Editor’s note: This story is based on discussions at Abarca Forward, a conference in San Juan, Puerto Rico, hosted by Abarca, a pharmacy benefit manager. MedCity News’ Editor-in-Chief Arundhati Parmar and Senior Reporter Katie Adams were invited to attend and speak at the conference. All travel and related expenses for the team were covered by Abarca. However, company officials had no input in editorial coverage.
In order for the U.S. healthcare system to operate smoothly, various stakeholders must cooperate with one another and share data seamlessly. But this notion is far from being achieved — the industry is still seriously plagued by data silos and a lack of interoperability.
Healthcare’s interoperability problem and the unique challenges it poses to the pharmacy space were the topics of discussion at a panel held Thursday at Abarca Forward, a pharmacy conference held in San Juan, Puerto Rico. While the panelists acknowledged that data connectivity issues remain a glaring issue, they expressed optimism about the automation technology that health plans, pharmacy benefit managers and providers can adopt to facilitate real-time data sharing.
The panelists discussed three main benefits they think will come as a result of greater interoperability technology adoption.
- Improved medication adherence
Not too long ago, doctors would write their patients prescriptions, send them on their way, and that was the end of it. Now, as pharmacy operations become more intertwined with providers’ electronic health records, physicians can see whether or not their patients have filled their prescriptions. This may seem like a simple change, but it does a great deal to help patients stick to their treatment plans, said Scott Rochowiak, manager of product performance at Surescripts.If a provider notices that their patient hasn’t picked up their prescription or has forgotten about a refill, they can intervene and potentially prevent the patient from experiencing an adverse event.Automated prior authorization can also play a significant role in ensuring medication adherence, Rochowiak declared.
“If there’s a patient who is relying on public transit or lives in a very rural area, and they go to the pharmacy only to hear ‘Oh, your prescription needs a prior authorization and is going to take two or three days,’ that can really be a burden on that patient. Some patients will abandon therapy at that point,” he said.
- Time savingsAbout 80% of the savings that come as a result of pharmacy automation technology end up going to providers, declared April Todd, chief policy and research officer at Council for Affordable Quality Healthcare (CAQH). The automation of administrative tasks like prior authorization not only frees up providers to spend more time focusing on patient care, but it also reduces burnout and therefore the number of providers seeking to leave the care delivery space, she pointed out.
Health plans also benefit from automation technology — Todd said that payers often see a 50-80% reduction in call center volume and faxing when they automate transactions.Todd’s remarks become even more significant when you consider the massive weight of the healthcare sector’s administrative burden. Her organization recently released a report showing that the U.S. healthcare system spent $60 billion on administrative tasks last year, which is about $18 billion more than it spent in 2021.
Administrative waste has been an issue that the healthcare industry has struggled with for years, and it doesn’t seem to be getting better from the sound of CAQH’s report. “Waste” refers to the fact that providers spend an excessive amount of time on administrative tasks, even though they have no impact on patients’ health outcomes. This is not only frustrating but also incredibly expensive. Harvard University economics professor David Cutler has estimated that the healthcare industry’s administrative costs account for twice the amount that the country spends on cardiovascular disease care annually — and three times cancer care spend.
- Cost savingsAs pharmacy technology becomes more advanced, it is starting to show clinicians more affordable drug regimens for their patients, Rochowiak said. While the patient is still in the room with their clinician, tools within the EHR can automatically present information about what formulary adherence really means at that moment.Rochowiak gave an example of what this could look like:
“What does it mean for your ingredient costs to change someone from a DPP-4 inhibitor like Trajenta to an optimized metformin regimen? There’s going to be tremendous savings there.”
The healthcare sector needs greater adoption of technology that fosters interoperability not only because of the benefits mentioned above, but also because the way patients receive care is changing, Todd pointed out.
Patients no longer receive all their care at their doctor’s office or hospital. Patients now seek care at retail pharmacy clinics, get vaccinations in churches and baseball stadiums, and order their prescription drugs from Amazon. All of these interactions influence a patient’s health, yet their clinicians often lack the data to inform them about these care experiences.
Photo: LeoWolfert, Getty Images