The 11-page report, released Oct. 16, covers a survey of 206 plans that were identified as active Part D participants using July 2008 claims data and surveys conducted in August and September of last year. The report was accompanied by a more weighty, 39-page companion piece in which the inspector general looked specifically at e-prescribing standards under Medicare Part D.
Medicare Part-D plans were required to implement the CMS-mandated e-Rx standards, but also voluntarily adopted e-prescribing promotional efforts.
Plan sponsors have come up with various approaches in developing e-prescribing programs, the inspector general noted. Some plans chose to pay for systems upfront. Other plans incorporated e-prescribing as a component in pay-for-performance. Still others have paid physicians to e-prescribe on a per-transaction basis, according to the report.
Twenty-one percent of Part-D plans responding to the inspector general's survey reported e-prescribing initiatives were under way, and another 18% of plans indicated they were planning to offer an e-Rx program.
An e-Rx program, according to the inspector general, has at least one of the following six accoutrements: free or discounted software, hardware, Internet connectivity, financial incentives and educational materials. Of the 44 Part D health plans that offered an e-prescribing program, most had one to three of the above program elements, but some had up to six. Free or discounted software and training were the most common combination.
One of the case studies cited in the report provides evidence of three lessons to be learned in implementing an e-prescribing program: mandate it, pay incentives to use it and incorporate it into an EHR.
Sierra Health Services, which was acquired by UnitedHealthcare in 2008, offered all Nevada prescribers free, stand-alone e-prescribing software as part of its Part D program. But only prescribers in one large medical group owned by Sierra, Las Vegas-based Southwest Medical Associates, took up the program, and even then, physicians were slow at first to adopt the technology.
But when Southwest Medical changed the program, mandating that only 100% compliant e-prescribers were eligible for bonuses, and incorporated the e-Rx software into the group's EHR, adoption increased dramatically, according to the inspector general's report. The number of e-prescriptions soared from zero to 80,000 in the first month. At the end of the inspector general's survey in September 2008, “almost all prescriptions generated by SMA were electronic,” its report said.
Of the 11 plans reporting they found a measurable benefit in promoting e-prescribing, eight reported an increase in substitution of lower-cost generic drugs and an increase in compliance with the drug formulary of the plan, according to the report. Five plans reported a decrease in medication errors, defined as the number of prescriptions changed in response to a computerized medication alert. Two plans reported cost savings.
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