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eValue8 and Health IT The eValue8 RFI is an effective tool for driving the health plan market to address purchaser expectations eValue8 has had health IT elements sprinkled in various sections in the past New for 2005 – the RFI will highlight health IT elements in a separate section to raise the visibility and communicate increased focus and importance of this topic GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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eValue8 and Health IT cont’d
The Health IT section of the RFI is still in development but will likely address: ePrescribing Adoption of national data standards Investments in web-based information and transaction systems to improve administrative and clinical efficiency and to empower members to improve their health care choices Personal Health Record functionality for members GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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GM Health Care Initiatives
e-Prescribing GM Health Care Initiatives GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Agenda GM Background Current Options SEMI Initiative
Connecting the Dots Conclusions GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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GM Background GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Background …what’s unique about General Motors?
Demographics Rx Protocols Largest private purchaser of health care in U.S. Number of Enrollees 1.1M Health Care Spend $4.8B Retiree/Active Ratio 2.4:1 Annual Drug Spend $1.3B Rx Plan Design Mail Order Coverage Criteria Utilization and Efficacy Community Outreach Total covered lives = 1.1M Very large retiree burden 80 hourly, 80 retirees Unique to GM, Plan design, most others can do triple tier designs and have eex pay difference based on drug choices. Very little differential due to CollBArg, movg a lot to MOPD bec more time to manage Rx, apply mgt. Little mgt and util tools Util and Eff, not spefic drug or condn, have many things, all util Cmmo be of limitations of pln design GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Community Initiatives ……a few examples
Drive patient safety efforts Reduce waste and inappropriate care in the delivery system Encourage appropriate care and appropriate use of prescription drugs Misuse, underuse and overuse Expand generic usage Promote wellness and disease prevention GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Increasing Pharmacy Trends ….one area of GM’s healthcare focus
823 million visits to physician offices in 20001 4 out of 5 patients who visit a physician leave with at least one prescription2 65% of the US population use a prescription medication each year3 Over 3 billion prescriptions are dispensed each year4 The number is expected to rise to 4 billion by 20064 Unfilled Renewals 0.4 B 0.5 B Refills 1.5 B 1.4 B New Scripts Another way to look at it, Rx going up significantly. Why so important to us. Why looking at Rx when so many things can do in HC 3.5 Billion Total Filled Prescription Transactions in 2003 1) Pastor PN et.al. chart book on trends in the health of Americans National Center for Health Statistics 2) The chain pharmacy industry profile. National Association of Chain Drug Stores 3) Agency for Healthcare Research and Quality. MEPS Highlights #11: distribution of health care expenses, 1999. 4) NACDS estimates GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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CURRENT OPTIONS GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Patient Safety …the cost of preventable adverse drug interactions?
Limited access to a patient’s comprehensive medication history contributes to medication errors and adverse drug events (ADEs), exacerbated by complex interactions among health care providers, patients, and medications The cost of ADEs are high in human and financial terms. Patients can suffer irreversible injury, permanent disability, or death Medication errors account for over 7,000 deaths annually (in and out of the hospital). Between 1-3% of hospital admissions are attributed to medications errors National hospital expenses to treat patients who suffer ADEs are estimated at $ $5.6 B per year Above and beyond cost, also care about safety, high in human terms Source: Institute for Safe Medical Practices Centers for Medicare and Medicaid Services (CMS) National Health Expenditure Report GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Healthcare Information Technology …..we support the paradigm shift
Current Paradigm Desirable Environment Physician can prescribe a medication without the comprehensive patient history We can do what’s been done before…….status quo Contend with the limited infrastructure to help clinicians Results in treatments that are… Redundant, ineffective Potentially dangerous Computerized patient records in every clinicians office Interoperable systems—secure connectivity across providers: physicians, payers, pharmacies Information available at the point of care for critical decision making Consumers have access to information to manage and access their own health care needs. Current vs ideal and what we would get with each. GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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HIT Rationale ….why e-Prescribing?
Improve efficiency of care and patient experience by making insurer formulary information available at the point of prescribing Systems are available, cost of adoption and use is low, and they result in physician office workflow efficiencies, particularly for repeat prescriptions Improve quality and safety by: Eliminating legibility problems Reducing the occurrence of drug interactions, dosage errors, and other adverse effects High roda here not cost, work in collaborative way. by guiding prescribing based on computerized assessment of patient and medication information , thereby reducing the need for reconsideration of a prescription at the time of dispensing Source: Agency for Healthcare Research and Quality (AHRQ) Centers for Medicare and Medicaid Services (CMS) Leapfrog Group GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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e-Prescribing …our view of the minimum specifications
Physician office adopts and uses an electronic system which includes all of the following: Decision support based on drug reference information Decision support which draws from a patient-specific database which includes age, weight, medications prescribed by that office, diagnoses, allergies, specified lab results, and electronically-available formulary information Printing of a paper prescription or its NCPDP-compliant electronic transmission to the pharmacy Min specs Our view of eRx will suppport…. Source: Agency for Healthcare Research and Quality (AHRQ) Centers for Medicare and Medicaid Services (CMS) Leapfrog Group GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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SEMI e-RX INITIATIVE GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Electronic Prescribing …why is GM interested?
…e-Prescribing is consistent with our community outreach objectives Doctors and Health Plans Pharmacy Reduces potentially harmful drug interactions before the prescription is submitted Lowers overall prescription costs due to increases in the use of generics and preferred drugs Ability to deliver prescriptions digitally, eliminating legibility errors Point of care eligibility and COB reduces third party liability, time for reconciliation Reduces pharmacy calls to physicians due to inaccuracies by 30% Expedites prescription refill process Reduces patient wait time at the pharmacy Encryption ensures confidentiality HIPAA compliant Concerned about constituents and concerned about all of them How this helps them GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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SEMI ePrescribing Initiative …why here and why now?
Alignment of Employers & Payers Endorsement by GM, Ford, Daimler-Chrysler All Regional Health Plans Next generation of “coordinated Rx care” Attractive clinical and financial drivers Alignment of PBMs RxHub coverage is 3.5 MM lives in SE Michigan, approximately 65% of market Alignment of System Vendors Strong vendor community Business model drives adoption CMS Modernization Act Catalyst for Change - encourages e-Prescribing, with promise of a mandate for e-Prescribing standards Not just GM, regional approach 65% covered lives already Choice/Options. Vendor agnostic. Functionalitynot specific system. Consumers choose where Rx whould go. More sence that have legible, elctronic, benefits. Physicain at POC. GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Eligibility Transactions
E-Prescribing Process ….a simplified approach Point of Care Application Middleware Application START 1. Find the patient 2. Search for Drug by name or therapy class and select drug PBM Application Match Patient to Payors & Route Eligibility Transactions Patient Eligibility Data Extract Patient Payor Demographic Data (MPI) 3. Check status and drug coverage Patient Medication History Extract Route Patient Medication History Plan/Group Formulary & Benefit Data Extract Route Formulary & Benefit Data 4. Perform drug utilization review and interaction checking Retail/Mail Pharmacy Application Minimum functionality we want. Middleware a variety of partners, Rx Hub, integration partners, etc. END Pharmacy Of Choice 5. Select alternative drug (If necessary) 6. Search for pharmacy of patients choosing 7. Submit Rx to pharmacy GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Foundation for Health Initiative
SEMI ePrescribing Initiative …reviewing past studies and pilots for insight Foundation for Health Initiative $4.00 PMPY - From Preventing Adverse Drug Events $35-40 PMPY – From Over/Under use of Medications $35-40 PMPY – From Preventing Unnecessary Lab and Radiology Use Total $ PMPY Medical cost increases were 19.3% less than control group Pharmacy cost was PMPM less than control group Patient safety errors were 8.93 less per physician per year On a scale of 1-5, with 5 being satisfied RPh rating = 4.67 MD rating = 4.25 Tufts Case Study Not doing in a vacuum, receptive to ideas, fleible on how bring out in marketplace. GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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SEMI ePrescribing Initiative
Basic project phases have been identified and segmented as the key drivers for success…. Phase One (2004) Phase Two (2005) Infrastructure Build All-Payer Network Broaden Tech Vendors Educate Community Identify Physician Leaders Align Incentives Adoption Active Recruitment Leverage Broad Network POC Vendor Community Implementation Performance Based Incentives GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Connecting the Dots ….the heavy lifting component of the project
Payers PBMs IT Vendors Providers Infrastructure Component Adoption Component Doctors BCBS MI Regional Plan Nat’l Plans Medicaid MHS ESRX CMX PBAs Others POC POMIS RxHub POC POMIS POC POMIS POC POC POMIS POMIS Bld and connectogether so end to end connectivity, linkage. Existing Mail Order Pharmacy Specialty Pharmacy Retail Pharmacy WIP Sure Script GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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CONCLUSIONS GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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How will SEMI succeed? Advocate ePrescribing Encourage Participation
Support patient safety Opportunity to drive innovation Opportunity to reduce healthcare costs Encourage Participation PBM connectivity POMIS & POC connectivity Physician adoption Asking Community Members to Provide Insight Business model Point of entry Go to market approach Appropriate incentive alignment Incentives: Don’t pay docs directly, asking plans to help us establish approp alignment of incentives. Help us here in SEM , how much caooitakl made avilable, what form, some oaid for adoption, exact structures and rates being debatred and finalkizrd. Need something to help drive more rapidly, Everyone should have skin in the game, Autos, Plans, Docs, etc. GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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The Elegant Solution …secure connectivity across physicians, payers, pharmacies
Patients Hospital Pharmacy Clinic Focus on encounter between patient and doctor. PBM/Payers GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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Thank You GM Descriptor; GM Sans Regular Italic 16pt
Final slide of every presentation Only abstract images should be used for the final slide GM Descriptor; GM Sans Regular Italic 16pt Thank You Region, country, division, department, or no descriptor GM CONFIDENTIAL DRAFT DO NOT FORWARD OR COPY
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