In more from the HIT conference, Leo Barbaro the network management services VP for Wellpoint Northeast (Blue Cross NH, Connecticut, Maine) gave a talk in which he jammed together an ePrescribing talk with his P4P talk and gave some ideas about what’s working to combine P4P and encourage ePrescribing as part of it. It’s an excellent talk with lots of info, and you can download a PowerPoint of it here.
Wellpoint is moving towards P4P for all products, rather than just for HMOs. They’re also starting to move quality payments away from HEDIS measures to paying for IT use. Now that Wellpoint is big enough to swing a bigger stick in many markets they’re starting to consolidate their P4P programs. In the 3 states Barbaro runs they give physicians points for doing the right thing. You can get 15 points out of 100 for adoption ePrescribing and another 25 if you prescribe all the generics you could. And if a physician gets to 80 points out of a hundred they get a 6% bonus payment on top of the FFS payments you get anyway — so the ePrescribing and generic substitution part is half-way there.
He also talked about Wellpoint’s technology Investment. This is $30m spent by the non-Anthem part of Wellpoint, (CA, GA, MS and WI) which offered free technology to 25,000 doctors in those states. 19,000 accepted –6,000 told them to go fish. For those that wanted ePrescibing Wellpoint gave them Allscripts or Zixcorp and paid for it for a year. For the rest they gave them a Dell desktop and connected them to a clearing house. 86% went for the desktop, only 14% took the ePrescribing package for which Wellpoint comped the $59 a month cost for a year. It seems that the rest were just getting a free computer to give to Betty in the front office and that that part of the giveaway had little value other than to make the physicians a little happier.
Of the 2700 who took the ePrescribing package, 2,000 registered on the system last year but only about 200 are using it with 30,000 Rxs submitted electronically. This program started in Fall 2004 so there is indeed some ramp-up to go, but in general, as Wellpoint’s chairman Len Schaeffer said, "free isn’t cheap enough". They are though doing a formal evaluation of both sides of the deal which will be available eventually.
The initial conclusion is that ePrescribing is not high on the radar screens of physicians, and getting to the small provider is a significant challenge.
Wellpoint did on another study in the northeast (Barbaro’s region) with a big MSGP (26 docs) to whom they gave an ePrescribing system. They found that with an ePrescribing system costs per Rx went down 2% in the Q3 2003 compared to Q3 2002, even though the number of scripts written continued to increase. As a control group they used other docs in the same region who’s costs per script went up 6%. Overall the PMPM costs of drugs for the target group was still higher that the control, suggesting that those docs were higher prescribers overall. But lots of other factors were being introduced at the same time. Most importantly they increased their level of generic prescribeing 4%, more than 4 times that of the control group. Which is a pretty sobering thing for pharma to consider until you realize that something like 30% of scripts written are never filled and presumably eScripts will be filled more or less automatically.
Barbaro’s view is that at some point if providers don’t have the systems to show that are giving value then they will just get less money. But this is going to be a long long haul.
A doc from Colorado somewhat disagreed and says that money would be better spent to get ePocrates to put PBM formularies on their software. He said that it’s just too hard to do ePrescribing without a full EMR. He thinks that it’ll fit their workflow better.
A tough topic for sure. The next day Mark McClellan from CMS said that ePrescribing will be mandatory for Medicare part D by 2009. But I’m not sure if that means mandatory for all doctors or just mandatory for the plans to accept eScripts. If it is mandatory for all doctors then we’ve only got three years to sort this out, which basically cannot be done — unless someone can show me another market that went from 5-10% penetration to 100% in three years!
So there’ll plenty more to say about this whole topic in the future.
Meanwhile I didn’t go but here’s the slides from a presentation about Kaiser’s EMR.
There’ll be more about McLellan either later today or tomorrow, but the hotel didnt have Wi-Fi so I wrote my notes by hand!! And typing them up later loses out to going to see the replay of today’s Chelsea v Barcelona Champions League game!
UPDATE: I am delighted to report that Chelsea beat Barcelona 4-2 in one of the better European Chanmpionship games of all time, going through to the next round.