Frank Harvey, CEO of Surescripts, lately spoke with Healthcare Innovation a couple of vary of points, together with a latest acquisition, the potential for pharmacists to play a bigger position on main care groups, and why Surescripts Well being Info Community LLC is making use of to develop into a Certified Well being Info Community (QHIN) below the Trusted Trade Framework and Widespread Settlement (TEFCA). 

Harvey succeeded Tom Skelton as CEO in 2022. A pharmacist himself, Harvey has held management positions within the healthcare know-how, pharmacy and pharmaceutical sectors. He joined Surescripts from ATLS Investments LLC, the place he led non-public fairness investing in healthcare know-how corporations.

Healthcare Innovation: Might you discuss a bit bit about how the position that pharmacists play within the healthcare ecosystem is evolving? 

Harvey: There are two main issues that we’re dealing with. One is the silver tsunami. Proper now we have now 58 million individuals aged 65 and older. By 2030, it is estimated that we’ll have 70 million individuals. By age 65, 80 p.c of individuals have at the least one persistent situation and 60 p.c of individuals have two persistent circumstances. As well as, you’ve gotten the burnout that clinicians are feeling due to the pandemic — nevertheless it’s not simply the pandemic. It is all this administrative burden that we have placed on physicians, pharmacists and all the care group. It is estimated that 20 p.c of physicians plan to retire within the subsequent two years. So you’ve got acquired an growing older inhabitants, and you have an estimated scarcity of about 135,000 main care physicians by 2034.

We’re not changing them quickly sufficient. So that basically forces us to have a look at the care group construction — how they work collectively, and who can decide up a few of that slack. Whenever you have a look at the care group, pharmacists have the scope of coaching to select up quite a lot of that first degree of main care. They wish to do this and it’ll assist with a few of the pharmacist burnout we have seen, too. Pharmacists are burning out identical to physicians as a result of they’re targeted on the menial duties that they need to be faraway from to allow them to give attention to extra of the first care-focused areas.

HCI: In lots of areas, the unbiased pharmacies have largely disappeared and the big retail chains dominate. Can the pharmacists in these retail environments tackle this position? And are these chains curious about seeing their pharmacist tackle that position?

Harvey: Completely. I believe if you happen to have a look at all the foremost chains, they’re already acknowledging the necessity for the pharmacist job to evolve, together with doing immunizations that we did such an ideal job of in the course of the pandemic. We have now to develop into persistent care managers, which implies we have now to let pharmacists do this decrease degree of main care to alleviate a few of that burden from the doctor. There’s actually a three-legged stool. One is know-how. That’s the position of Surescripts, ensuring we have got the suitable scientific info within the arms of the pharmacist or the doctor after they’re making these care choices. A pharmacist or a doctor would not have all day to learn via a 300-page medical chart, so our know-how helps boil that all the way down to a abstract.

One other leg of the stool is the reimbursement coverage. We have now to amend reimbursement coverage each on the CMS degree and on the well being plan degree to pay pharmacists for this extra exercise. There’s acquired to be compensation for that or they cannot afford to do it. 

The third piece is we want legislative adjustments throughout the U.S. and within the states. Throughout the pandemic, HHS gave pharmacists broader privileges and so they prolonged that via December of 2024. I believe we have to make these privileges go on from there. As a result of states are liable for licensure and monitoring, quite a lot of the states should go laws to acknowledge the scope of the pharmacists’ coaching and empower them to supply these features. The research we have completed have proven that physicians are in favor of a pharmacist doing extra as a part of a collaborative care group and it actually opens up their capability to give attention to the issues which are on the high of their their coaching.

HCI: Surescripts does surveys of pharmacists about their high challenges, and a latest report stated they spoke concerning the want for digital entry to scientific info, profit eligibility info, and digital prior authorization. How tough is it to assemble that info and current it to them on the level of care? 

Harvey: It isn’t that tough in any respect. As a matter of truth, we do this proper now via their pharmacy working techniques. I believe one among your articles within the final day or so was about some statistics concerning the burden of prior authorization. It is one of the crucial burdensome factor for the doctor’s workplace. It isn’t solely administratively burdening for the doctor, nevertheless it additionally delays take care of the affected person.

We have now an digital prior authorization resolution that is proactive. So when the doctor is writing the prescription, our resolution goes out instantly moderately than having to take two or three days to undergo a course of. As well as, with the Surescripts real-time prescription profit product, the doctor pulls up what medicine he needs to offer that affected person, and it reveals him therapeutic options. It reveals him and the affected person what their profit covers. It reveals them what the prices can be at retail. Nearly 20 p.c of sufferers will go to the pharmacy, after which the pharmacy has to name again to say ‘hey, this affected person cannot afford this. What are you able to do? Can you alter it?’ You get that taken care of proper on the doctor’s workplace.

HCI: Surescripts lately purchased an organization known as ActiveRadar. Are you able to clarify what was engaging about that firm?

Harvey: We checked out all the businesses on the market and we actually felt like ActiveRadar had the most effective therapeutic various resolution out there. All of the well being plans and all PBMs should have a therapeutic PMT committee that decides what medicine are interchangeable. It’s a very costly proposition, significantly for smaller regional plans. Via their know-how, ActiveRadar kind of does that work for for the plans and for the PBMs. That enables them to say, ‘Okay, I will simply use yours moderately than having to make use of all these further people to do it.’ It creates extra consistency throughout all of the completely different plans as properly. 

For those who have a look at real-time prescription profit, ensuring the suitable therapeutic options are introduced as part of that resolution is necessary as properly.

HCI: Surescripts Well being Info Community simply introduced it is making use of to be a QHIN below the TEFCA framework. Who can be logical companions to be sub-participants below the TEFCA framework? 

Harvey: The pharmacies, the labs, PBMs, the well being plans. We’re the biggest interoperability firm within the nation already. We did 22 billion transactions final yr. Solely about 2.35 billion of these are literally prescriptions. The remaining is all of the scientific knowledge. 

We’re very assured that we will serve everybody throughout the spectrum of healthcare. And if you concentrate on the Certified Well being Info, Networks in TEFCA, it actually does develop into a community of networks, as you’ll, as a result of each goes to achieve success bringing in individuals who can be their clients. We actually suppose the group at ONC has completed a beautiful job. If you concentrate on what is the significance of this, it comes again to the affected person’s capability to ensure they’re getting the suitable therapy after they’re in entrance of a care supplier, as a result of with an incomplete medical file, they’re by no means certain that the suitable choices are being made.


HCI: In September, the corporate named Lynne Nowak, M.D., its first chief knowledge and analytics officer. Why did Surescripts see a necessity for that position? And what are a few of the issues that she and her group are engaged on?

Harvey: Effectively, an ideal instance is that ActiveRadar goes to be part of her group. We all know the information has energy to ensure that we’re targeted on the issues that may very well be enhancing the standard of care, enhancing affected person security and decreasing the price of care. When you’ve gotten 22 billion transactions, there’s so many issues that may come out of that, that info, making an attempt to establish these issues which are greatest for the affected person. We imagine there is a important alternative for Lynne and our knowledge scientists to actually construct out the issues that can assist these core components of our mission.

HCI: Looking forward to 2024, are there some other plans you wish to speak about?

Harvey: We’re targeted on making an attempt to take the executive burden away from the care suppliers as a result of we actually do see it as a disaster whenever you see the pharmacists taking turns happening strike, if you’ll, due to their working circumstances and so they’re not capable of give attention to the issues that they wish to. So our goal is to look throughout all the issues we offer and proceed to excellent them. Within the final 4 years, we have improved the standard of e-prescriptions by over 200 p.c. We’re engaged on ensuring that our scientific direct messaging product is on the market and pervasive via healthcare so the pharmacist can message the doctor, the doctor can message the pharmacist proper in workflow, eradicating the executive burden of getting to ship a fax. Healthcare might be one of many final bastions of the fax machine. We would like to see an finish of that fax machine and we imagine quite a lot of our applied sciences can be useful in that finish.

HCI: Are there some ways in which all this pleasure and improvement round synthetic intelligence and huge language fashions can apply to the work you guys do?

Harvey: Individuals typically combine up machine studying and generative AI. We have been utilizing machine studying because the very starting inside our merchandise. We’re beginning to have a look at generative AI. We do suppose there are some issues we will put it to use for. Nevertheless, I will say we’re being actually cautious as a result of there are nonetheless quite a lot of unknowns about generative AI and it has hallucinations. Whenever you’re coping with the affected person’s file, you may’t have hallucinations. So we’re it, we’re testing it, doing quite a lot of pilot issues round it, however till we’re completely certain that it is what it must be, we’re not going to roll it out into our general portfolio.