10/27/2003
60
30
ME0xxxx90
KU-ZYME CAPSULE
10/29/2003
90
30
ME0xxxx90
ZITHROMAX 250MG Z-PAK TAB
10/29/2003
6
4
ME0xxxx90
IBUPROFEN 800MG TABLET
10/29/2003
30
15
ME0xxxx90
ALBUTEROL 90MCG INHALER
10/29/2003
17
30
ME0xxxx47
CEFTIN 500MG TABLET
10/31/2003
20
10
ME0xxxx60
SEROQUEL 300MG TABLET
10/31/2003
60
30
ME0xxxx47
ADVAIR 500/50 DISKUS
10/31/2003
60
30
ME0xxxx47
VIOXX 50MG TABLET
10/31/2003
30
30
www.ePrescribeFlorida.com
38
Identifying Doctor Shoppers
Medication History List Identifies Doctor Shopping
OS0xxxx68
HYDROCODONE/APAP 10/650 TAB
9/19/2003
31
7
OS0xxxx68
METHADOSE 10MG TABLET
9/26/2003
30
7
OS0xxxx68
METHADOSE 10MG TABLET
10/15/2003
30
7
OS0xxxx68
OXYCODONE W/APAP 5/325 TAB
10/15/2003
30
7
OS0xxxx68
OXYCODONE W/APAP 5/325 TAB
10/27/2003
30
5
OS0xxxx68
METHADOSE 10MG TABLET
10/27/2003
30
7
OS0xxxx68
OXYCODONE W/APAP 5/325 TAB
10/30/2003
30
5
ME0xxxx42
OXYCODONE W/APAP 5/325 TAB
9/22/2003
60
20
ME0xxxx42
HYDROCODONE/APAP 10/650 TAB
10/6/2003
60
15
ME0xxxx42
HYDROCODONE/APAP 10/650 TAB
11/6/2003
40
10
ME0xxxx42
HYDROCODONE/APAP 10/650 TAB
11/17/2003
20
5
ME0xxxx18
ACETAMINOPHEN/COD #3 TABLET
10/21/2003
40
13
ME0xxxx18
ACETAMINOPHEN/COD #3 TABLET
11/19/2003
100
25
www.ePrescribeFlorida.com
39
Identifying Doctor Shoppers
Medication History List Identifies Doctor Shopping
OS0xxxx68
HYDROCODONE/APAP 10/650 TAB
9/19/2003
31
7
OS0xxxx68
METHADOSE 10MG TABLET
9/26/2003
30
7
OS0xxxx68
METHADOSE 10MG TABLET
10/15/2003
30
7
OS0xxxx68
OXYCODONE W/APAP 5/325 TAB
10/15/2003
30
7
OS0xxxx68
OXYCODONE W/APAP 5/325 TAB
10/27/2003
30
5
OS0xxxx68
METHADOSE 10MG TABLET
10/27/2003
30
7
OS0xxxx68
OXYCODONE W/APAP 5/325 TAB
10/30/2003
30
5
ME0xxxx42
OXYCODONE W/APAP 5/325 TAB
9/22/2003
60
20
ME0xxxx42
HYDROCODONE/APAP 10/650 TAB
10/6/2003
60
15
ME0xxxx42
HYDROCODONE/APAP 10/650 TAB
11/6/2003
40
10
ME0xxxx42
HYDROCODONE/APAP 10/650 TAB
11/17/2003
20
5
ME0xxxx18
ACETAMINOPHEN/COD #3 TABLET
10/21/2003
40
13
ME0xxxx18
ACETAMINOPHEN/COD #3 TABLET
11/19/2003
100
25
www.ePrescribeFlorida.com
40
eMPOWERx Solution
The
eMPOWERx
Solution
www.ePrescribeFlorida.com
41
Benefits of eMPOWERx Solution
Improve Adherence by…
Refill Compliance Indicator
Date of Last Fill
www.ePrescribeFlorida.com
42
Benefits of eMPOWERx Solution
Enhance Safety by…
Automatic
Clinical
Reports
Supported
by Clinical
Content
www.ePrescribeFlorida.com
43
Benefits of eMPOWERx Solution
Lower Drug Costs by…
Comprehensive medication history
providing information for more
informed therapeutic decisions
Therapeutic duplications
flagged for further review
www.ePrescribeFlorida.com
44
eMPOWERx Ideals
 Empower the provider
 Quality clinical decision support at the point of care
 Provide efficiency throughout the process
 Enhance patient safety
 Optimal information
 Point-of-care access
 Better outcomes
 Eliminate waste
www.ePrescribeFlorida.com
45
Results of eMPOWERx Pilot Project
 Prescribers who use the PDA write fewer prescriptions
on average
 Significantly lower cost per patient for prescriptions
compared to non-PDA prescribers
 Florida providers have sent over 850,000 electronic
prescriptions to date
 eMPOWERx users receive more than 5,000 drug
interaction alerts each week; more than 1,000 of these
are of high or very high severity
 Savings from avoided hospitalizations due to
preventable drug interactions and reduced Rx cost is
estimated at more than $16 million annually
www.ePrescribeFlorida.com
46
Going Forward
 e-Prescribing options used for only 7% of eligible Rx’s
 Outreach
to physicians and pharmacies is ongoing
 New
technology and platforms experience a learning
curve
 Medicaid wireless handheld users prescribe 10%-16%
fewer Rxs than control group physicians
 Wireless handheld and desktop prescribing and
reference access moves system toward total electronic
records
www.ePrescribeFlorida.com
47
CMS Transformation Grant
GenRx Expansion Project
Tad Davis, PharmD – AHCA
Agency for Health Care Administration
www.ePrescribeFlorida.com
48
Medicaid Transformation Grant
 July 2006 CMS announces grant funding for
projects to “Transform” healthcare

Emphasis on increasing generic drug utilization

Enhancing patient safety through the use of
technology (e-prescribing, EMR … etc. )
 October 1, 2006 Florida Medicaid submits GenRx
Expansion Proposal
 January 25th, 2007 CMS Awards Florida Medicaid 2
year $ 1.73 million for GenRx Expansion Project
www.ePrescribeFlorida.com
49
GenRx Vision
 Promote e-prescribing via
 Provide 10 day generic starter pak
 Increase utilization of generic medications
 Promote recruitment and retention of Medicaid
Providers
 Improve patient outcomes by having with more
direct contact with clinical pharmacists
www.ePrescribeFlorida.com
50
Goals of GenRx Pilot Project
 Enroll 300 to 600 dispensing practitioners as
Florida Medicaid Pharmacy providers
 Establish over 100 practice sites as Medicaid
Pharmacy Providers
 Train office staff and medical personnel in
appropriate dispensing practices
 Increase e-prescriptions from 2% to 10%
 Increase average generic utilization in select drug
categories from 27% to 50%
www.ePrescribeFlorida.com
51
Why GenRx?
 Providers using e-prescribing use fewer
medications
 Compensate the prescriber for extra effort of
electronic prescribing
 Enhance Medication Compliance

Eliminates some transportation issues

Minimizes unfilled prescriptions
 Patient satisfaction – One stop shopping
 Provides alternative to Brand name samples
www.ePrescribeFlorida.com
52
Year One
www.ePrescribeFlorida.com
53
Initial Encounter
 Creation of Face Sheet

Patient Demographics

Medication History past 6 months

Procedures & ICD-9 Codes 2 years
 Patient Eligible for Office Dispensing
www.ePrescribeFlorida.com
54
Prescribing Encounter
 Review medication profile & compliance issues
 New medication needed

Clinical Pharmacology Assistance

Florida Medicaid Formulary/Plan Limits
 Patient desires 10 day Starter Pak
www.ePrescribeFlorida.com
55
Prescribing Encounter
 Prescriber enters drug selection once

Enters a 10 day SIG & Quantity

Enters 30 day Quantity & Refill Instructions

Confirms Both Prescriptions
www.ePrescribeFlorida.com
56
Heritage Hand-off
 eMPOWERx sends transaction to Heritage Info Sys

Validates Prescriber’s own inventory

Sends claim to ACS for payment

Sends Label back to Prescriber’s Office
www.ePrescribeFlorida.com
57
Back at the Office
 Duplicate Prescription Labels Printed

Staff build prescription

Duplicate Label becomes script to be signed

Script added to daily dispensing log
www.ePrescribeFlorida.com
58
Prescription Building
 Pre-packed medications have duplicate labels

Tear-off label attached to script

OBRA 90 medication instructions selected

Meds/Script/Instructions back to prescriber
www.ePrescribeFlorida.com
59
Prescriber Hand-off
 Prescriber’s Role

Checks medication label against script

Hands medication/instructions to patient

Offers to counsel
www.ePrescribeFlorida.com
60
Patient Follow-up
 Patient stops at front desk

Obtains new appointment

Receives discharge instructions
Rx Online Assistance Program (ROAP)
www.ePrescribeFlorida.com
61
Questions
Questions Anyone?
www.ePrescribeFlorida.com
62
Christopher B. Sullivan, Ph.D.
Agency for Health Care Administration
[email protected]
Kathy Mosbaugh, Exec Vice President
Informed Decisions, LLC
[email protected]
Tad Davis, PharmD
Agency for Health Care Administration
[email protected]
www.ePrescribeFlorida.com
63