1 Florida Medicaid Program: Impact of ePrescribing Christopher B. Sullivan, Ph.D. - AHCA Kathy Mosbaugh, Exec V.P. - Informed Decisions, LLC Tad Davis,

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Florida MedicaidProgram: Impact of ePrescribing

Christopher B. Sullivan, Ph.D. - AHCAKathy Mosbaugh, Exec V.P. - Informed Decisions, LLCTad Davis, PharmD - AHCA

2www.ePrescribeFlorida.com

Florida MedicaidWireless Handheld Clinical Pharmacology

Drug Information Database and E-Prescribing

Christopher B. Sullivan, Ph.D.Agency for Health Care Administration


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.


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.



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 for appropriate dosage.



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 electronic prescribing (e-prescribing)


Wireless Handheld PDAFactors to Optimizing Utilization Three Components of the Wireless Handheld

PDA Program:

Drug Information Patient Information Fraud and Abuse Detection




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.


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 selectionConfirm the patient’s payor information

Includes Controlled Substances, CIII - CV



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.


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.


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.


E-Prescribing - Data Tracking Capabilities

AHCA can: Track prescriptions at the recipient, doctor,

pharmacy or NDC level. Monitor outcomes resulting from drug therapy.


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GSM’s User Interface

100-day Manifest

PDL, Clinical PA, Drug Information

Prescription Writing and Tracking

Desktop PC

Wireless PDA

Medicaid Provider

1

2

3

4

5

ACS

Wireless

Handheld PDA Project

Approach


E-PrescribingResults

Florida providers have sent 361,586 electronic

prescriptions since the inception of the e-prescribing system.

Anecdotal feedback from users continues to be positive.


Medicaid Cost Per Member Per Month

Impact of e-Prescribing – Number of Claims


Medicaid Cost Per Member Per Month

Impact of e-Prescribing - Savings

Average Monthly Cost per Patient

$0.00

$100.00

$200.00

$300.00

Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06

PDA NonPDA

PDA $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

Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06


Integrated Drug Data TechnologiesFor Florida Medicaid Service Providers

Kathy Mosbaugh, Exec Vice PresidentInformed Decisions, LLC


The History of Rx History

ProDUR Possible with Point of Sale Claims in 1993 Pharmacies Got the Message / Physicians In the Dark

Prescribers would help if they had the information No “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 Access


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 issues Lost paper prescriptions Patient non-compliance Assignment of prescription claim to incorrect

prescriber


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 to the Florida Medicaid PDL Individual Medicaid patient medication history Ongoing education and support for prescribers


Impacting Utilization Through Technology

The wireless handheld drug information application was developed with expectations of creating value-added services by:Applying Patient Information Improving OutcomesSaving Money


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

eMPOWERx


Impacting the Delivery System

Accurate medication history Coordination of care – identify duplications Record of therapeutic failure

Formulary verification Avoid formulary disruption

Therapeutic fulfillment Impact on silent disease

Legible & complete prescriptions


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



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


Drug Interaction Alerts by Severity RankingJuly-September 2006



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


About the Program - Florida

Currently: Renewal of service for providers using PDAs Open online access for all Medicaid providers Increase ePrescribing eMPOWERx Office


CMS Acknowledgement


Independent Review


The eMPOWERx Programand the Provider


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


Patient Specific Information

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

100 Day Medication History List


Duplications of Therapy











Medication History List Identifies Duplicate Drugs









































Identifying Doctor Shoppers

OS0xxxx68 HYDROCODONE/APAP 10/650 TAB 9/19/2003 31 7

OS0xxxx68 METHADOSE 10MG TABLET 9/26/2003 30 7


OS0xxxx68 OXYCODONE W/APAP 5/325 TAB 10/15/2003 30 7




ME0xxxx42 OXYCODONE W/APAP 5/325 TAB 9/22/2003 60 20

ME0xxxx42 HYDROCODONE/APAP 10/650 TAB 10/6/2003 60 15



ME0xxxx18 ACETAMINOPHEN/COD #3 TABLET 10/21/2003 40 13


Medication History List Identifies Doctor Shopping


Identifying Doctor Shoppers

OS0xxxx68 HYDROCODONE/APAP 10/650 TAB 9/19/2003 31 7







ME0xxxx42 OXYCODONE W/APAP 5/325 TAB 9/22/2003 60 20






Medication History List Identifies Doctor Shopping


eMPOWERx Solution

The eMPOWERx Solution


Refill Compliance Indicator

Date of Last Fill

Improve Adherence by…

Benefits of eMPOWERx Solution


Automatic Clinical Reports

Enhance Safety by…

Supported by Clinical Content



Lower Drug Costs by…

Comprehensive medication history providing information for more informed therapeutic decisions

Therapeutic duplications flagged for further review



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


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


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


Tad Davis, PharmD – AHCAAgency for Health Care Administration

CMS Transformation GrantGenRx Expansion Project


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


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


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%


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


Year One


Initial Encounter

Creation of Face Sheet Patient Demographics Medication History past 6 months Procedures & ICD-9 Codes 2 years

Patient Eligible for Office Dispensing


Prescribing Encounter

Review medication profile & compliance issues

New medication needed Clinical Pharmacology Assistance Florida Medicaid Formulary/Plan Limits

Patient desires 10 day Starter Pak


Prescribing Encounter

Prescriber enters drug selection once Enters a 10 day SIG & Quantity Enters 30 day Quantity & Refill Instructions Confirms Both Prescriptions


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


Back at the Office

Duplicate Prescription Labels Printed Staff build prescription

Duplicate Label becomes script to be signed Script added to daily dispensing log


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


Prescriber Hand-off

Prescriber’s Role Checks medication label against script Hands medication/instructions to patient Offers to counsel


Patient Follow-up

Patient stops at front desk Obtains new appointment Receives discharge instructions

Rx Online Assistance Program (ROAP)


Questions

Questions Anyone?


Christopher B. Sullivan, Ph.D. Agency for Health Care [email protected]

Kathy Mosbaugh, Exec Vice President Informed Decisions, [email protected]

Tad Davis, PharmDAgency for Health Care [email protected]

1 Florida Medicaid Program: Impact of ePrescribing Christopher B. Sullivan, Ph.D. - AHCA Kathy Mosbaugh, Exec V.P. - Informed Decisions, LLC Tad Davis,

Documents

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