E-prescribing in Medicaid set to soar under HITECH
Some state Medicaid programs already have effective e-prescribing programs in place due to Medicaid Transformation Grants, while others are just getting started. Either way, these programs are expected to get a big push forward due to the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions in the American Recovery and Reinvestment Act (ARRA).
The Alabama Medicaid Agency's e-prescribing program launched in March as part of its QTool System and is currently being pilot-tested in nine counties. The tool allows physicians to consult a patient's medical and claims history, check the Agency's Preferred Drug List and enter the prescription online from the QTool interface. According to Kim Davis-Allen, director of transformation initiatives for the Alabama Medicaid Agency, 2,612 electronic prescriptions were transmitted in the first 5½ months the system was in place.
"E-prescribing has been identified as an essential feature of a successful electronic health records [EHR] system," says Alabama Medicaid Commissioner Carol H. Steckel. "Based on our initial experience, physicians see e-prescribing as an important practice management tool, as well as a way to ensure that recipients get medicine as prescribed."
Alabama Medicaid's e-prescribing system was designed with input from community-based pharmacists, pharmacy technicians, and state physicians. The new e-prescribing capability includes rules-based logic, including drug-drug interaction and other drug utilization review components.
"We do not currently have an e-prescribing program, but do expect to have one at some point in the future," says John G. Folkemer, deputy secretary of health care financing at Maryland's Department of Health and Mental Hygiene. "We plan to use the HITECH incentives as a source of funding for incentives for providers and prescribers to participate in e-prescribing with the Medicaid program."
Significant benefits expected
Once an e-prescribing program is in place, Athos Alexandrou, director of Maryland's Medicaid pharmacy program, says he expects to see the following benefits:
-more awareness of the Maryland Medicaid Preferred Drug List (PDL) and an increase in adherence to the preferred drug option;
-fewer medication errors due to illegible handwritten prescriptions, and reduced prescription fraud, waste, and abuse caused by "doctor shopping" and medication diversion;
-increased timeliness of services, due to real-time resolution of problems at the time the prescription is generated;
-fewer repetitive and unnecessary phone calls between providers, pharmacists, and Medicaid pharmacy staff;
-possible availability of access to more health-related patient information at the point of sale, to assist the providers with safe and effective medication use;
-real-time access to patient insurance information and a reduction in possible third party liability (TPL) issues;
-easier identification of possible drug/drug or drug/allergy interactions;
-improved patient compliance with original and refill prescriptions, due to enhanced electronic notification by pharmacies;
-reduced overall cost for the Maryland Medicaid program.
Because e-prescribing is a critical component of certified electronic health record products in the HITECH Act, New Mexico Medicaid expects a significant increase in the use of e-prescribing. "A concrete figure for the level of expected increase is difficult to ascertain, as eligibility criteria for HITECH incentives is still loosely defined," says Carolyn Ingram, New Mexico's Medicaid director.
To date, New Mexico Medicaid's e-prescribing efforts have been driven by a Medicaid Transformation Grant award in 2007. The grant runs through the end of 2009. "This provided the funding necessary to make technical changes, to enable the Medicaid pharmacy claims system to respond to HIPAA [Health Information Portability and Accountability Act]-compliant eligibility, formulary, and medication history inquiries," says Ms. Ingram.
The grant also enables Medicaid to provide financial assistance to help rural, nonprofit, Medicaid providers to adopt e-prescribing. The efforts to facilitate adoption are conducted through a Medical Assistance Division pilot program, and another pilot program through the New Mexico Prescription Improvement Coalition. Medicaid has helped more than 50 practitioners to adopt e-prescribing to date and is expected to assist up to 200 practitioners by the grant completion.
Ms. Ingram says Medicaid expects to see numerous impacts from the e-prescribing process. These include increased quality of care, through the elimination of prescription legibility issues, reduction of adverse drug events, and reduced prescription processing time.
"Physicians and pharmacies should realize cost savings through reduced physician-pharmacy interactions," says Ms. Ingram. "By the merits of making the prescription process electronic, e-prescribing should enable greater physician medication management capabilities. Finally, the e-prescribing process should increase formulary adherence and generic utilization rates among Medicaid providers."
Provider adoption is slow
In addition to providing incentives for adoption of e-prescribing and EHRs in patient-centered medical homes, New York Medicaid is implementing a statewide infrastructure to support e-prescribing and care coordination, by providing 90 days of medication history extracted from pharmacy claims.
"These data can be used by practitioners, with patient consent, to help construct a reconciled medication list for each Medicaid beneficiary in a clinician's practice," says James Figge, MD, MBA, medical director of New York Medicaid.
The data can be used in point-of-care electronic prescribing software applications to minimize medication errors by detecting drug-drug interactions, and therapeutic duplication. The data can also help the clinician assess the adherence of a given patient to the prescribed medication regimen.
In a pilot implementation of this program, Medicaid learned that provider adoption is slow. "Practice workflow re-engineering is required to help clinicians integrate this rich source of data into their daily workflows," says Dr. Figge. "Medicaid also learned that patient privacy, security, and consent issues are complex. It is critical to develop sophisticated policy and technical responses to these issues. That's what we're working on now."
Since the ARRA views HIT as a tool for improving the quality of health care, clinicians and hospitals must demonstrate "meaningful use" of an EHR to qualify for incentive funds. "New York Medicaid shares this vision, and the state's current budget authorizes implementation of two critical incentive programs that will align with ARRA and stimulate adoption of HIT among Medicaid clinicians," says Dr. Figge.
First is an incentive to promote electronic prescribing of 80 cents paid to the prescriber and 20 cents to the pharmacist for each dispensed e-script. "E-prescribing is, itself, a component of 'meaningful use' under ARRA," says Dr. Figge. "E-prescribing in Medicaid will, over time, reduce medication errors, encourage pharmaceutical practices that produce better patient outcomes, and yield savings."
Second, the budget authorizes Medicaid incentive payments for the development of patient-centered medical homes in New York. Hospitals and community clinics, as well as doctors and nurse practitioners that coordinate and integrate their patients' care in accordance with medical home standards, will receive additional fee-for-service and managed care payments through this initiative.
"HIT is a critical component required for successful implementation of a medical home," says Dr. Figge. "New York Medicaid expects that these initiatives will be further advanced by the ARRA stimulus package."
California's Medi-Cal program is participating in two e-prescribing pilots, both started in late 2008. One is currently under way in the northern part of the state, a conglomeration of rural counties with various clinics and safety net providers. The other will begin in late 2009 in San Mateo County.
"What Medi-Cal is doing is providing prescription data at the point of care, so providers can pull up a patient's name and see all the prescriptions that the individual has received from the Medi-Cal program," says Toby Douglas, chief deputy director of the California Department of Health Care Services and the state's Medi-Cal director. "They will have a medication history that will help them know exactly what they should be prescribing, including the formulary we follow."
Though no data are available yet, the University of Arizona is evaluating the program's impact on the quality of care, medication errors leading to adverse health outcomes, and cost reduction.
Medi-Cal also is part of a multistate prescribing collaborative with the national Association of State Medicaid Directors, and a statewide coalition working to move the state forward in advancing e-prescribing. "We work closely with all the other entities," says Mr. Douglas. "Private purchasers, our largest insurance plans, and pharmacy associations are all a part of this network. That helps us have a voice in the adoption of e-prescribing."
Mr. Douglas says that he expects that the pilot projects will demonstrate improved quality of care and reduced costs within the Medicaid program. "We envision this going to a statewide effort over the next couple of years, with the HITECH incentive grants stimulating the adoption of e-prescribing. That is one of the specific ways that a provider can achieve meaningful use," says Mr. Douglas.
Contact Mr. Alexandrou at [email protected], Mr. Douglas at [email protected], Dr. Figge at (518) 474-8045 or [email protected], Mr. Folkemer at 410-767-4139 or [email protected], Ms. Ingram at (505) 827-3106 or [email protected], and Ms. Steckel at (334) 242-5600 or [email protected].
Some state Medicaid programs already have effective e-prescribing programs in place due to Medicaid Transformation Grants, while others are just getting started. Either way, these programs are expected to get a big push forward due to the Health Information Technology for Economic and Clinical Health (HITECH) Act provisions in the American Recovery and Reinvestment Act (ARRA).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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