Part two of a two-part series (access part one here):
Since the start of the Southeast Michigan e-Prescribing Initiative, under way since February 2005, the rate of generic-drug prescribing has risen from 56% to 71%, said Matt Walsh, associate vice president of purchaser initiatives at Health Alliance Plan, a not-for-profit health plan affiliated with the Henry Ford Health System. The health system has saved $3 million a year through the program, Walsh said, primarily through the increased use of generics and more adherence to the plans formulary.
The alliance has been so successful that it expanded to the inpatient side late last year at 736-bed Henry Ford Hospital in Detroit. So far, 10 physicians at the hospital are participating. They can access patients' medication histories upon admission and see their insurer's drug formulary. When the patient is discharged, his or her medical list is sent to the physician's outpatient e-prescribing system so drugs can be reconciled, continued or changed. "It closes the loop," Walsh said.
Other Blues plans have experienced similar initial successes but are re-evaluating their strategies. CareFirst Blue Cross and Blue Shield of Maryland achieved a threefold return on its e-prescribing investment through lower drug costs since launching its pilot program in 2004, though the insurer would not disclose a dollar figure. CareFirst lent access for about 300 physicians to DrFirst's Web-based e-prescribing tool or a PDA. Formulary compliance increased by 4%, which the health plan considered significant, said Pete Stoessel, director of administration, medical systems and business development at CareFirst.
But CareFirst is phasing out the program and integrating e-prescribing into its existing pay-for-performance incentives, Stoessel said. "We got a lot of attention, which meant that vendors started calling," he said. "We wanted to get out of managing the sponsorship piece." Participating physicians will continue to use the technology, but physicians new to e-prescribing will choose their own vendor.
Ultimately, CareFirst decided it shouldn't be purchasing a certain technology and pressing it onto providers, he said. "You open up the portal to e-prescribing and let the provider decide which vendor will be the winner and the loser," Stoessel said.
That's the approach the Florida Blues is taking as well, with ePrescribe Florida. Launched last year, the initiative involves the Blues; other major insurers, including Humana and UnitedHealthcare; the Florida Hospital Association and Florida Medical Association. The collaborative aims to educate providers about e-prescribing and provide some minimal criteria for vendor participation while remaining vendor-neutral. The Florida Blues will give physician incentives to use e-prescribing through pay-for-performance. The insurer is hoping to boost e-prescribing among Florida providers from 2% in 2007 to at least 8% this year, Peper said.
"We are hoping it will be replicated around the country," she said. Peper said that although the Florida Blues was "a little nervous" about working with competitors like UnitedHealth Group, there was little resistance to the idea of working together to get physicians around the state to adopt e-prescribing. Florida is the first such state to have this collaboration.
Staying the course
Insurance giant WellPoint, however, is continuing to move forward with sponsorship-based e-prescribing, with pilot projects in Ohio and New Hampshire, along with participating in RxHub, a repository of formulary, eligibility and benefit information that is owned by the top pharmacy benefit managers. "Unless you have the health plans pushing this, it will take a mandate from Congress or decades for e-prescribing to be adopted widely," said Charles Kennedy, vice president of health information technology at Indianapolis-based WellPoint. He said the uptake in generic prescribing and resulting reduced pharmacy costs paid by WellPoint, is funding the e-prescribing initiatives.
Getting critical mass around e-prescribing could happen if it is required by Medicare, many experts agree. "Medicare is going to be the only thing that leads the way," said Kristin Begley, pharmacy practice leader with human resources consulting firm Hewitt Associates.
In another move to advance e-prescribing, U.S. Sen. John Kerry (D-Mass.) and U.S. Rep. Allyson Schwartz (D-Pa.) in December 2007 introduced the Medicare Electronic Medication and Safety Protection Act. The bill provides a one-time bonus to physicians of between $1,000 and $2,000 toward startup costs of e-prescribing, as well as bonus payments for each script written electronically. Physicians not e-prescribing by January 2011 would see a 10% reduction in Medicare fee schedules, according to the legislation. Physicians could get one- to two-year hardship exemptions.
As of Jan. 8, healthcare organizations representing hospitals and nursing homes, HMOs, insurers, health professionals and other health services have donated a total of $148,700 to Schwartz's 2008 re-election campaign, out of $1.5 million in total donations. Kerry has received a total of $111,664 from the same healthcare sectors for his 2008 re-election campaign out of a total of $14.7 million raised, according to the Center for Responsive Politics.
Schwartz announced last month that she was forming a task force on healthcare with fellow Democratic representatives Rep. Lois Capps of California and Rep. Jason Altmire of Pennsylvaniaall former health professionalsto push e-prescribing and disease-management bills. Capps has received $55,750 from healthcare industry groups, out of a total $476,754 raised for her 2008 campaign, and Altmire received $52,900 from healthcare industry groups, out of a total $1.1 million raised this election cycle, according to the Center for Responsive Politics.
In a separate effort, the Senate Judiciary Committee held a hearing in December to speed up a long-awaited Drug Enforcement Administration decision on whether to permit e-prescribing of controlled substances, which make up about 10% of prescriptions written nationwide. Pharmacy benefit managers and some physicians testified that allowing these drugs to be e-prescribed would reduce fraud and abuse and boost e-prescribing adoption, particularly among specialists who routinely prescribe controlled medications such as opioid painkillers. Earlier this month, the DEA announced it drafted a rule to lift the ban and sent it to the Justice Department and the Office of Management and Budget for review. The American Medical Association opposes a federal e-prescribing mandate, but agrees that controlled substances should be allowed to be e-prescribed.
An imperfect tool
Joseph Heyman, who has a solo gynecological practice in Amesbury, Mass., and is chairman-elect of the AMA board of trustees, has been e-prescribing for about five years and pays $40 a month for his Web-based e-prescribing program. He said that while it is a great tool, the technology is too imperfect for it to be mandated. "These programs have to be good enough for everyone to use them," Heyman said. "It's also important that physicians not become prisoners of whoever is supplying the technology."
Another concern is that employers or insurers could use e-prescribing data for other purposes, such as targeted drug marketing, he said.