Frank Harvey, CEO of Surescripts, just lately spoke with Healthcare Innovation a few vary of points, together with a current acquisition, the potential for pharmacists to play a bigger position on main care groups, and why Surescripts Health Information Network LLC is making use of to grow to be a Qualified Health Information Network (QHIN) below the Trusted Exchange Framework and Common Agreement (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: Could you discuss somewhat bit about how the position that pharmacists play within the healthcare ecosystem is evolving?
Harvey: There are two main issues that we’re dealing with. One is the silver tsunami. Right 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 not less than one persistent situation and 60 p.c of individuals have two persistent situations. In addition, you’ve the burnout that clinicians are feeling due to the pandemic — nevertheless it’s not simply the pandemic. It’s all this administrative burden that we have placed on physicians, pharmacists and the complete care staff. It’s estimated that 20 p.c of physicians plan to retire within the subsequent two years. So you have received an getting old inhabitants, and you have an estimated scarcity of about 135,000 main care physicians by 2034.
We’re not changing them quickly sufficient. So that actually forces us to have a look at the care staff construction — how they work collectively, and who can decide up a few of that slack. When you have a look at the care staff, pharmacists have the scope of coaching to choose up loads of that first degree of main care. They need to do 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 targeted on the menial duties that they need to be faraway from to allow them to give attention to extra of the first care-focused areas.
HCI: In many areas, the unbiased pharmacies have largely disappeared and the massive retail chains dominate. Can the pharmacists in these retail environments tackle this position? And are these chains serious about seeing their pharmacist tackle that position?
Harvey: Absolutely. I believe when you have a look at all the key chains, they’re already acknowledging the necessity for the pharmacist job to evolve, together with doing immunizations that we did such a terrific job of in the course of the pandemic. We need to grow to be persistent care managers, which suggests now we have to let pharmacists do this decrease degree of main 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 best medical info within the palms of the pharmacist or the doctor once 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.
Another leg of the stool is the reimbursement coverage. We need to amend reimbursement coverage each on the CMS degree and on the well being plan degree to pay pharmacists for this extra exercise. There’s received to be compensation for that or they cannot afford to do it.
The third piece is we’d like legislative modifications throughout the U.S. and within the states. During the pandemic, HHS gave pharmacists broader privileges they usually prolonged that via December of 2024. I believe we have to make these privileges go on from there. Because states are accountable for licensure and monitoring, loads of the states need to cross laws to acknowledge the scope of the pharmacists’ coaching and empower them to supply these capabilities. The research we have achieved 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 means to give attention to the issues which are on the prime of their their coaching.
HCI: Surescripts does surveys of pharmacists about their prime challenges, and a current 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’s not that troublesome in any respect. As a matter of truth, we do 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’s probably the most burdensome factor for the doctor’s workplace. It’s not solely administratively burdening for the doctor, nevertheless it additionally delays look after the affected person.
We have an digital prior authorization resolution that is proactive. So when the doctor is writing the prescription, our resolution goes out instantly quite than having to take two or three days to undergo a course of. In addition, with the Surescripts real-time prescription profit product, the doctor pulls up what treatment he desires to offer that affected person, and it reveals him therapeutic alternate options. It reveals him and the affected person what their profit covers. It reveals them what the prices might be at retail. Almost 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 modify it?’ You get that taken care of proper on the doctor’s workplace.
HCI: Surescripts just lately purchased an organization referred to as ActiveRadar. Can you clarify what was enticing about that firm?
Harvey: We checked out all the businesses on the market and we actually felt like ActiveRadar had the most effective therapeutic various resolution obtainable. All the well being plans and all PBMs need to have a therapeutic PMT committee that decides what medication are interchangeable. It’s a extremely costly proposition, significantly for smaller regional plans. Through their expertise, ActiveRadar type of does that work for for the plans and for the PBMs. That permits them to say, ‘Okay, I’ll simply use yours quite 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 nicely.
If you have a look at real-time prescription profit, ensuring the best therapeutic alternate options are offered as part of that resolution is vital as nicely.
HCI: Surescripts Health Information Network 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 12 months. Only about 2.35 billion of these are literally prescriptions. The relaxation is all of the medical information.
We are very assured that we will serve everybody throughout the spectrum of healthcare. And if you consider the Qualified Health Information, Networks in TEFCA, it actually does grow to be a community of networks, as you’ll, as a result of each goes to achieve success bringing in individuals who might be their prospects. We actually assume the staff at ONC has achieved a beautiful job. If you consider what is the significance of this, it comes again to the affected person’s means to ensure they’re getting the best therapy once they’re in entrance of a care supplier, as a result of with an incomplete medical file, they’re by no means positive that the best selections are being made.
HCI: In September, the corporate named Lynne Nowak, M.D., its first chief information 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: Well, a terrific instance is that ActiveRadar goes to be part of her group. We know the info has energy to make it possible for we’re targeted on the issues that might be bettering the standard of care, bettering affected person security and decreasing the price of care. When you’ve 22 billion transactions, there’s so many issues that may come out of that, taking a look at that info, making an attempt to determine these issues which are finest for the affected person. We imagine there is a important alternative for Lynne and our information scientists to essentially construct out the issues that can help these core elements of our mission.
HCI: Looking forward to 2024, are there some other plans you need to speak about?
Harvey: We’re targeted 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 happening strike, if you’ll, due to their working situations they usually’re not capable of give attention to the issues that they need to. So our goal is to look throughout all the issues we offer and proceed to good them. In the final 4 years, we have improved the standard of e-prescriptions by over 200 p.c. We are 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 love to see an finish of that fax machine and we imagine loads of our applied sciences might be useful in that finish.
HCI: Are there some ways in which all this pleasure and improvement round synthetic intelligence and enormous language fashions can apply to the work you guys do?
Harvey: People generally combine up machine studying and generative AI. We’ve 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 assume there are some issues we will put it to use for. However, I’ll say we’re being actually cautious as a result of there are nonetheless loads of unknowns about generative AI and it has hallucinations. When you are coping with the affected person’s file, you may’t have hallucinations. So we’re taking a look at it, we’re testing it, doing loads of pilot issues round it, however till we’re completely positive that it is what it must be, we’re not going to roll it out into our total portfolio.