Providers need access to complete patient information to achieve the Triple Aim of the value-based care system.
Stakeholders in the public and private sector have their sights set on delivering high-quality care, improving population health management, and lowering healthcare costs through the establishment of a value-based care system.
The industry has made some progress in abandoning the fee-for-service model in favor of value-based care.
With providers soon heading into Year 3 of the Quality Payment Program (QPP), healthcare organizations are becoming accustomed to receiving federal incentive payments based on the quality of services delivered rather than the number of tests or procedures performed.
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While changes at the federal and regulatory level are necessary to pave the way for this shift, improvements in the way healthcare organizations access, exchange, and use patient data are equally important.
Overcoming persistent barriers to interoperability so that healthcare organizations have access to a comprehensive view of patient health will position care teams to achieve improvements in care quality and patient health outcomes.
EHRIntelligence.com sat down with Surescripts CEO Tom Skelton to discuss the factors that may inhitbit progress toward improving interoperability and value-based care, as well as how Surescripts and other health IT innovators can help to overcome these obstacles.
“One of the most challenging aspects of interoperability is identifying the models and business models that support the use cases the industry, caregivers, and patients most want to see,” said Skelton, who will also deliver the keynote speech on Day 2 of Xtelligent Media’s Value-Based Care Summit (VBCS) in Boston October 17-October 19. “There is a lot of value being created here.”
“The question is, how do we do this in a way that allows the country to achieve its objectives in a timely manner, and get everyone aligned strategically, economically, and clinically?”
For its part, Surescripts has developed solutions including its National Record Locator Service (NRLS), Sentinel e-prescribing solution, prior authorization solution, and price transparency tool.
These solutions are designed to address the clinical, financial, and administrative sides of prescribing to help providers make better-informed clinical decisions without adding administrative or financial burden.
Since its inception in 2001, Surescripts has seen significant increases in the number of providers engaging in health data exchange.
“If you look just at information sharing on the clinical side, we’re going to share a billion medication histories this year with prescribers and with caregivers at acute care facilities,” said Skelton. “When you look at patient identification and where patients have been and who they’ve seen, our record locator and exchange products go in to deliver 65 million summaries.”
“The industry is making strides,” he emphasized. “As an industry, we have not necessarily done the most fabulous job of telling our story and measuring outcomes.”
While Surescripts and other data exchange services providers have helped to boost interoperability, the industry has not yet achieved the kind of network-to-network connectivity federal entities such as ONC would like to see.
ONC is currently working to spur improvements in this area through its Trusted Exchange Framework and Common Agreement (TEFCA). TEFCA is a voluntary health data exchange framework intended to achieve a nationwide network-of-networks through the establishment of qualified health information networks (QHINs).
According to Skelton, this incremental progress toward achieving a network-of-networks is not unique to healthcare.
“The biggest lesson we’ve learned is that building out this type of many-to-many connectivity platform takes time,” he said. “It’s no different than when cellphones came out. I had four or five people I could call when they first came out, so the utility of the device was limited. But over time, everyone had a phone.”
“All of a sudden this app ecosystem comes into play, and now it’s not even about phone calls,” continued Skelton. “It’s about communication. It’s a whole different type of device. We’ve seen the same thing with the Surescripts platform.”
Surescripts made the decision to expand its solution offerings by noting ancillary avenues and potential benefits stemming from its initial e-prescribing product. Now, the organization has dipped into medication histories, medication management, and other areas.
“It’s not about speed,” maintained Skelton. “It’s not about how fast you can get that initial connectivity. It’s about getting a broad-based coalition over a period of time, and that’s really what we’ve tried to do with the Surescripts Network Alliance.”
Currently, Surescripts is focused on addressing problems with medication price transparency.
“The ability to have a prescriber understand, ‘Hey, something just showed up in my office. I’m going to prescribe a high blood pressure medication. Here’s what his plan says it’s going to cost him,’” explained Skelton.
In November 2017, Surescripts partnered with CVS Health to allow pharmacy benefits managers (PBMs) within CVS Caremark to provide real-time, member-specific prescription benefit information and lower-cost therapeutic alternatives.
This solution takes all of a patient’s co-pay information into account when calculating and presenting the potential cost of a medication. The solution then offers prescribers five recommendations for therapeutic alternatives in case the prescriber or the patient opts to pass up the medication in favor of a less costly route.
“For us, that is extraordinarily important,” said Skelton.
Currently, about 77 percent of the population is covered by Surescripts’ price transparency solution, including a number of prescription drug monitoring programs (PDMPs) and health plans.
Skelton anticipates the price transparency offering will help to significantly improve healthcare delivery on both an individual and global scale.
“People are more interested in the health plan world and the payer world of managing their population,” said Skelton. “We’re doing our best to understand where members of this population have been seen, as well as who saw them, and what they were seen for.”
“We’ve begun moving toward alerting capabilities around this and we’re providing some new information sets to help with the care management of this to ensure health plans, pharmacists, and physicians have all the information they need,” he added.
Ensuring all members of a patient or population’s care team has access to complete medication and prescription information lays the groundwork for the kind of holistic, well-informed, comprehensive care delivery that is ideally at the crux of a value-based care system.
If health IT innovation, health data access, and health data exchange continue to progress along the current trajectory, Skelton predicts the industry’s goal of achieving a learning health system will be well within reach.
“We are in an era of extreme experimentation and innovation,” said Skelton. “We just have to remember what we’re trying to do here is achieve these changes at scale.”
“We’re at the early stages of a learning health system and it will do nothing but accelerate.”
