Historically, providers have struggled to make effective prescribing decisions because of a lack of comprehensive cost and coverage data. In fact, 77% of physicians have admitted to having difficulty advising patients on out-of-pocket prescription costs.

THE PROBLEM

UCHealth in Colorado conducted a survey through its CARE Innovation Center that gave it key insights into prescribing behavior. The health system found providers often defaulted to prescribing medications they were familiar with, without confirming formulary or coverage on the patient's plan.

In addition, providers frequently would have to call the pharmacy to ask for pricing information, since it was not readily available. This lack of information also prevented prescribers from having informed conversations with their patients about drug costs and alternatives.

Another common issue came from lack of insight into prior authorization requirements, as physicians faced restrictions in prescribing drugs that required approval by insurance.

To lower the cost of medications for patients, many physicians had to manually search for alternatives or drug coupons on behalf of the patient. While this did effectively lower costs in some cases, the process interrupted provider workflows since these outside tools did not integrate with the EHR.

On a related note, the health system found that effective EHR design for price transparency data was extremely important to physicians, and that EHR design greatly influenced prescribing patterns.

"Having a large quantity of data is great, but if it's not reliable, providers won't use it and your transaction success rate won't increase."

Dr. CT Lin, UCHealth

"More than 80% of prescriptions at UCHealth were being filled out of network, leading to concerns about safety, quality and adherence by patients," said Dr. CT Lin, CMIO at UCHealth and a practicing physician in internal medicine. "We needed a solution that would allow providers to easily access all the necessary data and identify medication alternatives based on cost and coverage.

"To benefit both patients and providers, we aimed to simplify the prescribing process and increase price transparency."

PROPOSAL

UCHealth turned to RxRevu, a vendor of real-time prescription benefit software, for help.

"We found RxRevu through the CARE Innovation Center – the same program that conducted the survey I mentioned," Lin noted. "Among other functions, this group actively seeks promising startup companies in the region to partner with and came across Denver-based RxRevu, which offered a solution that perfectly aligned with our goal to create greater price transparency for our prescribers and their patients.

"The real-time prescription benefit technology would give physicians access to comprehensive cost, coverage and formulary data at the point of care," he continued. "The technology empowers prescribers with patient-specific information, from the most common PBMs in the market, enabling them to choose the most useful and cost-effective medication option at the time of prescribing."

The technology also helps avoid prior authorization hurdles by identifying medication options that do not require it, he added.

"In addition, the technology streamlines workflows, since their real-time prescription benefit technology integrates with our existing EHR," Lin explained. "When creating prescription orders, RxRevu displays a pop-up window within the EHR that allows providers to view previously inaccessible data, such as lower-cost options, prior authorization alerts, pharmacy locations and more.

"By making this information accessible at the point of care and integrating with our EHR, the technology also reduces administrative burden on clinical staff and streamlines workflows," he continued. "Physicians no longer have to make phone calls to the pharmacy to ask about cost information or manually search for medication alternatives or coupons."

MEETING THE CHALLENGE

UCHealth implemented the real-time prescription benefit technology across all 16 of its hospitals and 1,000 clinics in the Rocky Mountain region.

"The technology was very easy to get up and running, since all the hospitals in the system use Epic as our EHR," Lin noted. "Because of this, we rolled out real-time prescription benefits for the entire health system at once, and providers across all the hospitals and clinics could then view real-time cost and coverage data.

UCHealth worked with the vendor to implement two different ways of using the tool.

"First, when considering a medication to prescribe, a provider can click an Estimate button," Lin explained. "This displays a window with all available cost information and any alternatives, making it easy for providers to proactively view and switch to a different drug if they choose.

"The second option is when a prescription order is being finalized," he added. "When clicking the Submit button, the same cost, coverage and alternative therapy information is displayed, and an alert window pops up if there are lower-cost or more effective alternatives available."

Immediately after implementation, UCHealth began working to figure out how to best leverage the vendor's technology. The health system has been live with RxRevu for a couple of years now, but it constantly is testing different options to determine the ideal configuration within Epic.

"RxRevu's technology now is used every single day by UCHealth physicians," Lin said. "In 2021, about 4,500 providers within the health system had access to real-time prescription benefit cost and coverage data, and more than 2,200 prescription transactions were made daily with this information available. This has added up to well over 250,000 patient interactions using real-time prescription benefit data, and this number increases daily.

"We work closely with the vendor on an ongoing basis to understand what is working and what could be improved, and we measure behavior change and medication switches so we know where to focus our efforts," he continued. "One of the great things about the technology is that we can go back and review how physicians have used it."

UCHealth has found physicians sometimes miss opportunities to swap medications that could save patients hundreds of dollars. By tracking physician behaviors and identifying opportunities to make the software more effective, the health system can focus its attention on areas of improvement and continue to find ways to lower costs for patients.

RESULTS

UCHealth immediately saw changes in prescribing behavior after implementing the technology.

Across 2021, the technology returned alternatives on more than 450,000 prescription transactions. These opportunities were either based on therapeutic alternatives, such as identifying a drug that has a lower cost or is unrestricted by prior authorization, or fulfillment alternatives, such as opting for a mail-order option.

During that same time, 48% of providers who saw an alternative with a savings opportunity made a switch to that lower-cost option. On an individual level, the health system is able to save patients an average of $35 on their prescriptions, which can be the difference between a patient adhering to a medication or skipping it altogether.

"Prescription inhalers for asthma are a common example where we identify savings opportunities," Lin said. "In one case, the pended prescription would have cost the patient $145 out of pocket for a 30-day supply.

"However, RxRevu's solution returned two alternatives, both of which only cost $15 for the same quantity," he continued. "The switch saved the patient $130 on a single fill of the prescription and more than $1,500 annually. It was extremely easy for the prescribing physician to see these lower-cost alternatives and make the switch, yet it resulted in major cost savings for the patient."

UCHealth also has seen major improvements in prior authorization avoidance. Providers avoided about 5% of the prior authorizations by selecting an alternative medication option.

That enables patients to start a therapy immediately, instead of waiting for their insurance to approve it – which significantly reduces the risk of treatment abandonment. This also has eased the administrative burden on providers, saving them many hours of dealing with phone calls and paperwork associated with prior authorizations.

With the technology, UCHealth has achieved a 98.3% success rate in prescription transactions between PBMs and the Epic EHR.

"This metric truly shows how reliable and accurate the real-time prescription benefit data is," Lin said. "In the past, there were times when the data presented to prescribers was incorrect, or no data was shown at all. RxRevu ensures physicians now have access to accurate, real-time, patient-specific data at the point of care, and it has greatly improved our success rate in completing prescription transactions."

ADVICE FOR OTHERS

"Real-time prescription benefit technology is essential for health systems to empower prescribing decisions with price transparency," Lin contended. "With access to comprehensive data, patients, providers and plans all benefit.

"Patients find lower-cost drugs and achieve greater medication adherence," he continued. "Health systems see streamlined and improved workflows for providers and more positive interactions with patients. Finally, health plans reduce their administrative workload and encourage better patient outcomes."

Lin offers some advice on implementing this type of technology from his experience.

"First, make it as seamless as possible," he said. "We found at UCHealth that having the technology fully integrated into the EHR was key. If it's not integrated or interrupts workflows, it won't be used. On a similar note, offer support to new users.

"No matter how seamless the implementation, training initiatives are essential to drive adoption and utilization," he continued. "At UCHealth, we've conducted regular training to get to our current rate of adoption, including holding training sessions at specific clinics, providing informational materials, and facilitating Q&As to help providers understand how to use the technology."

Another piece of advice from Lin is to focus on the quality of the data.

"Having a large quantity of data is great, but if it's not reliable, providers won't use it and your transaction success rate won't increase," he said. "Lastly, constantly test new features and measure new metrics.

"Even if you've used a technology for years, provider preferences always are changing," he concluded. "If you can stay in tune with which features and functionalities providers prefer, you can drive greater adoption and overall success in the technology."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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