Outcomes and Implications of Florida Medicaid’s e-Prescribing Pilot Project

1. Outcomes and Implications of Florida Medicaid’s e-Prescribing Pilot Project National e-Prescribing Conference Sponsored by CMS and Industry Partners - October 6 & 7, 2008 Christopher B. Sullivan, Ph.D. Agency for Health Care Administration

2. Background to the Presentation This presentation will cover three topics that relate to the e-prescribing initiatives taken by Florida state government. • A summary overview of the Florida Medicaid e-Prescribing Pilot Project, including the outcomes of fewer prescription claims and lower costs to Medicaid. • An overview of the Electronic Prescribing Clearinghouse website developed by the Agency to promote e-prescribing. • A description of the Medicaid e-Prescribing Adoption Program to be proposed for legislation in FY 2009-10.

3. Medicaid e-Prescribing Pilot Project In 2003, the Florida Legislature directed AHCA to develop a wireless handheld drug information application for prescribers to use at point of care. AHCA developed a model in which clinical outcomes and “over-prescribing” could be positively impacted at the point of care. The system was expected to provide: Continuously updated clinical pharmacology information for prescriber reference Reference to the Florida Medicaid PDL Individual Medicaid patient medication history

4. Value of the e-Prescribing Pilot Project Florida Medicaid e-Prescribing Pilot makes 100 days of a patient’s prescription drug history available to practitioners. The medication history: is available at the point of service; permits immediate utilization and compliance review; provides information about coverage and restrictions; incorporates an e-prescribing function that permits immediate transmission of prescription authorization to the patient’s pharmacy.

5. Expected Outcomes from the e-Prescribing Pilot The e-prescribing application contracted by Medicaid is eMPOWERx. This program is expected to provide a drug utilization review to the physician for purposes of: Minimizing adverse drug reactions. Detecting overuse or under use of drugs. Detecting duplicate therapies. Detecting potential allergic responses. Screening for appropriate dosage. Halting “doctor shopping” for medications

6. ePrescribing Provides a Medication History Drug Interactions Identified Comprehensive medication history for well informed therapeutic decisions Therapeutic duplications flagged for further review

7. e-Prescribing Pilot Drug Interaction Alerts Medicaid e-prescribing is integrated with a clinical information database, which includes screening tools to reduce the potential for medication errors before they occur. Employs Clinical Pharmacology and clinical report tools, empowering clinicians to screen a prescription for adverse effects. Alerts the provider to potential drug-drug or drug-allergy interactions The e-Prescribing component provides Medicaid Preferred Drug List information and offers recommendations for alternative medications.

8. Interaction Alerts From July 2007 to March 2008

9. Medicaid e-Prescribing Features The Medicaid e-prescribing system is supported through a Web-based, real-time prescribing system: Allows providers to write prescriptions from a desktop computer or a PDA with prompts for the patient’s last pharmacy. The desktop version of of the e-prescribing software includes a data feed from SureScripts-RxHub. Physicians can obtain a medication history from both Medicaid and non-Medicaid sources using the desktop version.

10. Medicaid e-Prescribing, January-June, 2008

11. Medicaid ePrescribing Volumes, January to June 2008

12. Fewer Medicaid Prescription Claims per Patient

13. Greater Medicaid Cost Savings per Patient

14. Outcomes of the Medicaid e-Prescribing Pilot Project • Prescribers in the Medicaid pilot write 25% fewer prescriptions than physicians not using the system. • Prescribers in the Medicaid pilot save Medicaid an average of $48 more per month per patient on prescription claims. • Florida Medicaid reports $1.8 - $2 million in monthly savings from physicians using e-prescribing. • During a 9 month period in 2007-08 e-prescribing physicians received an average of 18,122 alerts per month, for a projected savings of $208,933 each month in claims.

15. Public Health Opportunities for Medicaid e-Prescribing • Duval County Health Department is initiating a pilot project using eMPOWERx. • Florida Medicaid is working with the Duval County Health Department to obtain extra wireless PDAs for the pilot. • The eMPOWERx Desktop version has extra benefits with its RxHub feed, but security is an important issue that needs to be resolved. • AHCA Medicaid is reaching out to make eMPOWERx available to all County Health Departments in Florida

16. 2007 Legislative Session – HB 1155 • Mandates information clearinghouse on electronic prescribing (s. 408.0611 FS) • “To promote the implementation of electronic prescribing by healthcare practitioners, healthcare facilities, and pharmacies in order to prevent prescription drug abuse, improve patient safety, and reduce unnecessary prescriptions.” • “The agency shall work in collaboration with private sector electronic prescribing initiatives and relevant stakeholders to create a clearinghouse of information of electronic prescribing for health care practitioners, health care facilities, and pharmacies.”

17. E-Prescribing Clearinghouse Mandate Provide information regarding the availability of electronic prescribing products. Regularly convene stakeholders to assess and accelerate implementation of electronic prescribing. The Agency shall monitor the implementation of electronic prescribing The Agency shall annually report on the progress of electronic prescribing implementation to the Governor and Legislature – due January 31. 17

18. E-Prescribing Clearinghouse – www.fhin.net/eprescribe

19. E-Prescribing Initiatives Across the Country 19

20. E-Prescribing Vendor Clearinghouse 20

21. Monitoring the Progress of E-Prescribing in Florida 21

22. Medicaid Electronic Prescribing Adoption Program, FY 2009-2010 The Agency is considering developing an incentive program to promote the adoption of electronic prescribing among Medicaid providers. • Offering financial incentives to Medicaid providers benefits Florida Medicaid beneficiaries by: • E-prescribing enhances quality patient care. • Makes electronic medication records available at the point of care.

23. Medicaid Electronic Prescribing Adoption Program, FY 2009-2010 The proposed incentive payment would be continued for a limited number of years and gradually be decreased in subsequent years. The Agency is NOT considering imposing a penalty related to low utilization of electronic prescribing.

24. Expected Adoption Rates from the Incentives The current level of adoption of e-prescribing by pilot project providers is estimated at 19.5% of the physicians using the eMPOWERx program, or an estimated 3.8% of all Medicaid physicians. 46,866 electronic prescriptions were reported by Medicaid in the second quarter of 2008. The proposed program would fund incentives to achieve 5% level of adoption of electronic prescribing among Medicaid physicians targeting 679,126 e-prescriptions in fiscal year 2009-2010.

25. Medicaid e-Prescribing Adoption Program Issues Metrics: The number of electronic prescriptions sent by the Medicaid clinician relative to the number of prescriptions generated by the Medicaid clinician during the measurement period. Qualifying Metric for Incentive Payment: The qualifying metric should be set high enough to document that the clinician is committed to electronic prescribing and the qualifying metric should reward increased use of electronic prescribing. Data Sources: Use claims data to track e-prescribing; avoid creating new reporting requirements if possible.

26. Medicaid e-Prescribing Adoption Program Issues • What e-prescribing tool standards are available? • CCHIT certified EMRs • ePrescribe America • The proposed method to implement program change: • Amend the State Plan • Adopt a rule amendment and incorporate changes in the Florida Medicaid Provider Reimbursement Handbook and Physician Services Coverage and Limitations Handbook. • Include proviso language in appropriations bill

27. Medicaid e-Prescribing Incentives Program Issues Program funding: • The proposed source of funds for the first year would be general revenue with federal match. • The proposed source of funds for the second year is prescription drug savings from year one. • And subsequent years.

28. CMS Medicaid Policy for Promoting Adoption of e-Prescribing How will states be supported to establish incentive programs? What have we learned from Physician Quality Reporting Initiative (PQRI)? What metrics will be most cost effective to administer? What program design would be most acceptable to physicians and encourage Medicaid participation?

29. Carolyn H. Turner Christopher B. Sullivan, Ph.D. Agency for Health Care Administration Florida Center for Health Information and Policy Analysis 2727 Mahan Drive Tallahassee, FL 32308 turnerc@ahca.myflorida.com sullivac@ahca.myflorida.com