Blue Cross and Blue Shield Plans

Blues Plans Are Introducing More E-Prescribing Pilots, Initiatives

Reprinted from the February 2007 issue of The AIS Report on Blue Cross and Blue Shield Plans, a hard-hitting independent monthly newsletter on business strategies, products and markets, mergers and alliances, and financing of BC/BS plans.

WellPoint, Inc. is joining other Blues plans in sponsoring e-prescribing for providers, partnering with General Motors Corp. (GM) in an Ohio-based e-prescribing pilot and co-sponsoring the National ePrescribing Patient Safety Initiative (NEPSI). Meanwhile, Blue Cross and Blue Shield of Florida (BCBSF) is initiating an effort with four major health plans in that state to promote e-prescribing to members. According to another plan, e-prescribing sponsorship has sped adoption of such tools, which are helping to reduce drug-related medical errors and improve cost savings for health plans, enrollees and payers.

WellPoint, along with Aetna, Inc. and Horizon Blue Cross Blue Shield of New Jersey, are health plan sponsors of NEPSI, which offers providers eRx NOW, a free Web-based e-prescribing tool developed by Allscripts, LLC. Through its Anthem subsidiary in Ohio, WellPoint also is piloting a one-year e-prescribing program that will pay for 100 providers in the Dayton and Warren/Youngstown areas to implement and use e-prescribing services provided by Quest Diagnostics subsidiary MedPlus.

Both NEPSI and the Anthem pilot are significant developments, says Tony Schueth, CEO and managing partner at e-health consulting firm Point-of-Care Partners. "GM has a vested interest in this. They spend a significant amount of money per car on [health care]. They have a vested interest in improving patient safety and reducing health care costs," he says. NEPSI is "exciting as well, and there are health plans that are sponsoring it as well. It's a win win win," he asserts. "If the doctor uses [e-prescribing], studies show it improves efficiency and reduces medication errors," he explains.

NEPSI says that a July 2006 study by the Institute of Medicine of the National Academy of Sciences found that preventable medication errors injure at least 1.5 million Americans and claim more than 7,000 lives a year. However, fewer than one in five providers now use e-prescribing, according to NEPSI. And "studies indicate that most physicians have been reluctant to adopt electronic prescribing largely because of the cost of the systems, and a perception that the technology requires too much time to learn and install."

Small Physician Practices Are Obstacles

Indeed, Charles Kennedy, M.D., vice president of health information technology (HIT) at WellPoint, explains that "physicians practice in solo to small group practices, and that has been a historically hard market to break into. That makes implementation more complicated. One of the reasons we were interested in working with Quest on this is that they could contact physicians already" about e-prescribing.

According to Kennedy, the plan is introducing the pilot in Ohio because of its relationship with GM and the state's demographics. The state "is frequently used for polls and other surveys across America," he says.

Kennedy tells The AIS Report that Anthem modified its pay-for-performance program in Ohio to increase pilot participants' fee schedule by 1%. "That provided a good financial incentive for [providers] to try something," he says. He adds that the system can be integrated into the participant's practice-management system and used for all of the provider's patients.

The pilot also includes a fee-schedule increase of 2% for participating providers who implement a full electronic medical record, says Sam Shalaby, director of community health care initiatives at GM. He adds that providers will receive a 5% to 12% increase in their fee schedule if they meet benchmarks for increasing generic prescriptions and making other improvements. "Hopefully that will increase the adoption of the technology," Shalaby says.

GM has about 61,000 health plan enrollees in the two Ohio regions — 31,000 in Dayton and 30,000 in Warren/Youngstown, according to Shalaby. He expects that all of GM's health plan enrollees in the area eventually will have e-prescribing available through their providers. But "the target for 2007 is to expand it by an additional 200 physicians."

The pilot is providing up to $750 in computer hardware and paying the $40 monthly subscription fee for providers participating in the pilot, says Kennedy. According to Shalaby, half of the hardware reimbursement is made up front, and the other half is made three months after the provider begins using the e-prescribing.

WellPoint spokesperson Jim Gavin says the health plan identified 250 out of about 3,200 providers for the program and then capped participation at 100 providers. He stresses that "it's not a program targeted toward a lot of doctors in our network." Kennedy notes that high prescription volume was a factor in selecting providers, but "there were also some surveys in terms of interest level of physicians."

Fla. Blues Let Providers Choose Vendors

In Florida, BCBSF is joining with four other major health insurers in the state to increase use of e-prescribing by providers. But the plans are taking a different approach than NEPSI. "One of the core differences is that NEPSI is focused on a specific product; our approach is vendor agnostic," says Catherine Peper, vice president of health information technology for BCBSF. "Physicians want to exercise choice over the vendor and products that they use," she asserts. In addition, "our physicians have told us very clearly" that they want the products to be interoperable with multiple payers. Therefore, the ePrescribe Florida collaborative is establishing criteria for vendors of the technology. She says that plans will require certification from the Certification Commission for Healthcare Information Technology and will also look for vendors that certified with SureScripts and RXhub.

Florida providers are already beginning to adopt e-prescribing and HIT. "About 24% of [BCBSF] physicians already have e-health records. And 60% of the providers who have an EMR system are using e-prescribing as one of the features. We want to drive that up; we want it to be 100%," Peper says.

The effort is still in its first phase, Peper tells The AIS Report. The collaborative has just established two committees - a provider outreach committee, and a vendor outreach and requirements committee. "They have 30 days to come up with their work plan," she says. Following the committees' decisions, the collaborative will begin performing outreach to interested providers and offer e-prescribing to providers that have made a choice.

Provider incentives that could be part of the effort, she says, are "really part of the second phase." She adds that incentives for the program would be left up to the individual health plans.

Beyond the benefits of patient safety, e-prescribing can lower members' medication costs by increased use of generic drugs and drugs in their formulary, Peper says. In addition, "we hope to increase [members'] compliance with maintenance medications." E-prescribing will allow physicians to see if a provider's patients are taking the prescribed medication, she says. The tools also can produce a "30% to 50% reduction in callbacks" from pharmacies to providers to check on prescriptions for errors and lack of clarity, she says.

BCBSF's partners are UnitedHealthcare, Humana Inc., CIGNA Corp. and Av-Med Health Plans in a venture called ePrescribe Florida.

Blue Cross and Blue Shield of Massachusetts has experienced positive results through its e-prescribing system, says spokesperson Chris Murphy. The plan has promoted e-prescribing since 2002 and in 2004 began offering providers wireless e-prescription tools and software through the eRx Collaborative, a partnership with Tufts Health Plan, Neighborhood Health Plan, Zix Corp. and DrFirst.

That effort has resulted in 8,000 prescription changes a month, Murphy says. "Those are corrected because the e-prescription system caught an error." The e-prescribing program and adoption of HIT has led to cost savings and reduced administrative overhead, he says. BCBSMA also added 850 new prescribers in 2006, Murphy notes.

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