Past Educational Programs
November 2006 - The Medicare Modernization Act: Lessons from the Trenches; Opportunities for the FutureAugust 2006 - The Big Picture: The Growing Role of NCPDP Standards in Achieving HIT Interoperability
November 2005 - Innovation and the Prescription Drug Benefit
August 2005 - Countdown to MMA: New & Unfinished Business
November 2004 - Medicare Modernization Act and Its Impact on the Industry
August 2004 - e-Precribing: The Wave of the Future
November 2006 - The Medicare Modernization Act: Lessons from the Trenches; Opportunities for the Future |
On November 14, 2006 in Addison, TX, industry representatives met to discuss The Medicare Modernization Act: Lessons from the Trenches; Opportunities for the Future. Medicare Part D is now a reality and some of the early lessons from implementing balloted and emerging standards for electronic prescribing, formulary and benefits, medication history, prior authorization, and patient impact are starting to show early results. What are we learning as we move from theory to practice? What were the successes and where are improvements needed?
John Hill, Director, Strategic Operations, Argus Health Systems, Inc., an NCPDP Educational Committee member, welcomed the attendees. Joel Brill, MD, FACG, CMO, Predictive Health, LLC, served as moderator for the program. He opened the program by discussing the initiatives and hot topics of the healthcare landscape, wondering if these will be forerunners of health policy.
Tracey McCutcheon, Deputy Director of the Medicare Drug Benefit Group at the Centers for Medicare and Medicaid Services (CMS), and Jeffrey Grant, Director, Division of Payment Centers, Centers for Medicare and Medicaid Services started out the program with "Lessons Learned and the Future of MMA". They provided attendees with lessons learned during the first year of the Medicare Prescription Drug Program. Coordination of Benefits was one of the challenges. They presented an overview of what to prepare for in 2007 and the existing processes and the challenges for the future. They also discussed information on the deadline for submissions and understanding of payment and costs between benefit years, payment reconciliation processes and direct and indirect remuneration (DIR), information on changes in subsidy status, and enhancements to the Eligibility (E1) transaction.
Paul Precht, Medicare Rights Center (MRC) Policy Coordinator and Director discussed "Access Problems under Part D", which included handling problems with enrollment and the dispute process. He suggested improvements in the ability for plans to effectively communicate formularies to patients. He offered potential solutions of information sharing, information being available for and to the pharmacy and to the patient.
In the session "Part D Lessons and Challenges Faced by the Industry", panelists from various sectors of the industry discussed the lessons learned as it relates to Part D. They discussed how they have approached Part B, challenges with messaging, prescription and eligibility, that affect pharmacists; retail, chain, independent and long term care pharmacies. Charlie Oltman, MBA, National Managed Care Administrator for Target Stores discussed how the Eligibility transaction, the use of the NCPDP Pharmacy ID Card, and CMS participation in problem solving were of great benefit to the industry. He cited opportunities of more differentiation of when to bill a drug for Part B versus Part D, and of standardizing coordination of benefits. He also noted that mitigating the need for pharmacies to reverse and rebill claims would be an important improvement, as would responding with accurate copays and deductibles, enhanced eligibility information, and improving the reject messages. Gary Schoettmer, R.Ph., President and CEO of RNA Health Information Systems discussed information he had obtained from people in the long term care industry. Seventy percent of the Medicare Part D population in long term care settings is dual eligible. Challenges include incorrect copays, the one calendar month delay for zero copay, insufficient information in eligibility responses, nursing home claims not always paid at long term care rates, and the impact of formulary changes, prior authorization variations, and emergency fill process variations. Mike Staudenmaier, Pharm. D., Argus Health Systems discussed the challenges of Medicare Part B in a Medicare Part D world. He noted that multiple management options were used as entities tried to interpret and understand the differences. Stacey Swartz, Director, Management & Educational Affairs for the National Community Pharmacists Association discussed the impact to independent pharmacies with challenges of the start up of Medicare Part D, cash flow problems, copay and benefit program misinformation. She noted ongoing challenges in medication therapy management impact to pharmacies, dual eligibility transaction in 2007, and late enrollments. Michele Vilaret, R.Ph., National Association of Chain Drug Stores cited the challenges and issues of the first months, but the impressive effort of CMS and the industry to work through issues. All presenters suggested areas where improvements could occur in 2007, to lessen the impact of the second year changes.
"e-Prescribing Pilot Programs: The Challenges and Outcomes" This panel discussed the e-Prescribing pilot programs released this year the work to be accomplished in less than one year. They discussed how RxNorm terminology impacted the translation to NDC for clinical drug terminology. Michael Bordelon, EVP of Long Term Care Product Development at Talyst, Inc. discussed the pilot for the long term care settings, with its nuances of information flow between the prescriber, the facility, and the pharmacy. He discussed the goals of the pilot for patient safety, savings of time and sharing of information for the pharmacy and the facility, and he shared early findings. Tony Schueth, MS, founder, CEO and managing partner of Point-of-Care Partners, LLC noted that the findings from the pilots will be outstanding due to the larger sample sizes. He discussed the conceptual model of the pilot they are participating in, and the surveys to their participants. Kenneth Whittemore, Jr., R.Ph., MBA, President of Professional and Regulatory Affairs for SureScripts discussed their participation in multiple pilots and the evaluation of how the standards work in different business cases. He discussed their baseline data collection. Also of note were the different areas where the different pilot organizations collaborated on deliverables of the pilot. Teri Byrne, tByrne Associates reported on the pilots that RxHub, LLC is participating in. She noted the challenges with testing the prior authorization processes, and creative solutions that were used to help facilitate the testing without the major systems overhaul the prior authorization process could impact. She discussed some of the initial findings.
"Payers Panel Discussion" shared the lessons learned and the challenges in implementing PDE, the impact in managing P2P Reconciliation, LICS Retro Adjustments and S2P Reconciliation. They shared their best practices for educating staff (sales and customer service) members, and the pharmacy community in understanding Part D. Panelists also provided lessons in how to determine how to file as an MAPD for PDP Program. Scott G. Hughes, R.Ph. Corporate Vice President of MemberHealth, Inc. reviewed the basic enrollment process. He discussed how education and outreach to staff and providers was very important. He noted the impact to the call centers, as well as the creation of a compliance team for Part D. He offered suggestions on outstanding enrollment, benefit level, and PDP operations issues. John Jones, R.Ph., J.D., Vice President of Government Affairs and Pharmacy Policy at Prescription Solutions discussed lessons learned with incorrect eligibility information. He noted it was important to participate in regional meetings to discuss issues with the industry, and the value of having experienced plan benefit resources to understanding the nuances of Medicare Part D. Betsy Warren, Pharm D., Director, Medicare Program for Humana, Inc spoke on the challenges, but also the amount of outreach of Humana. She discussed the medication therapy management outreach, and how important it is to provide information to consumers. Terri Swanson, Vice President of CIGNA Senior Care discussed the plan to plan reconciliation challenges and offered suggestions for improvements in the future.
Thank you to all the presenters of the Educational Summit. Thank you to the sponsors. If you would like to be part of the team creating educational opportunities by joining the Educational Committee, please contact Katelyn Koch.
August 2006 - The Big Picture: The Growing Role of NCPDP Standards in Achieving HIT Interoperability |
On August 15, 2006 in Salt Lake City, UT, industry representatives met to discuss "The Big Picture: The Growing Role of NCPDP Standards in Achieving HIT Interoperability". A number of seminal events - the passage of the Medicare Modernization Act of 2003, the appointment of Dr. David Brailer as the first National Coordinator for Health Information Technology in 2004, and the creation of the American Health Information Community to name a few - have conspired to create an intense focus on HIT interoperability and the standards harmonization required to make this vision a reality. This NCPDP Educational Summit explored the role of NCPDP standards in the transformation of healthcare - both now and in the years ahead and how NCPDP will relate to other standards and interface with other systems and stakeholders. Laura Topor, PricewaterhouseCoopers, a member of the NCPDP Educational Committee, welcomed the attendees. Bruce Henderson, PricewaterhouseCoopers, served as moderator for the program. He opened the program by noting that the industry is primed for change; the technical tools are ready, the standards are moving forward. Reed Liggin Per-Se Technologies discussed "A Look Back and a Look Ahead". The presentation noted the history of some of the NCPDP standards and how the technology vendors have contributed to the creation of standards. He discussed the concept of pharmacy as a healthcare destination, with a vision of a connected healthcare community. Bob Beckley, SureScripts and Teri Byrne RxHub, LLC discussed "How NCPDP Standards have Impacted Healthcare Information Technology (HIT)" with an overview of the current standards and how they were created, brought forward from the industry, vetted, and approved. It was noted that in the early days the transaction focus was mostly financial; electronic prescribing was a different focus. They provided information about Medication History transactions and the Formulary and Benefit Standard in use, as well as information about the CMA/AHRQ electronic prescribing pilots.
"The Medicare Modernization Act Electronic Prescription Standards Pilots" was discussed by Jon White, M.D., AHRQ. He provided an overview of the requirements of the pilots, discussed the different pilots underway, and commended the industry for the collaboration of meeting the needs of the industry and the providing valuable pilot studies. He also noted the milestones when the pilots complete at the end of 2006, the report to Congress, and the possible steps of the Secretary of Health and Human Services. Carla Saxton McSpadden, R.Ph., CPG, American Society of Consultant Pharmacists and Shelly Spiro, R. Ph R. Spiro Consulting informed attendees on "Long Term Care Health Information Technology Industry Actions and Strategies on e-Prescribing and Medication Safety". They noted the differences in the long-term care settings and information about the LTC HIT Summit in 2005 which set the roadmap and in 2006 which began discussing the business cases and funding, improving quality, chronic care and wellness management, and a discussion of the electronic prescribing pilots. They provided a video of possible new ways of looking at care in the future.
Mark Leavitt, M.D., Ph.D., Certification Commission for Healthcare Information Technology (CCHIT) spoke on "EHR Product Certification: A Catalyst to Accelerate HIT Adoption". He provided an introduction to the work of CCHIT, the 2006 criteria for ambulatory EHRs, the 2006 certification program underway. Next steps in 2007 include certification requirements for inpatient EHR, with network certification requirements next in line. "How Can Data Standards Affect Clinical Quality" was the topic of H. Eric Cannon, PharmD, SelectHealth/Intermountain Healthcare. He discussed how data can be used to drive clinical outcomes, and provided an informative session on the IOM Preventing Medications Errors report.
PHR/EHR Panel Discussion of "HIT Interoperability: What Matters to Pharmacists and Other Healthcare Professionals" was moderated by Bruce Henderson, PricewaterhouseCoopers. Nancy Davenport-Ennis, National Patient Advocate Foundation, discussed the foundation, a patient centric environment, and the AHIC "The Community" and the Consumer Empowerment Working Group. Sumit Nagpal, Wellogic discussed two large-scale interoperability systems with different perspective and goals, and how they both experienced convergence needs. Ob Soonthornsima, BCBS LA, discussed "It's Time to Get Out of the Sandbox" and collaborate. He discussed how HIT is necessary part of LA recovery from Hurricane Katrina. He discussed the Claims-based Health Record (CHR). Steve Waldren, MD, MS, Center for Health Information Technology, AAFP discussed how important it is for systems to provide value to doctors. AAFP is strategically looking at the family practice environment of the future and how information available to the patient and the doctor may assist in the future with choosing the best health plan (as in Medicare Part D) based on the patient's formulary, medication history, and other information. Susan Winckler, R.Ph., Esq., APhA, provided a perspective of the pharmacist practitioner looking for accessible information timely, accurate information, protected information, and how information must come from more sources than claims and provider interventions. She noted the industry should be vigilant about unintended consequences, and needed training for providers about the limitations of the information available. A question and answer session followed.
Thank you to all the presenters of the Educational Summit. Thank you to the sponsors. If you would like to be part of the team creating educational opportunities by joining the Educational Committee, please contact Katelyn Koch.
November 2005 - Innovation and the Prescription Drug Benefit |
The final NCPDP Educational Summit of 2005 "Innovation and the Prescription Drug Benefit" was held November 8, 2005 in Long Beach, CA. The summit focused on industry stakeholders who are developing innovative new services and benefits to improve patient safety and the quality of healthcare, as well as manage overall healthcare costs. Ross Martin, MD, Pfizer, Educational Committee Chair, welcomed the attendees. Lynette Haiflich, Reden & Anders, Ltd, served as moderator for the program.
Mark Knutson, PacifiCare Health Systems, opened the program with Pay for Performance in the Call Center in which he outlined the steps that are needed to create and integrate a quality based incentive plan, sharing practical experience. Knutson walked though the steps to create an effective incentive plan beginning with analyzing the company culture, the development of an objective measurement, determining funding sources, selling the plan internally, and driving/controlling change management. He explained moving from a control culture to an achievement culture, the successes achieved, the lessons learned, the valuable information continuing.
David Schulke, The American Health Quality Association, spoke on "Quality Measurement and Improvement in the New Medicare Prescription Drug Benefit". The new Medicare prescription drug benefit goes into effect January 1, 2006. In the Medicare Modernization Act, Congress created quality measurement and improvement mechanisms for the new benefit, including requirements for measurement and public reporting of drug plan performance, medication therapy management (MTM) programs, and a national drug therapy improvement initiative to be run by Quality Improvement Organizations (QIOs) with funding from CMS. As a result, measuring and improving the quality of drug therapy for patients is now a critical challenge for the Centers for Medicare and Medicaid Services, drug plans, physicians and pharmacists. He discussed how quality should be measured under the new Medicare prescription drug benefit, the potential for providing incentives to MA/PDP and PDPs to reward high-quality performance by Medicare drug plans, and the optimal approach for QIOs to adopt in assisting plans with measuring and improving drug therapy. He discussed the opportunities for QIO projects available to the industry in eprescribing, MTM, disease specific therapy with integrated Medicare Parts A, B, and D data.
Bill Braithwaite, eHealth Initiative presented "Health Information Exchange: The Big Picture" which described the logical framework that relates the goal of high quality, cost-effective healthcare to the underlying need to exchange information about medical knowledge, patient conditions, and incentives. Standards are necessary but not sufficient. Computable interoperability is required, but this concept is complex and poorly understood. Braithwaite discussed the components of a complete interoperability profile. He also discussed the national agenda from the President, the Congress, and HHS since its culmination in a series of contracts is being let by HHS to resolve some of the issues that are barriers to true interoperability in the form of an NHIN.
Richard Bruzek, HealthPartners, Inc., Pritpal Virdee, Express Scripts, Inc., Tony Schueth, Point-of-Care Partners, LLC, and Glenda Owens, PacifiCare Secure Horizons, participated in "Beyond Co-Pays and Formularies: The Role of PBMs and Payers in Improving Healthcare Outcomes" The panel discussion focused on PBMs, their services and capabilities. They discussed Medicare Part D and what is happening with PBMs as the deadline for implementation draws near. They reviewed how PBMs are handling the changes occurring in the marketplace for Medicare Part D. Virdee provided an MTM overview showing criteria, tiered cost sharing, the unknown of specialty tiers, utilization management, quality assurance, and electronic prescribing. Bruzek discussed the importance of MMA on safety improvements of DUR and electronic prescribing, and important considerations of the use of Coordination of Benefits (COB), impacts to customer support, out of pocket limits, reprocessing of claims due to retroactive membership, the move of cash to benefit programs, and other impacts. Schueth discussed Medicare Part D and eprescribing. He discussed the eprescribing final rule and the pilots. He also noted to the attendees the Notice of Proposed Rule Making (NPRMs) for Physician Referral Prohibition (Stark Law) and Anti-Kickback Safe Harbor. There is possible future work on discretionary grants to physicians, pay for performance, eprescribing rules based on the pilots, and possible additional pilots. Owens focused on low income and resources subsidy of Medicare Part D - extra help that is available to patients that meet income and asset criteria. She discussed how coverage is calculated and the process if a beneficiary signs up in the middle of the month and the effect on retroactive membership.
Robert Fox, Zweber Pharmacy, NCPA, led a timely discussion of "Lessons From Katrina". Hurricanes Katrina and Rita displaced and changed the lives of hundreds of thousands of peopleincluding community pharmacy owners. For those pharmacies that were decimated by the hurricanes issues of taking care of their patients, salvaging or destroying affected stock, and rebuilding were just some of the issues they face. Pharmacy owners not directly affected by the storms began receiving hundreds of hurricane evacuees who came to their pharmacy with no prescription records. Fox discussed the efforts of industry participants in the creation of the website katrinahealth.org, which provides medication history information.
Gordon Norman, Alere ® Medical, Inc., DMAA, spoke on "Drugs & DM: Have We Come Full Circle Yet?" Drugs and Disease Management have been intimately related since the emergence of DM in the early 1990s. While the industry has undergone impressive growth and significant evolution since that time, pharmaceuticals remain an important component of best-of-breed DM programs. He discussed the industrys evolution of DM and population health management. He led the attendees through some best practices from a leading DM services provider and a large regional health plan, and discussed the current role of prescriptions, pharmacy data, and pharmacy benefits.
Thank you to all the presenters of the Educational Summit. Thank you to the sponsors. If you would like to be part of the team creating educational opportunities by joining the Educational Committee, please contact Katelyn Koch
kkoch@ncpdp.org.
August 2005 - Countdown to MMA: New & Unfinished Business |
August 16, 2005, Philadelphia, PA was the place for the NCPDP Educational Summit "Countdown to MMA: New & Unfinished Business".
The summit focused on the Medicare Modernization Act (MMA) and the impact to the industry. What should the pharmacy industry be prepared for in Medicare Part D transaction processing? What is coming for e-Prescribing under the MMA? What standards are involved and what is NCPDP's role? What's new for HIPAA? How will we handle new versions of named transactions under HIPAA? How about new standards?
Ross Martin, MD, MHA, of Pfizer and the NCPDP Educational Committee Chair, welcomed the attendees. Bruce Grant, Medical Broadcasting Company served as moderator for the program. Bruce put the program in historical perspective by discussing the introduction of national healthcare - the Medicare program and what it originally covered (no coverage of drugs). Then came the later explosion of medications and healthcare coverage has changed dramatically. The next big impact has and will continue to be, electronic healthcare.
Tony Trenkle, Office of E-Health Standards and Services (OESS) provided an overview to "CMS eHealth Activities". He discussed the "Medicare Prescription Drug, Improvement & Modernization Act of 2003, why the expansion of CMS' Office of HIPAA Standards to the new Office of eHealth Standards and Services, the Agency's eHealth priorities and key initiatives, including e-Prescribing under the MMA and provided updates on HIPAA activities and compliance deadlines. Trenkle said that CMS is 20% of the US budget and 45% of the nation's healthcare spending. It covers 83 million beneficiaries. Efforts within CMS are on HIPAA, the Consolidated Health Informatics (CHI), electronic prescribing, and Medicare Part D. Priorities include the support of ONCHIT, to promote healthcare quality improvement, increase efficiency of operations, meet stakeholder expectations, and leverage partnerships with key public and private entities. Their key initiatives include a Medicare beneficiary web portal, the support of personal health records, electronic prescribing, provider awareness to CMS via the Internet, NPPES, claims attachments, and to be an early adopter of CHI.
Rita Gangi of Fox Systems provided insight to "Medicare Part D and Dual Eligible Beneficiaries". She focused on the population of beneficiaries that are eligible for both Medicaid and Medicare, described the demographics, drug spend and other unique characteristics. She demonstrated the potential differences between the coverage the beneficiaries have today and what will happen with Part D in 2006 and discussed specific examples of what States are doing to anticipate and minimize issues. Gangi stated that 15% of the Medicare population is dual eligible (Medicaid and Medicare) and 1.5 million are institutionalized with more health needs than other Medicare beneficiaries. She discussed the enrollment steps for dual eligible and low-income beneficiaries. She also stressed that the population will have more choices than they are used to, will be exposed to premiums, plan design parameters, and formularies. Education is critical.
"Current Opportunities in Billing for Pharmacist Clinical Services" was presented by Daniel E. Buffington, PharmD, MBA of Clinical Pharmacology Services, Inc. He posed a question of whether Medicare Part D sponsors will pay for clinical services. He discussed the difference in the dispensing event and the service event and also the various roles of a pharmacist in clinical trials, consulting, local education, expert review and testimony, and patient care consultations. Buffington provided an introduction and orientation to the use of CPT codes for billing for pharmacist's clinical services. He addressed the role of CPT service codes in the MTMS in the MMA. He described the process of how new pharmacist's CPT codes were developed and methods for implementing them in various practice settings.
Jeanne Scott, of TheJeanneScottLetter, led a lively discussion "Let's Play Congress! You're All Congresscritters Up for Re-Election in 2006, How Will You Vote On the Issues Impacting Healthcare?" She asked participants to put themselves in Congress' shoes where perception and re-election plays a strong part in issues. She highlighted the impact of healthcare costs on U.S. jobs, of outsourcing healthcare to other counties. Jeanne also discussed misinformation on the MMA.
Dan Smith of ASTM International, Stacey Barber of EDS (representing X12), Scott Robertson of Kaiser Permanente (representing HL7), Anthony Schueth of Point-of-Care Partners LLC and Brenda Gleason of Informed Decisions, LLC, participated in a panel discussion led by moderator Jeanne Scott on "Standards and MMA: How the Two Can Work Together". After an introduction by each panelist, they discussed interoperability and MMA and how vendors are approaching MMA. Barber discussed enhancements to the ASC X12 270/271 and the 278, both version 5010. Schueth discussed the industry work on the Prior Authorization Workflow-to-Transactions Task Group. He also discussed trends in standards development that interoperability use cases will drive standards development and that there is a likely increase in non-transaction standards. Gleason provided some food for thought with what the MMA might be trying to accomplish - perhaps more of a managed care model?
The attendees discussed the adoption of MMA, where there are gaps, how the pilots could be successful, and adoption versus utilization. They discussed adoption because of being paid versus for clinical information, the pay for performance model. It was proposed that the MMA is paying for structure (now), payment for utilization, and then paying for outcomes (future).
Ross Martin, of Pfizer, Inc., served as the moderator for "Where Do We Go From Here: MMA in the Larger Context of the HIT Landscape". Stanley Nachimson of the Office of E-Health Standards and Services, Alexandra Goss of the Washington Publiching Company (representing X12), Maria Ward of PricewaterhouseCoopers (representing HL7), and Margaret Weiker of EDS (representing NCPDP) discussed what's to come and where the industry goes from here. The panel discussed version control, AHIC and standards harmonization and how MMA fits into the bigger picture as part of DSMOs. The panelists shared lessons learned from HIPAA - that not all business cases are included in standards for different reasons, that new business functions evolve, that it is difficult to change business habits. The federal regulatory process is long and unwieldy and it has taken longer to develop regulations and implement the transactions and code sets than anticipated; that not all viewpoints are always heard, even with best intentions. The federal government is mandating standards for itself; it is hoped this evolves to the industry. The panelists discussed versioning of standards and some of efforts that have been proposed and how HIPAA is very specific and is unique in this regard. MMA is not as specific, but is impacted by HIPAA because some of the same standards are named. MMA only affects Medicare. It was noted that going forward, ROI from the industry is needed when requesting new versions. There was discussion of collaboration efforts between standards organizations.
Thank you to all the presenters of the Educational Summit. Thank you to the sponsors.
If you would like to be part of the team creating educational opportunities by joining the Educational Committee, please contact Katelyn Koch at kkoch@ncpdp.org.
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November 2004 - Medicare Modernization Act and Its Impact on the Industry |
The National Council for Prescription Drug Programs, Inc. (NCPDP) presented its 3rd Annual Drug Benefit Educational Forum with a program titled, "Medicare Modernization Act and Its Impact on the Industry," at the Hyatt Regency Atlanta on November 16, 2004.
The Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003 was created to provide seniors and people living with disabilities with a prescription drug benefit, more choices and better benefits under Medicare. Topics for the forum covered managing the benefit at the physician's office, Health Savings Accounts, e-Prescribing and the National Provider Identifier (NPI).
Sharad Mansukani, M.D., M.B.A, Senior Advisor and Medical Officer for the Centers for Medicare and Medicaid Services provided a comprehensive presentation on the historical timeline and subsequent development of the initiative from a government perspective. Richard Brook, Vice President, Pharmacy Services for ProxyMed, presented a walk through of the NCVHS recommendation letter to HHS regarding the standards to enable electronic prescribing in ambulatory care. Each recommendation was discussed with emphasis on where e-Prescribing is today and what it will take to reach industry wide compliance with the recommendation.
Patricia Peyton of the Office of HIPAA Standards CMS/HHS provided an educational overview of the NPI, requirements of the NPI Final Rule and what steps covered entities should take in order to implement the NPI. Walter Suarez, President and CEO SGA, Midwest Center for HIPAA Education, presented a segment focused on the NPI specifically in reference to the Pharmacy Industry and associated practical implementation issues. David Schulke, Executive Vice President of the American Health Quality Association, introduced attendees to the current role of QIOs (Medicare Quality Improvement Organizations) under Medicare and explored how QIOs and pharmacy benefit managers, pharmacies and prescribers can best work together to assist in quality improvement for the Medicare beneficiary.
A panel discussion was presented by the following speakers: John R. Hickman, Attorney at Law, Aston Bird, LLP on HSA's Shift Consumer Driven Healthcare; Len Greer, Vice President, Medco Health Solutions on Expanding the Consumer Choice Market: The Pharmacy Benefit; and Elizabeth Hanson, Eastern Region Account Executive for the UnitedHealth Allies business unit of the Uniprise Consumer Solutions Group, HSA's and Their Impact on Pharmacy Cost.
The pharmacy benefit represents significant opportunity to engage consumers as part of the healthcare cost solution and this forum, which discussed how PBMs are embracing consumer driven healthcare and integrating the pharmacy benefit into the consumer driven healthcare model was among NCPDP's most attended thus far.
August 2004 - e-Precribing: The Wave of the Future |
An impressive line-up of speakers combined with a hot topic resultedin record-breaking attendance at the August NCPDP Educational Forum, "e-Prescribing: The Wave of the Future".
The program began as the Chair of the Educational Programs Committee, Catherine Graeff, R.Ph., MBA of FourThought Group, Inc. welcomed the attendees and introduced the program moderator, Ross Martin, MD, Mha, who is a Senior Manager of Business Technology at Pfizer, Inc. Martin described how the general public perceives the current prescription process as a simple transaction between the physician, patient and pharmacists. Obviously, the process is much more complex than that simplified perception, particularly when prior authorization and refills are added to the sequence.
"Mapping the Future of e-Prescribing Through Standards" was the title of the next presentation. Two prestigious speakers delivered the presentation, Helga Rippen, MD, PhD, MPH, Senior Advisor, Health Information Technology, Department of Health and Human Services (HHS) and Simon Cohn, MD, MPH, National Director for Health Information Policy for Kaiser Permanente Medical Care Program. Cohn is also the Chair of the Subcomittee on Standards and Security for the National Committee on Vital and Health Statistics (NCVHS). Rippen gave an overview of the President's vision of improving care and reducing healthcare costs through Heath Information Technology (HIT). This vision includes ensuring that the proper medical information is available at the time and point of care, improving healthcare quality while reducing medical errors and healthcare costs. Cohn discussed the Medicare Modernization Act of 2003, the role of NCVHS in e-Prescribing, and the plan for implementation going forward.
"Enhancing the Value and Accelerating the Adoption of Electronic Prescribing" was the topic of the presentation by Janet Marchibroda, CEO of eHealth Initiative (eHI) and Executive Director of Connecting for Health, and Doug Bell, MD, PhD, of RAND Corporation. Marchiboda discussed the value of national adoption of computer physician order entry (CPOE) systems, the government's strategic action framework, the focus and functionality of eHI and key imperatives to the successful implementation of e-Prescribing. Doug Bell discussed the results of an expert panel study intended to create recommendations for e-Prescribing that promote patients' best interests, considering safety, health and cost management. The study also tried to assess the number of commercial e-Prescribing products that are currently available and is already implementing the resulting recommendations.
J. Marc Overhage, MD, PhD, Investigator at the Regenstrief Institute for Health Care presented on "The Road Ahead: Connecting the Community". Dr. Overhage presented a physicians perspective and discussed the current state of the National Health Information Infrastructure (NHII).
Three separate speakers delivered the next presentation titled, "Riding the Wave: Challenges to Adoption". Michael Simko, R.Ph., of Walgreen Company, Andrew Sperling of the National Alliance for the Mentally Ill (NAMI) and Michael Weinberger of Johnson & Johnson Health Care Systems each discussed various problems that could occure in the wide scale adoption of e-Prescribing. Simko identified many of the benefits of e-Prescribing and addressed adoption challenges in the clinical environment. Sperling offered a different perspective on this issue as his organization, NAMI, is a large patient advocacy group focused on access to the newest and most effective treatments for their members and affiliates. Weinberger mentioned the many benefits of e-Prescribing as the first step toward broader adoption of healthcare technology but also discussed some concerns, including that some stakeholders could possibly use e-Prescribing technology to influence physician decision-making.
"Riding the Wave: Breaking Down the Barriers" was the title of the next presentation. The discussion featured presentations by Bob Elson, MD, MS, Vice Presidet of Medical Affairs for RxHub LLC, and Rick Ratliff, Chief Operating Officer of SureScripts. Elson discussed the objectives of an e-Prescribing system and the level of adoption by the physician community. Ratliff illustrated the current system where the patient deliveres a precription to the pharmacy directly or it is sent via fax from the physician and the renewal process, which requires "phone tag" and/or "fax tag" in a time-consuming, costly process.
The day concluded with Overhage, Simko, Sperling, Weinberger, Elson and Ratliff sitting down together for a panel discussion. Led by moderator, Ross Martin, the six panelists were able to answer some of the audiences questions regarding the future of electronic prescribing.