By Kim Diehl-Boyd, Vice President, Industry Relations and Government Affairs, CoverMyMeds
Policies to Support Data Liquidity: Improving Medication Access through Healthcare IT
Healthcare interoperability and transparency policies are a priority for legislatures in 2021 after many were tabled to address COVID-19 in 2020. Forward progress in healthcare IT depends on policies supporting a person-centered, value-based care environment and the access and secure exchange of patient-specific information.
Recent federal final rules aim to improve data liquidity, the ability to enter data once and have it available for other systems and users, and interoperability. Healthcare stakeholders are expected to implement these policy provisions over the next three years.
At the state level, transparency and data liquidity are current topics, as legislators keep patient affordability and access paramount. Real-time information at the point of care can be critical to patients understanding their options to afford, access and adhere to their medication, not to mention reducing provider burden.
Technology innovation is outpacing policy; however, data liquidity is not. State and federal policymakers should continue promoting policies that advance healthcare data liquidity.
Price Transparency Starts with Interoperability
To empower confident conversations between healthcare teams and patients, the industry needs systems that can acquire and consume data necessary to make informed decisions.
While care team members often help inform prescribing, 75 percent said they look multiple places for medication and coverage information because it’s not contained in one source.1 At the pharmacy, 43 percent of pharmacists said they go outside their system to complete day-to-day tasks, including finding patient coverage and affordability options.2
Proficient data liquidity allows providers and pharmacists to surface patient-specific, relevant health data. Unimpeded and accurate data flow may reduce administrative burden, especially when surfacing patient benefit and medication information.
The ONC 21st Century Cures Act Final Rule implements the interoperability and information-blocking sections of the 21st Century Cures Act.
Similarly, the CMS Interoperability and Patient Access Final Rule provides CMS-regulated payers with specific guidance for privacy, security and standards related to data exchange, information blocking and patient access to their health data.
These final rules require an open application programming interface (API), modernizing healthcare data exchange standards to allow innovation freedom while maintaining a common set of communication standards. This better allows patients and health systems to select apps and EHRs that best suit their needs.
The intent of these rules is to move to a system of access, exchange and use. However, even with looming compliance deadlines, there are still many stakeholders who remain unclear on these rules, with mixed responses across the healthcare ecosystem.
State-Level Price Transparency Legislation
Multiple states, including California, Tennessee and New York, are introducing legislation this year to address point-of-care price transparency and coverage information. These bills could help reduce provider burden, simplify the prior authorization (PA) process and improve patient adherence by enforcing sharing of and exposure to cost and coverage information before patients reach the pharmacy counter.
Over three-fourths of providers reported patient out-of-pocket costs are rarely or never available within their EHRs.3 With the growth of patient healthcare consumerism, innovations and policies that spark productive conversations between healthcare teams and patients should endeavor to keep pace. Healthcare stakeholders have a real opportunity to provide transparency around all aspects of care to meet the unique needs of patients.
Technology available to put into practice today
While upcoming policies can widen the path to medication access, health systems shouldn't wait to implement cutting-edge transparency solutions. Care team tools built with the patient in mind can provide price, treatment method and communication options. When providers use a prescription decision support solution, such as real-time prescription benefit, patients are 19 percent more adherent to picking up their medication.4
Patient-specific information, provided by a plan or pharmacy benefit manager (PBM), infused into IT systems can not only surface access and affordability options, but also inform the electronic prior authorization (ePA) process. ePA can help improve patient adherence rates, especially with PA visibility during the prescribing process.
However, when providers start PAs at the point of prescribing, patients can get their medications an average 13.2 days sooner, compared pharmacy-initiated requests.5
Real-time ePA and prescription transparency applications may also reduce administrative burden for pharmacists. Two thirds of pharmacists surveyed manually run prescriptions through insurance for PA status updates.2 Only one third of pharmacists receive PA updates in their pharmacy system.2 Pharmacy ePA solutions offer often-automated, in-workflow PA processes so pharmacists can spend more quality time with patients.
While healthcare policy and rule mandates can help achieve a fully accessible and interoperable healthcare ecosystem, adoption takes time and can be variable, creating an implementation patchwork. Stakeholders should continue prioritizing a person-centered and value-based care system. Plans and PBMs should be readily providing healthcare teams and their partners with patient-specific information to inform the medication access journey. By infusing this information into decision support technology, health systems and their integration partners can lead the way for affordability, adherence, quality, convenience and an improved patient experience.