Everyone seems to be searching for a business model to make regional data sharing work.
Stanley Borg, chief medical officer of Blue Cross and Blue Shield of Illinois, says he looked at the successes and failures of similar e-prescribing initiatives across the country and thinks his Illinois group has cherry-picked the best elements for the e-prescribing program launched this week by a consortium of payers, providers, medical societies and a local business group.
The program will be kicked off with the Blues plan making an initial contribution to get about 500 doctors up and running on an e-prescribing platform. Right now, there are two vendors of stand-alone e-prescription systems chosen for the plan, but others, including vendors of complete electronic medical-records systems, could participate if their products can pass a certification process, Borg said.
The effort, called the Illinois e-Prescribing Collaborative, aims to involve multiple payers and be self-sustaining, Borg said. It will assess the health plans a transaction fee that will not only cover the operating cost of that transaction, but also be sufficient to build up a pool of funds to pay for the installation and set up costs for physicians wanting to join the program later.
The contracted e-prescribing software vendors will keep count of prescriptions written for each participating health plans members and assess the plans only for those prescriptions. As part of the deal, the collaborative has agreed to provide the service free to the Illinois Medicaid program.
From the plans' perspective, it lets them pay as they go. "I dont have to figure out what my market share is," Borg said. "If they only have a few members, they only have to pay for a few members."
Doctors gain, he said, because electronic prescribing cuts down on administrative hassles with prescription refills, provides physicians with formulary guidance for each patient at the point of care, and alerts them to drug reactions with other medications the patients may be on.
Plans gain because even modest increases in generic usage prompted by the e-prescribing system will lower a plans drug cost.
"In Illinois, our generic utilization is just below the national average at 53% to 54%," Borg said, clarifying that 53% or 54% of all drugs prescribed are generics. "Weve taken a conservative estimate of looking at a 1% or 2% increase (and) the program pays for itself. We really didnt even calculate in formulary compliance," which should bring more savings to the plan, Borg said.