Frank Harvey, CEO of Surescripts, just lately spoke with Healthcare Innovation a few 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 out to be a Certified Well being Info Community (QHIN) underneath 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 non-public fairness investing in healthcare expertise firms.
Healthcare Innovation: May you speak slightly 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. Proper now we have now 58 million individuals aged 65 and older. By 2030, it is estimated that we’ll have 70 million individuals. By age 65, 80 p.c of individuals have no less than one continual situation and 60 p.c of individuals have two continual circumstances. As well as, you will have the burnout that clinicians are feeling due to the pandemic — however it’s not simply the pandemic. It is all this administrative burden that we have placed on physicians, pharmacists and your complete care staff. It is estimated that 20 p.c of physicians plan to retire within the subsequent two years. So you have bought 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 take a look at the care staff construction — how they work collectively, and who can choose up a few of that slack. While you take a look at the care staff, pharmacists have the scope of coaching to choose up loads of that first stage of major care. They wish to try this and it’ll assist with a number of the pharmacist burnout we have seen, too. Pharmacists are burning out identical to physicians as a result of they’re targeted on the menial duties that they need to be faraway from to allow them to concentrate on extra of the first care-focused areas.
HCI: In lots of areas, the unbiased pharmacies have largely disappeared and the big retail chains dominate. Can the pharmacists in these retail environments tackle this position? And are these chains keen on seeing their pharmacist tackle that position?
Harvey: Completely. I believe in case you take 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 throughout the pandemic. We have now to turn out to be continual care managers, which implies we have now 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 precise medical info within the fingers of the pharmacist or the doctor once they’re making these care selections. A pharmacist or a doctor does 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 have now 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 bought 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. In the course of 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. As a result of states are liable for licensure and monitoring, loads of the states need to go laws to acknowledge the scope of the pharmacists’ coaching and empower them to supply these capabilities. The research we have finished 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 concentrate on the issues which might be on the prime of their their coaching.
HCI: Surescripts does surveys of pharmacists about their prime challenges, and a latest report mentioned they spoke concerning the want for digital entry to medical info, profit eligibility info, and digital prior authorization. How troublesome is it to collect 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 reality, we try this proper now via their pharmacy working techniques. I believe one in all your articles within the final day or so was about some statistics concerning the burden of prior authorization. It is some of the burdensome factor for the doctor’s workplace. It isn’t solely administratively burdening for the doctor, however it additionally delays look after the affected person.
We have now an digital prior authorization answer that is proactive. So when the doctor is writing the prescription, our answer goes out instantly moderately 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 medicine 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 shall be at retail. Virtually 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. Are you able to clarify what was engaging about that firm?
Harvey: We checked out all the businesses on the market and we actually felt like ActiveRadar had the perfect therapeutic various answer obtainable. All of the well being plans and all PBMs need to have a therapeutic PMT committee that decides what medication are interchangeable. It’s a very costly proposition, notably for smaller regional plans. By means of their expertise, ActiveRadar kind of does that work for for the plans and for the PBMs. That enables them to say, ‘Okay, I will simply use yours moderately than having to make use of all these further people to do it.’ It creates extra consistency throughout all of the completely different plans as nicely.
Should you take a look at real-time prescription profit, ensuring the precise therapeutic options are introduced as part of that answer is essential as nicely.
HCI: Surescripts Well being Info Community simply introduced it is making use of to be a QHIN underneath the TEFCA framework. Who can be logical companions to be sub-participants underneath 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 remainder is all of the medical information.
We’re very assured that we are able to serve everybody throughout the spectrum of healthcare. And if you concentrate on the Certified Well being Info, Networks in TEFCA, it actually does turn out to be a community of networks, as you’ll, as a result of every one goes to achieve success bringing in individuals who shall be their clients. We actually suppose the staff at ONC has finished a beautiful job. If you concentrate on what is the significance of this, it comes again to the affected person’s means to verify they’re getting the precise remedy once they’re in entrance of a care supplier, as a result of with an incomplete medical report, they’re by no means certain that the precise 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 number 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 be sure that we’re targeted on the issues that could possibly be bettering the standard of care, bettering affected person security and reducing the price of care. When you will have 22 billion transactions, there’s so many issues that may come out of that, taking a look at that info, attempting to determine these issues which might be finest for the affected person. We consider there is a vital alternative for Lynne and our information scientists to actually construct out the issues that may help these core elements of our mission.
HCI: Waiting for 2024, are there some other plans you wish to speak about?
Harvey: We’re targeted on attempting to take the executive burden away from the care suppliers as a result of we actually do see it as a disaster while you see the pharmacists taking turns occurring strike, if you’ll, due to their working circumstances they usually’re not capable of concentrate on the issues that they wish to. So our goal is to look throughout the entire 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 love to see an finish of that fax machine and we consider loads of our applied sciences shall 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: Individuals typically combine up machine studying and generative AI. We have been utilizing machine studying because the very starting inside our merchandise. We’re beginning to take a look at generative AI. We do suppose there are some issues we are able to put it to use for. Nevertheless, I will say we’re being actually cautious as a result of there are nonetheless loads of unknowns about generative AI and it has hallucinations. While you’re coping with the affected person’s report, you’ll be able to’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 certain that it is what it must be, we’re not going to roll it out into our total portfolio.
