EHR-integrated Benefit DesignJake Halpert, Clinical Programs                                  1
Solution Overview High Level Solution Description:   • SampleRX lets healthcare payers provide virtual sample     closets...
Improvements in Care Quality of Care  Treatment initiation is smoother,  easing the patient’s financial and psychologica...
Usability and DesignProvider Workflow 1—The provider is in the patient’s EHR chart documenting a new   diagnosis and deci...
Usability and Design               Figure 1. Provider-facing drug selection screen                                        ...
Usability and Design In the separate payer-facing portal, the plan’s  formulary administrators have controls to:   1) upd...
Integration Description SampleRX operates as a web-based application. For  integration with the Allscripts Enterprise EHR...
Development Stage The product is currently in the prototype phase, with  sponsored partnerships with HMOs and ACOs rollin...
Go to Market Plans Our pricing for healthcare payers is based on a  $PMPM model. We target a 3-4% reduction in  pharmaceu...
Video Demonstration Short demo video This video illustrates the points of integration with  Allscripts, sample selection...
Recap EHR-integrated value-based benefit designSampleRX encourages physicians and other providers toselect medications ba...
Thank you for your time.                           12
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SampleRX: Allscripts Open App Challenge

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SampleRX: Allscripts Open App Challenge

  1. 1. EHR-integrated Benefit DesignJake Halpert, Clinical Programs 1
  2. 2. Solution Overview High Level Solution Description: • SampleRX lets healthcare payers provide virtual sample closets for physicians at the point of care. The health plan decides what drugs can be trialed for its members, and these are displayed in the physician’s EHR during patient exam. Medications are e-prescribed to retail or mail-order with a $0 patient copay during trial period (typically a 30-day supply). Healthcare/Business problem addressed: • Rising pharmaceutical costs (for insurers and patients) The application developed addresses the following category:  Innovative approaches to addressing value-based care imperatives. 2
  3. 3. Improvements in Care Quality of Care  Treatment initiation is smoother, easing the patient’s financial and psychological commitment to a new prescription while drug effectiveness and tolerance is being established Cost-Efficacy  The most value-based medication options are promoted at the point of care, reducing drug expenditures for both the patient and the payer 3
  4. 4. Usability and DesignProvider Workflow 1—The provider is in the patient’s EHR chart documenting a new diagnosis and deciding on treatment options. 2—In the Sample Closet tab (integrated into the EHR), the provider can view medications—generic and brand—sponsored by the health plan. Samples are sorted according to condition. 3—The provider can select one or multiple medications, which are e- prescribed to retail or mail-order with a proprietary insurer voucher code automatically attached on the backend for $0 patient copay. 4—The e-prescription is saved automatically to the EHR, and the provider returns to the native EHR. 4
  5. 5. Usability and Design Figure 1. Provider-facing drug selection screen 5
  6. 6. Usability and Design In the separate payer-facing portal, the plan’s formulary administrators have controls to: 1) update what medications are sponsored to trial for plan members 2) target specific medication promotions to certain patient segments based on demographic and diagnostic criteria 3) analyze physician-usage metrics in real-time 6
  7. 7. Integration Description SampleRX operates as a web-based application. For integration with the Allscripts Enterprise EHR, a UAI Command button (“Sample Closet”) is created on the Clinical Desktop that links to the application. To give the physician flexibility within his prescription workflow, additional hooks can be placed in EEHR medication- related views according to client specifications as allowable by the Allscripts integration API. Web service calls utilized: GetPatientFull, GetPatientPharmacies, GetPatientProblems, GetRXFavs, GetUserID, SaveRX, SaveSimpleRX, SearchPharmacy 7
  8. 8. Development Stage The product is currently in the prototype phase, with sponsored partnerships with HMOs and ACOs rolling out in late 2013. 8
  9. 9. Go to Market Plans Our pricing for healthcare payers is based on a $PMPM model. We target a 3-4% reduction in pharmaceutical spend per client from value-based drug promotion and take a 30% share of savings. The product is being rolled out in large integrated payer-provider systems, starting with HMOs and ACOs. • Next, we are approaching PPOs and large third-party insurers with network providers. We sell to large organizations with at least 1000 physicians and 100,000 members due to the fixed per- group implementation costs necessary for secure EMR integration and admin setup. 9
  10. 10. Video Demonstration Short demo video This video illustrates the points of integration with Allscripts, sample selection process, and sample formulary administration. 10
  11. 11. Recap EHR-integrated value-based benefit designSampleRX encourages physicians and other providers toselect medications based on value, as opposed to drugsampling promotion strategies around expensive or recentbrand-name drugs. This saves money for both the patientand the insurance plan and leads to better patientadherence with the drug regimen, further improving overallcare. This has earned SampleRX the following monikerfrom the director of one of the largest ACOs in the U.S. –“the white knight of drug promotion.” 11
  12. 12. Thank you for your time. 12

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