Frank Harvey, CEO of Surescripts, just lately spoke with Healthcare Innovation a couple of vary of points, together with a latest acquisition, the potential for pharmacists to play a bigger position on major care groups, and why Surescripts Well being Info Community LLC is making use of to turn into a Certified Well being Info Community (QHIN) below the Trusted Trade Framework and Frequent Settlement (TEFCA).
Harvey succeeded Tom Skelton as CEO in 2022. A pharmacist himself, Harvey has held management positions within the healthcare expertise, pharmacy and pharmaceutical sectors. He joined Surescripts from ATLS Investments LLC, the place he led personal fairness investing in healthcare expertise corporations.
Healthcare Innovation: May you speak a little bit bit about how the position that pharmacists play within the healthcare ecosystem is evolving?
Harvey: There are two main issues that we’re going through. One is the silver tsunami. Proper now now we have 58 million folks aged 65 and older. By 2030, it is estimated that we’ll have 70 million folks. By age 65, 80 p.c of individuals have at the very least one continual situation and 60 p.c of individuals have two continual circumstances. As well as, you might have the burnout that clinicians are feeling due to the pandemic — nevertheless it’s not simply the pandemic. It is all this administrative burden that we have placed on physicians, pharmacists and the whole care staff. It is estimated that 20 p.c of physicians plan to retire within the subsequent two years. So you have acquired an getting old inhabitants, and you have an estimated scarcity of about 135,000 major care physicians by 2034.
We’re not changing them quickly sufficient. So that basically forces us to have a look at the care staff construction — how they work collectively, and who can choose up a few of that slack. Once you have a look at the care staff, pharmacists have the scope of coaching to select up lots of that first stage of major care. They need to try this and it’ll assist with a few of the pharmacist burnout we have seen, too. Pharmacists are burning out similar to physicians as a result of they’re centered on the menial duties that they need to be faraway from to allow them to deal with extra of the first care-focused areas.
HCI: In lots of areas, the impartial pharmacies have largely disappeared and the big retail chains dominate. Can the pharmacists in these retail environments tackle this position? And are these chains considering seeing their pharmacist tackle that position?
Harvey: Completely. I believe when you have a look at all the foremost chains, they’re already acknowledging the necessity for the pharmacist job to evolve, together with doing immunizations that we did such an amazing job of in the course of the pandemic. We’ve got to turn into continual care managers, which implies now we have to let pharmacists try this decrease stage of major care to alleviate a few of that burden from the doctor. There’s actually a three-legged stool. One is expertise. That’s the position of Surescripts, ensuring we have got the appropriate medical info within the fingers of the pharmacist or the doctor after they’re making these care selections. A pharmacist or a doctor would not have all day to learn via a 300-page medical chart, so our expertise helps boil that right down to a abstract.
One other leg of the stool is the reimbursement coverage. We’ve got to amend reimbursement coverage each on the CMS stage and on the well being plan stage to pay pharmacists for this extra exercise. There’s acquired to be compensation for that or they can not afford to do it.
The third piece is we want legislative modifications throughout the U.S. and within the states. In the course of the pandemic, HHS gave pharmacists broader privileges and so they prolonged that via December of 2024. I believe we have to make these privileges go on from there. As a result of states are liable for licensure and monitoring, lots of the states need to move laws to acknowledge the scope of the pharmacists’ coaching and empower them to supply these features. The research we have performed have proven that physicians are in favor of a pharmacist doing extra as a part of a collaborative care staff and it actually opens up their skill to deal with the issues which are on the prime of their their coaching.
HCI: Surescripts does surveys of pharmacists about their prime challenges, and a latest report mentioned they spoke in regards to the want for digital entry to medical info, profit eligibility info, and digital prior authorization. How troublesome is it to assemble that info and current it to them on the level of care?
Harvey: It isn’t that troublesome in any respect. As a matter of truth, we try this proper now via their pharmacy working programs. I believe one in all your articles within the final day or so was about some statistics in regards to the burden of prior authorization. It is one of the burdensome factor for the doctor’s workplace. It isn’t solely administratively burdening for the doctor, nevertheless it additionally delays take care of the affected person.
We’ve got an digital prior authorization resolution that is proactive. So when the doctor is writing the prescription, our resolution goes out instantly relatively than having to take two or three days to undergo a course of. As well as, with the Surescripts real-time prescription profit product, the doctor pulls up what remedy he needs to provide that affected person, and it exhibits him therapeutic options. It exhibits him and the affected person what their profit covers. It exhibits them what the prices will probably be at retail. Nearly 20 p.c of sufferers will go to the pharmacy, after which the pharmacy has to name again to say ‘hey, this affected person cannot afford this. What are you able to do? Can you alter it?’ You get that taken care of proper on the doctor’s workplace.
HCI: Surescripts just lately purchased an organization known as ActiveRadar. Are you able to clarify what was enticing about that firm?
Harvey: We checked out all the businesses on the market and we actually felt like ActiveRadar had one of the best therapeutic various resolution out there. All of the well being plans and all PBMs need to have a therapeutic PMT committee that decides what medicine are interchangeable. It’s a very costly proposition, significantly for smaller regional plans. Via their expertise, ActiveRadar form of does that work for for the plans and for the PBMs. That permits them to say, ‘Okay, I am going to simply use yours relatively than having to make use of all these further people to do it.’ It creates extra consistency throughout all of the totally different plans as properly.
If you happen to have a look at real-time prescription profit, ensuring the appropriate therapeutic options are introduced as part of that resolution is vital as properly.
HCI: Surescripts Well being Info Community simply introduced it is making use of to be a QHIN below the TEFCA framework. Who could be logical companions to be sub-participants below the TEFCA framework?
Harvey: The pharmacies, the labs, PBMs, the well being plans. We’re the biggest interoperability firm within the nation already. We did 22 billion transactions final yr. Solely about 2.35 billion of these are literally prescriptions. The remaining is all of the medical knowledge.
We’re very assured that we are able to serve everybody throughout the spectrum of healthcare. And if you consider the Certified Well being Info, Networks in TEFCA, it actually does turn into a community of networks, as you’ll, as a result of every one goes to achieve success bringing in individuals who will probably be their prospects. We actually suppose the staff at ONC has performed a beautiful job. If you consider what is the significance of this, it comes again to the affected person’s skill to ensure they’re getting the appropriate remedy after they’re in entrance of a care supplier, as a result of with an incomplete medical document, they’re by no means certain that the appropriate selections are being made.
HCI: In September, the corporate named Lynne Nowak, M.D., its first chief knowledge and analytics officer. Why did Surescripts see a necessity for that position? And what are a few of the issues that she and her staff are engaged on?
Harvey: Effectively, an amazing instance is that ActiveRadar goes to be part of her group. We all know the information has energy to guarantee that we’re centered on the issues that may very well be enhancing the standard of care, enhancing affected person security and reducing the price of care. When you might have 22 billion transactions, there’s so many issues that may come out of that, that info, making an attempt to determine these issues which are greatest for the affected person. We consider there is a important alternative for Lynne and our knowledge scientists to essentially construct out the issues that may assist these core components of our mission.
HCI: Waiting for 2024, are there another plans you need to speak about?
Harvey: We’re centered on making an attempt to take the executive burden away from the care suppliers as a result of we actually do see it as a disaster once you see the pharmacists taking turns occurring strike, if you’ll, due to their working circumstances and so they’re not capable of deal with the issues that they need to. So our goal is to look throughout all the issues we offer and proceed to excellent them. Within the final 4 years, we have improved the standard of e-prescriptions by over 200 p.c. We’re engaged on ensuring that our medical direct messaging product is on the market and pervasive via healthcare so the pharmacist can message the doctor, the doctor can message the pharmacist proper in workflow, eradicating the executive burden of getting to ship a fax. Healthcare might be one of many final bastions of the fax machine. We would like to see an finish of that fax machine and we consider lots of our applied sciences will probably be useful in that finish.
HCI: Are there some ways in which all this pleasure and growth round synthetic intelligence and enormous language fashions can apply to the work you guys do?
Harvey: Folks generally combine up machine studying and generative AI. We have been utilizing machine studying for the reason that very starting inside our merchandise. We’re beginning to have a look at generative AI. We do suppose there are some issues we are able to put it to use for. Nonetheless, I am going to say we’re being actually cautious as a result of there are nonetheless lots of unknowns about generative AI and it has hallucinations. Once you’re coping with the affected person’s document, you may’t have hallucinations. So we’re it, we’re testing it, doing lots of pilot issues round it, however till we’re completely certain that it is what it must be, we’re not going to roll it out into our total portfolio.
