1. Best Practices for Electronic Prior Authorization (ePA) Implementation and Adoption: Eliminating Barriers to Workflow Integration for Pharmacists and Providers

2. About NCPDP
Founded in 1977, NCPDP is a not-for-profit, ANSI-accredited, Standards Development Organization with over 1,600 members representing virtually every sector of the pharmacy services industry. NCPDP members have created standards such as the Telecommunication Standard and Batch Standard, the SCRIPT Standard for e-Prescribing, the Manufacturers Rebate Standard and more to improve communication within the pharmacy industry. Our data products include dataQ®, a robust database of information on more than 76,000 pharmacies, and HCIdea®, a database of continually updated information on more than 2.3 million prescribers. NCPDP's RxReconn® is a legislative tracking product for real-time monitoring of pharmacy-related state and national legislative and regulatory activity.

3. About CoverMyMeds
Founded in 2008, CoverMyMeds is the nation’s largest and most connected electronic prior authorization (ePA) solution. We help patients receive the medication they need to live healthy lives by automating the prior authorization (PA) process, saving health care professionals valuable time and reducing prescription abandonment. CoverMyMeds integrates directly within prescriber and pharmacists’ existing workflows as well as with health plans and payers to allow for near immediate determinations. More than 700,000 providers and over 49,000 pharmacies currently process ePA requests through the CoverMyMeds web portal, as well as via their electronic health record (EHR) or pharmacy system vendor. Our technology integrates with more than 500 EHR vendors, 80 percent of pharmacy system vendors and payers representing 8- percent of U.S. prescription volume. Providers using our solution successfully process more than 1.6 million PA requests every month.

4. About HIMSS
HIMSS North America, a business unit within HIMSS, positively transforms health and healthcare through the best use of information technology in the United States and Canada. As a cause-based non-profit, HIMSS North America provides thought leadership, community building, professional development, public policy and events. HIMSS North America represents 64,000 individual members, 640 corporate members and over 450 non-profit organizations. Thousands of volunteers work with HIMSS to improve the quality, cost- effectiveness, access, and value of healthcare through IT. Major initiatives within HIMSS North America include the HIMSS Annual Conference & Exhibition, National Health IT Week, HIMSS Innovation Center, HIMSS Interoperability Showcases™, HIMSS Health IT Value Suite, and ConCert by HIMSS™. HIMSS Vision: Better health through information technology.

5. Caitlin Graham, Manager, Provider Relations and Solutions, CoverMyMeds
Caitlin leads the provider account management, implementation and analytics teams for CoverMyMeds. She’s responsible for CoverMyMeds’ EHR (electronic health record) vendor and health system partnerships. Caitlin has been part of the CoverMyMeds team for over five years. During that time, she advised some of the top health systems in the U.S., launched CoverMyMeds’ first EHR partnerships and helped grow the CoverMyMeds platform to over 700,000 users. Caitlin is an active member of HIMSS (Health Information Management Systems Society), wellness advocate and passionate supporter of CoverMyMeds' mission to get patients the medication they need to live healthy lives.

6. Brian Kolligian, CarePATH Ambulatory Team Lead Manager, Mercy Health
Brian started at Mercy Health as an Application Coordinator on the Inpatient Epic team, later becoming an Inpatient Manager and part of the world's fastest implementation schedule (Epic) and currently as the Ambulatory Team Lead Manager for Epic software at Mercy Health. Mercy Health had over 5 million encounters in the past year at more than 450 places of care including, 23 hospitals, seven senior health and housing facilities and seven home health agencies throughout OH and KY. Mercy is the largest health care provider in Ohio and one of the largest in the country, with over 1,300 employed providers and more than 34,000 employees. Brian has over 10 years of health care experience working with business and clinical IT applications and holds a Masters of Health Care Administration from Ohio University.

7. Amanda Bruskotter, CarePATH Ambulatory Application Coordinator, Mercy Health
As an Application Coordinator on the EpicCare Ambulatory team at Mercy Health for four years, Amanda has supported and optimized the electronic medical record (Epic) for Ambulatory physician offices across nine markets, led several lab implementations and became the lead AC for onboarding physicians. Additionally, she leads the CoverMyMeds implementation at Mercy Health Amanda has over 10 years of health care experience working in the laboratory and clinical IT applications. Amanda has a Bachelors in Medical Technology from Bowling Green State University. After graduation, Amanda spent six years working for New Vision Medical Laboratory applying medical technology to diagnose illnesses and run routine lab tests. She later received her Master’s in Business Administration with Healthcare Concentration from the University of Findlay.

8. Accreditation Statement
The Institute for Wellness and Education, Inc., is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.  Participants of the session who complete the evaluation and provide accurate NABP e-Profile information will have their credit  for 1.0 contact hours (0.10 CEU) submitted to CPE Monitor within 60 days of the event. Please know that if accurate e-Profile information is not provided within 60 days of the event, credit cannot be claimed after that time.  
ACPE program numbers are: H04-P and H04-T
Initial release date is March 28, 2017

9. Learning Objectives
Explain the reasoning behind the barriers to adopting a new procedure in the workplace
Identify what training procedures your business currently has in place ensuring easy adoption of improved solutions

10. Pre-Test Questions
What is your current method for implementing a new technical solution in your practice or pharmacy?
Do you have a key person responsible for overseeing specific processes and procedures?

11. Implementing New Technology in Provider or Pharmacy Setting

12. Why Implement A New Technology?
Streamlined workflow for staff, often enhancing current technologies implemented
More visibility into notes and documentation made by other participants
Connected network communicating without fax, phone and other archaic methods of communication
Faster response times and insight into current status of process

13. Dependencies For Technology Adoption
A growing number of new technologies are becoming available within health care that can improve the quality of care, reduce costs and enhance working conditions.
However, such effects can only be achieved if technologies are used as intended. The following study aims to gain a better understanding of determinants influencing the success of the introduction of new technologies as perceived by nursing staff specifically, but can apply to various health care roles.

14. Determinants
The success of transitioning from one phase to the next highly depends on several critical determinants:
The innovation itself
The (potential) user of the technology
The organization
Socio-political context

15. Critical Determinants
The Innovation Itself
Involve users in the selection process for the innovation
Gauge perceived complexity of the innovation
Establish relative benefits compared to current process
The (Potential) User of the Technology
Knowledge or skills needed to use the technology
Outcome expectations or perceived support by colleagues or management

16. Critical Determinants
The Organization
Staff turnover/capacity
Resource allocation or decision making process in the organization
The Socio-Political Context
State mandates to be followed
Company policy to be followed
Up-front incentives to be claimed

17. Determinants Drive Process
Innovation Process
Dissemination Providing users with access to the technical innovation
Adoption The user will develop a positive or negative intention to use the innovation
Implementation The user attempts the innovation in daily practice and experiences what working with the innovation really means
Continuation Working with the innovation becomes a routine practice

18. Likelihood of New Technology Use by Health Care Professionals
Survey Question: How likely are you to try new technology?
Social desirability bias is a social science research term that describes a type of response bias that is the tendency of survey respondents to answer questions in a manner that will be viewed favorably by others
Key Take-Aways:
95% of respondents were on the positive side of the spectrum of likelihood to try new technology
Results likely influenced by social desirability and non-response bias

19. Learning New Technology
Survey Question: What best describes your approach to learning new technology?
Key Take-Away: “Tinkering on own” and “reading instructions” are the most frequently selected approaches to learning technology overall

20. Learning New Technology by Gender
Survey Question: What best describes your approach to learning new technology?
Key Take-Away: Male respondents selected “tinkering on own” at a greater proportion than female respondents

21. Learning New Technology by Age
Survey Question: What best describes your approach to learning new technology?
Key Take-Aways:
Preferences for “tinkering on own” decrease with age
Asking for help (either from someone you know or via company support) increases with age

22. Setting up an Implementation Process for ePA

23. Barriers to ePA Adoption
Change in workflow/routine
Lack of technological skills
Learning curve for how process works
Uncertainty of what to expect
Although the manual prior authorization (PA) process is outdated, tedious and filled with overhead expenses, adopting the optimal electronic method can be challenging, just like implementing any new technology can be.
Convincing providers and their staff to make a behavior change when implementing a new technology in their existing process can be difficult. At CoverMyMeds, we frequently see this in ePA adoption, since moving from the traditional paper, fax and phone prior authorization (PA) methods to an electronic solution can be challenging. While providers are growing increasingly weary of the outdated paper form process, the idea of implementing a new, albeit better solution, can seem intimidating.

24. Setting Up a Successful Implementation: Pre-Work
Establish the need and create a baseline
Create a resource bank
Your front line is your best asset
Leverage data to drive home value

25. Establish the Need and Create a Baseline
Examples:
Reduce hours spent on manual PA
Limit administrative waste in your health system
Reduce prescription abandonment
Eliminate duplicate tasks
The mission could be to reduce the number of patients who leave without being seen, or perhaps the wait time for the patient. In the world of ePA, it might be to limit administrative waste in your health system and reduce prescription abandonment. Understand what procedures the staff are currently going through to complete the process you’re attempting to streamline, and document pre-integration stats regarding time and financial cost

26. Create a Resource Bank
Determine the most important tools to put on place. Do this by:
Identifying where the pain points are in the process
Anticipate assistance that will be needed
Example: If staff is not comfortable using technology, they won’t be comfortable using online resources to train on a new solution. Creating printed reference guides for their workstations will alleviate this barrier.
For example, if the staff is not comfortable with using technology, they may not feel confident utilizing online resources to assist with their new electronic solution. Create printed guides for them to reference at their workstations to alleviate this barrier. Always have a detailed triage plan for user support when rolling out an adoption plan and consider a phased rollout to work out the kinks with a controlled group.

27. Your Front Line is Your Best Asset
Your users have already considered a solution to the problem being addressed.
Once the existing process has been established, leverage their ideas to discover how they would solve this problem if they had the ability to do so.
Creates buy-in by discussing the thought process behind the new technology being implemented and identifying the bottleneck for adoption.
You may even gain some insight to implement on future product development, or identify “super users” who are already on board with the new process, encouraging others to adopt.

28. Leverage Data to Drive Home Value
Data overload is a real thing.
Translate results in a way that will show cause and effect of your users’ work; paint a real-life picture.
Share the number of PA requests that were submitted and consequently received a determination. This will identify the number of patients that were able to begin their therapy who otherwise might still be waiting for (or abandoning) their medication.
Data overload is a real thing. There’s something to the saying, “paralysis by analysis,” and when it comes to measuring the output data from your EHR, it’s tough to identify what is applicable to the newly integrated solution. It’s even more difficult to take that data and share it with your users in a way they will understand. Be sure to translate these results in a way that will show them the cause and effect of their work; paint a real-life picture. If you’re implementing an ePA solution, share the number of PA requests that were submitted and consequently received a determination. This will identify the number of patients that were able to begin their therapy who otherwise might still waiting for (or abandoning) their medication.

29. Tactical Rollout Plan Create project prerequisite checklist
Establish time commitment and timeline
Identify a project lead
Create training and education strategy

30. Project Prerequisite Checklist
Completed
Task
Complete and sign pre-project documents:
Business Associate Agreement
Master Level Service Agreement and Statement of Work
Security Questionnaire (if required)
Work with Information Security Team to address any concerns or security reviews
Set up product demonstration for key stakeholders in rollout process
Review business version of end user guide

31. Establish Time Commitment and Timeline
Stage 1: Prerequisites
Contracting: 1-2 months
Security Review, Q&A: 1-2 hours (optional)
Stage 2: Implementation
Stakeholder Meeting: 1-2 hours
Planning: 2-4 hours, will vary based on size
Communication and Education about rollout; caries based on size
Training: Dependent on training resources chosen
Options include webinars, on-site computer training, on-site presentation training and train the trainers classroom training
Stage 3: Go-Live
Stage 4: Post Go-Live
Ongoing support, maintenance and reporting calls

32. Identify A Project Lead
It’s important to find the correct candidate within your organization to manage your solution rollout. The ideal candidate has a background in organizational and/ or project management, is familiar with operations and has a thorough understanding of the process. In the examples moving forward, this will be for the prior authorization (PA) process.

33. Project Manager Responsibilities
Serve as the primary point of contact for vendor
Develop, organize and implement a training plan in conjunction with the vendor’s account manager
Champion the process by using the technology
Distribute education and training materials
Gather list of location site addresses and contact information
Assist account manager in setting up end-user “groups”
Liaison between vendor and locations
Hold ongoing reporting and status calls with account manager
Communicate project initiatives to the relevant staff members organization-wide

34. Create Training & Education Strategy
Training should be customized to fit your organization’s needs. It is strongly recommended to leverage any current Learning Management System (LMS) and current education and training processes your organization has.

35. Webinars Ideal For: Individual Training
Offices needing extra training after on-site training sessions
Supplemental training for new users after a rollout
Planning: 2 hours
Executing: 1 hour
Post-Training: 1 hour
Total Time: 4 hours

36. On-Site Computer Training
Vendor comes on-site for a short demonstration on an office computer and assists staff with creating accounts and submitting PA requests.
Ideal For:
Training small groups of five or less
Offices without access to projectors or meeting rooms
Rolling out the solution to one department
Planning: 2 hours
Executing: 2 hours
Post-Training: 2 hours
Total Time: 6 hours

37. On-Site Presentation Training
Vendor comes on-site to provide a short demonstration via a projector screen in a meeting room and assists the staff with creating accounts and submitting PA requests
Ideal For:
Training small groups of six to 24
Offices with access to projectors and a meeting room
Rolling out the solution to several different departments
Planning: 3 hours
Executing: 3 hours
Post-Training: 2 hours
Total Time: 8 hours

38. Train the Trainers Classroom Training
Identify a “Champion” that is trained by vendor’s staff who would then train their respective departments.
Ideal For:
Training large groups 25+
Offices with projectors and large meeting rooms or classroom style rooms
Enterprise rollouts
Planning: 6 hours
Executing: 5 hours
Post-Training: 3 hours
Total Time: 14 hours

39. Electronic Prior Authorization Implementation Tips
Focus on training staff members who are actively managing PA requests as part of their role
In prescriber setting, obtain corporate approval for clinical staff to sign off on PA requests. Since the prescriber has authorized the signature on the prescription, any authorized individual from the office can sign the request.
Consider a Centralized PA function in your organization to free up nurses and staff for patient care

40. Sample Implementation Checklist

41. Sample Implementation Checklist

42. Mercy Health’s Prospective ePA Solution

43. Background
Working in conjunction with Mercy Health, CoverMyMeds implemented their electronic prior authorization (ePA) solution through an integration with the electronic health record (EHR) vendor, Epic.
Implementation: CoverMyMeds and Mercy Health created an implementation plan to roll out their integrated solution. 
Timeline: CoverMyMeds collaborated with Mercy Health to build a tailored timeline.
Project Plan: CoverMyMeds provided a custom project plan specific to the Mercy Health team’s needs.

44. Best Practices Core Build
Utilization of CoverMyMeds’ “Auto Search Patient’s Payer” as default 
Completion of CoverMyMeds’ PA Detail 
Transmission of the prescription upon prescriber signature 
Go Live
Pilot launch with 30 to 50 NPIs to ensure enough volume to account for various workflows.
Run the pilot for four to six weeks.
CoverMyMeds is available to assist with on-site or remote training.
CoverMyMeds team can provide elbow support to clinics as they go live.

45. Adoption Strategy
Craft a staggered rollout approach to ensure comprehensive training is provided to each user. 
Distribute messaging to all staff impacted by ePA, increasing awareness of the new functionality and in-workflow messaging. 
Most importantly, implementing a robust training and communication plan. 

46. Results
Time to PA determination decreased by 39%. 

47. Results
Requests per NPI increased 330% from portal only ePA to portal and integrated ePA.

48. Results
In workflow submission rate six months post-integration launch increased 43%.

49. References
BioMed Central Study: Successful implementation of new technologies in nursing care: a questionnaire survey of nurse-users
CoverMyMeds user and non-user market research with SHC Universal: Implementing A New Technology
CoverMyMeds Portal Implementation Guide
Mercy Health Data

50. Post-Test Questions
1. Which of the following is not a primary responsibility of a project lead? a) Serve as the primary point of contact b) Develop technical build of the solution c) Be a champion of the process d) Implement a training plan

51. Post-Test Questions
1. Which of the following is not a primary responsibility of a project lead? a) Serve as the primary point of contact b) Develop technical build of the solution c) Be a champion of the process d) Implement a training plan

52. Post-Test Questions
2. True or False: Once you transition to a paperless method for prior authorization, you can no longer manually process requests. a) True b) False

53. Post-Test Questions
2. True or False: Once you transition to a paperless method for prior authorization, you can no longer manually process requests. a) True b) False

54. Post-Test Questions
3. The best way to ensure accurate reporting for your organization’s PA management? a) By having all users manage PA with their personal account as log in identifier b) By using one account for all users c) By having an internal team member dedicated to monitoring reporting and progress d) By having all users manage PA through their EHR, or through the portal with their organization address e) Both C and D

55. Post-Test Questions
3. The best way to ensure accurate reporting for your organization’s PA management? a) By having all users manage PA with their personal account as log in identifier b) By using one account for all users c) By having an internal team member dedicated to monitoring reporting and progress d) By having all users manage PA through their EHR, or through the portal with their organization address e) Both C and D

56. Post-Test Questions
4. Who should you look to first when searching for advocates of your new solution to promote adoption? a) CoverMyMeds b) Your EHR or pharmacy system vendor c) Your end users d) Leadership at your company

57. Post-Test Questions
4. Who should you look to first when searching for advocates of your new solution to promote adoption? a) CoverMyMeds b) Your EHR or pharmacy system vendor c) Your end users d) Leadership at your company

58. Post-Test Questions
5. What is the most beneficial thing to identify when creating a process adherence plan? a) Who is the owner of the project? b) What are the anticipated pain points in this process? c) What are the ramifications of not adhering to this process? d) None of the above

59. Post-Test Questions
5. What is the most beneficial thing to identify when creating a process adherence plan? a) Who is the owner of the project? b) What are the anticipated pain points in this process? c) What are the ramifications of not adhering to this process? d) None of the above

60. Questions?

61. Save the Date NCPDP17 – 40th Anniversary Conference
NCPDP’s annual technology & business conference will be held May 8-10 in Scottsdale, AZ. For more information, please visit