HIMSS19 Q&A: Surescripts CEO Tom Skelton on efforts to take on high prescription drug prices, interoperability

When it comes to some of the biggest issues in healthcare from prescription drug prices to interoperability, e-prescribing company Surescripts has a big potential role to play.
And the software company has been working to grab that mantle, rapidly expanding its footprint from digitizing prescriptions to its latest effort to allow physicians to see the costs of the drugs they are prescribing in real time. So far, there are about 115,000 physicians utilizing the new solution, which has resulted in a 20% improvement in adherence among their patients, CEO Tom Skelton told me as we sat down for a conversation at the Healthcare Information and Management Sytems Society's (HIMSS) annual conference and exhibition this week.
"We see these numbers increasing rapidly over the next two to three years. It took 10 years to get half the market to use electronic prescribing. We think in the next two to three years, we’ll exceed that as we look at real-time prescription benefits," Skelton said. 
As part of HIMSS, Skelton said the company is also working to get the word out about its other interoperability play, a record locator and exchange which can allow physicians to electronically query for a patient's health records from any of their other providers if they are in the same system—helping patients avoid answering all those pesky questions about their health history again.

"All of these questions that you as a patient and consumer are forced to answer can actually be answered electronically and that's a better way to handle this," Skelton said.

Here's a bit more from our conversation from the show floor this week:

FierceHealthcare: CMS Administrator Seema Verma had some strong words for the industry this week about interoperability and patients' access to their own data. What do you think?

Tom Skelton: I don’t think there’s any argument about that. The patient owns their data and should have access to it. But I think we should start by remembering that access and interoperability are not the same things. You having access to your records is not the same as two physicians being able to share your record of treatment. And sometimes that gets blurred in the conversation. The access piece of it, I think we just need to nail and get done as quickly as possible. Interoperability is going to be a bit longer journey. 

FH: Why aren’t we there yet?

TS: Things take time. We made one heck of an infrastructure with the EHRs under meaningful use and then they had to get their feet underneath them and start to optimize all those workflows, get the things that maybe these EHR’s weren’t designed to handle in the way they would have liked. I think its a natural adoption curve. And now we’re looking at it and we’re starting to see a lot of records moving.

FH: Surescripts just released a report that most physicians don't know how much the drugs they are prescribing cost. Can you talk a bit about that problem?

TS: In the panel this morning, I asked the audience "Raise your hand if you’ve done some type of comparison shopping in the last week?" And almost every hand went up. That’s not true in healthcare. If you look at the way prescribing has gone up historically, you’ve got a piece of paper, you walk to the pharmacy, you hand it to them. Then you find out what cost, what other paperwork is necessary, how long it’s going to take. It’s not an optimized patient experience. 

We started by digitizing med scripts so not it's not a piece of paper. Then we started with If you need prior authorization, let’s automate that. Now we’ve added to that. It’s "Y’know, we want you to know what it’s going to cost and we want you to have that discussion with your prescriber." That’s what this whole thing is about.

FH: In your panel today, you were sitting down with Cigna and CVS Health, both representing industries that have taken some flak in the drug price debate. 

TS: And as they highlighted, transparency is in everybody’s interest because otherwise, we end up irritating the consumers. Everybody is a consumer of healthcare. Only some of us are patients at any given time. We don’t get to pick when the line changes. So we have to be addressed upstream early, often frequently, so that when care does occur, we are prepared to deal with it. That’s what these solutions are all about. 

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FH: What do you think about the efforts by the Trump administration to address drug prices such as trying to end drug rebates to PBMs or saying we need to have drug prices posted? 

TS: I think the underlying theme here is the price of medications is rising too quickly. In 2015, I think the number was $475 billion on prescription drugs. That number is going to be almost $600 billion in a few years. It’s just unsustainable. That was the commitment that Trump made to his constituency—we’re going to go after drug pricing. Now you’re left with: What does that mean? Is that drug pricing meaning the co-pay? Is that drug-pricing meaning the cost of the plan? What does that mean? In my opinion that is the journey we’re on. The inpatient experimentation to see what starts to get that cost curve to flatten so that we’re not paying more for every drug.

FH: You say Surescripts is helping patients save money because they'll be able to comparison shop. But if a whole system pushes the prices higher upstream, aren’t your efforts being undermined? 

TS: No doubt. What it will do is it will start to highlight for the patients in a conversation what that cost looks like and also identify the alternative. What we’ve actually done is at the point of prescribing, we’ve said, "OK, the doctor chose one. But there are five others that do the exact same thing clinically that could either be a lower price or require less paperwork." And we’re allowing them to make that informed decision. But to your point, it’s not going to solve those macrosystemic problems that are going on. It’s going to take years to sort some of these out.

FH: What is your relationship with these PBMs and insurers?

TS: One of the great things about SureScripts is we see ourselves as neutral. We’re not trying to get anyone the advantage in what we do. We don’t advantage the EHRs. We don’t advantage the payers. We don’t advantage the PBMs. We believe in a couple of things. We believe that the patients have a benefit plan that we can help communicate. That’s vital because right now physicians don’t know what’s on that formulary and what’s not. We think these patients need to make a decision about where these medications are dispensed. Our job is to create that sandbox to let everyone do what they need to do.