Prescription affordability and price transparency tools in EHRs Podcast - September 9, 2020 Patient Engagement Population Health Health Information Technology Sign in to save MGMA Staff Members MGMA · Prescription Affordability and Price Transparency in EHRs The issue of price transparency as a readily available tool to physicians as part of their EHR platform has become more widespread as technology has changed. But getting frontline physicians to use those tools – and to have those crucial conversations with their patients – is still a work in progress. MGMA partnered with Surescripts for a recent thought leadership panel discussion to examine the overall benefits of including price transparency as a fundamental part of every patient interaction, and the substantial increases in patient satisfaction that can result. The panel, moderated by Daniel Williams, senior editor at MGMA, included: Andrew Mellin, MD, MBA, chief medical information officer at Surescripts Jeffrey Hyman, M.D., chief medical officer, eMDs Jill Helm, Pharm.D, vice-president, solutions management, Veradigm Health Jason Wilson, MBA, BSN, RN, senior director clinical advisory consulting services, Greenway Health This interview has been edited and condensed. How do you define medication price transparency, and how does that fit into the national conversation about healthcare cost? Andrew Mellin: Medication price transparency is really making sure both the physician and the patient are fully aware of their costs associated with that medication. It's so important now because medication costs have obviously been increasing. Secondly, benefit plans have become more complex. And third, people care deeply about these costs. We surveyed about 1,000 individuals and 28% of millennials said they would be willing to find a new doctor based on whether or not that physician was able to have a medication cost conversation with them. Jeffrey Hyman: I find that having that price conversation is more important with my Medicare patients than my younger patients. Before price transparency, I never had a conversation about price, and I really never followed up on adherence to medications – I never thought it was my job to. But I kept realizing that some of my diabetic patients, especially during COVID-19, are choosing between medication or rent or food. Jill Helm: Price transparency also includes actionable insights, ways to provide low-cost alternative medications or cost-alternative delivery channels for patients. It helps bring the patient into the conversation. And it also empowers patients to make choices. Jason Wilson: As a nurse and a patient advocate, (it’s critical) having the technology at the time and place of care to really demonstrate the cost of a medication, copays or patient responsibilities and those out-of-pocket expenses. It doesn’t all have to fall on the shoulders of the prescribing provider; it really is the healthcare team. How can price transparency tools help providers, their staff and their practice overall? Wilson: Why do patients go to the doctor? To have a diagnosis and symptom management. What’s the primary route of symptom management? It’s really the medication regimen. So if we don’t have those types of conversations occurring amongst our nurses or medical assistants performing medication triage before the provider sees those patients, and if we don’t have conversations with pharmacists as a follow-up about adherence and interactions … price transparency is (a way for) providers to re-establish a relationship outside of transactional measures. Helm: (We found that) 91% of our providers feel that not having financial information at the point of care is a barrier to them prescribing some medications, particularly more costly specialty therapies and biopharmaceutics. This is a time saver for those physician practices by getting it right the first time and eliminating that call from the pharmacy when the patient simply can’t afford their medication. We’re seeing that as improving provider workflow. Hyman: Most patients are attached to their local pharmacies, for whatever reason. They know the people behind the counter and they feel comfortable going there. So my conversation always starts with, “if you want me to send this to your mom and pop pharmacy, I respect that. Thirty days is gonna cost you $25. But if I send a 90-day supply with Surescripts, it will cost you $10.” And that’s the great startup conversation – they’ll say “yes, send it to my 90-day clearinghouse.” Mellin: It’s also other related information about the medication, such as prior authorization. We know that takes time and it’s a burden. At the same time, there may be alternatives that don’t need prior authorization, or maybe there’s something they can change around the supply or number of pills to eliminate the need for prior authorization. In the past, that information was invisible. What we’re seeing with these price transparency tools is the ability to have this information and change to a therapeutically equivalent regimen, and completely avoid the prior authorization altogether. How should leaders communicate the value of having that medical cost conversation with their providers? Helm: For many of our practices, rather than adding this as yet another thing on the list to do during a patient encounter, it’s really best to involve a larger group within the practice. More healthcare professionals such as the nurses and the MAs are speaking to the patient during intake, or perhaps providing information to the patient as they’re leaving and scheduling their next appointment. The more people in the practice that can be involved in the price conversation, the more seamless it is for the patients, and less of a perceived burden it is on the providers. Wilson: From a patient perspective, patients want to have that conversation, but they’re fearful in bringing it up. There are some great techniques to start the conversation. From a value perspective, when we think about the administrative burden that gets tacked on the patient visit, it’s important to realize that patient satisfaction about the quality of care will improve as a result of having that conversation. You can’t have anybody more engaged in their care than when you think about what their fears and concerns are and what barriers might be to adherence to a treatment plan. Mellin: I’ve been involved in health IT for 20 years now, and adoption and change is really difficult. A number of doctors have said this is one of the best clinical decision support tools they’ve ever had in their EHR. But there’s still a large number of physicians who aren’t eager to do something else in the exam room – because they’re not aware the capability exists, they’re worried it’s going to take more time, or they don’t feel like it’s their responsibility. What’s really important as a practice leader is making sure they understand the value of this. I think the biggest thing is don’t expect to just flip the switch and have 100% adoption. To really see the value and benefit, it should be a systemic effort. It would seem like having these conversations would benefit the provider. What are the do’s and don’ts of having them with patients? Hyman: Do not push this on the patient. Don’t make the visit about cost, because then it changes the whole tone of the relationship between patient and doctor. If there’s any pushback, I tell my docs to stop. The conversation is always very low-key and non-pressured. “Do you want to talk about price? I could offer you a less expensive alternative.” You want to bring it calmly into the conversation so the choice really becomes theirs to continue. Mellin: One is, don’t assume by your patient that they do or don’t have a cost problem. They may have had a job change or other struggles. Don’t assume by the way they dress, how they carry themselves, or even past history. That leads to a ‘do’ of just having a consistent way to ask, every time. The other ‘do’ is to figure out a way that works with your EHR and your style, to engage a patient. Some physicians I know will bring the patient right up to the EHR screen and show them the information, and have a shared decision-making conversation. If that works with your physician’s way of doing things, that’s fantastic. Wilson: You have to make sure you are having a systematic approach to this conversation, because you don’t want to make any one particular patient feel like they’re being centered out, they’re marginal or subpar, because they might feel that you’re judging them. Often, we don’t take advantage of enabled technology at the time and place of care because of concerns about distraction from care. But I think if you can show them on the screen that they can see the alternatives, you can see what their out-of-pocket expense is, and that you’re trying to take that extra step in making sure that they’ll adhere to the treatment plan, it shows that you care about them. Helm: As a pharmacist for 30 years, I’ve seen the price of medications jump dramatically. And I think we should assume there’s pricing pressure across all of our patient population. We routinely see $50, $75, $100 or more for a single medication for a 30-day supply. That starts to get into some serious dollars and cost burden for patients. When I go in and see some of our clinics, I notice that they have sticky notes on their computers so they know which retailers have zero-cost generic antibiotics or $10 30-day supplies for diabetes medication. This technology takes those notes and actually puts them into the provider workflow and that patient-specific, therapy-specific prescribing space. Do you have a specific success story about price transparency in action? Helm: Many of our providers ask if the price transparency information in the EHR is really the same info that the pharmacist gets, and is it really what the patient will pay? One of our providers had a patient who had two different insurances and got the prescription under one insurance, with the price transparency information. When they went to the pharmacy, the price was different, because they used a different insurance that would have cost the patient more. Now the patient knows to process it under their other insurance, because they know they’ll pay less. Mellin: A medical school classmate of mine contacted me and said she started using the new feature that allowed her some insights into the cost of meds for her patients before prescribing. She said, “it totally helps. I’ve been meaning to email you and express my appreciation.” I’ve heard variations of that again and again, about how this helps make physician decision-making better and provide a better outcome for their patients. Hyman: The possibility of sending a prescription to a clearinghouse versus local pharmacies happens about 10 times a day for me, and that’s important. Generic versus brand comes up all the time, especially Synthroid, or hypertensive medicines all the time. I got used to seeing Avapro and Benicar – I keep writing those into my prescription writer, and it comes up with a brand name. And I keep seeing the price differential go from $125 to $5 for Losartan. The key here is to get them to use it. Wilson: With so much of the insurance industry moving to high-cost deductible plans, this level of information is so important. I used to carry a Palm Pilot and look at national averages for pricing and turn to my ER physicians and say, “I looked at this patient, she doesn’t have any insurance for this antibiotic for her child, is there another alternative that will work for her? And sometimes we found a therapeutic substitution, or even sample medications. It was all about trying to help the child that needed that antibiotic. What is it going to take for price transparency to become a regular part of every practice? Mellin: Over 88% of US prescribers today are served by an EHR that has this feature, or will have it soon. Understand that this is a win, not just for the patient, but for the practice and the physician. So figure out ways to have that maybe one-minute conversation with that super-busy physician who may not realize that this exists in their EHR and get them over the edge. Wilson: Have an open discussion with all of your staff in the office, and encourage them to share their wins about how they’ve made a difference with this type of change. I think we’re in this business because we’ve got a servant heart. It’s those kinds of stories that really drive the success. Helm: I’m encouraged by the willingness of health plans and pharmacy benefit managers to share this information, so we’re seeing price transparency available to almost all of our patients seen by physicians using our EHR. We’re continuing to see that information get increasingly richer into 90-day pricing and therapeutic alternatives. In a survey with our providers, we found that 85% of the felt that adding price transparency information at the point of care increased patient satisfaction with the practice. And who doesn’t want happier patients leaving their office? Additional resources: Thanks again to SureScripts for helping make this episode possible and for their part in designing the content for today’s panel discussion. As discussed in this episode, a one-minute conversation about medication costs can have an enormous impact on patients, and they will leave for the pharmacy confident they can afford and start their medication. Also, it allows practices to avoid the hassle and interruptions from script rework. To have those crucial patient conversations, try these five medication cost “conversation starters”. In addition, you can find out if price transparency is available in your EHR.