Frank Harvey, CEO of Surescripts, recently spoke with Healthcare innovation on a variety of topics, including a recent acquisition, the potential for pharmacists to play a larger role on primary care teams, and why Surescripts Health Information Network LLC is applying to become a Qualified Health Information Network (QHIN) under the Trusted Exchange Framework and Common Agreement (TEFCA).
Harvey succeeded Tom Skelton as CEO in 2022. Harvey, a pharmacist, has held leadership positions in the pharmaceutical, pharmaceutical and health technology sectors. He joined Surescripts from ATLS Investments LLC, where he led private equity investment in healthcare technology companies.
Healthcare Innovation: Could you talk a little about how the role pharmacists play in the healthcare ecosystem is evolving?
Harvey: There are two important things we face. One is the silver tsunami. Right now we have 58 million people aged 65 and over. It is estimated that in 2030 we will have 70 million people. By age 65, 80 percent of people have at least one chronic disease and 60 percent have two chronic diseases. Additionally, there is the burnout that doctors are feeling due to the pandemic, but it is not just about the pandemic. It’s all this administrative burden that we have imposed on doctors, pharmacists and the entire care team. An estimated 20 percent of doctors plan to retire in the next two years. So we have an aging population and an estimated shortage of about 135,000 primary care physicians by 2034.
We are not replacing them fast enough. That really forces us to look at the structure of the care team: how they work together and who can take on some of that work. When we look at the care team, pharmacists have the scope of training necessary to acquire much of that first level of primary care. They want to do that and it will also help with some of the pharmacist burnout that we’ve seen. Pharmacists are burning out just like doctors because they are focused on the menial tasks that should be eliminated from them in order to focus on more areas focused on primary care.
HCI: In many areas, independent pharmacies have largely disappeared and large retail chains dominate. Can pharmacists in those retail settings take on this role? And are those chains interested in having their pharmacist take on that role?
Harvey: Absolutely. I think if you look at all the major chains, they are already recognizing the need for the pharmacist’s work to evolve, including vaccinations which we did a great job on during the pandemic. We have to become chronic care managers, which means we have to let pharmacists handle that lower level of primary care to take some of that burden off the physician. There is actually a three-legged stool. One is technology. That’s the role of Surescripts: to ensure that we have the right clinical information in the hands of the pharmacist or doctor when they make those care decisions. A pharmacist or doctor doesn’t have all day to read a 300-page medical chart, so our technology helps reduce it to a summary.
Another leg of the stool is the refund policy. We need to modify reimbursement policy at both the CMS level and the health plan level to pay pharmacists for this additional activity. There has to be compensation for that or they won’t be able to afford it.
The third piece is that we need legislative changes throughout the United States and in the states. During the pandemic, HHS gave pharmacists broader privileges and extended them through December 2024. I think we need to make those privileges continue from there. Because states are responsible for licensing and monitoring, many of them have to pass laws to recognize the scope of pharmacists’ training and empower them to perform those functions. Studies we have done have shown that physicians are in favor of a pharmacist doing more as part of a collaborative care team and this really opens up their ability to focus on the things that are at the top of their training.
HCI: Surescripts surveys pharmacists about their top challenges, and a recent report says they talked about the need for electronic access to clinical information, benefit eligibility information, and electronic prior authorization. How difficult is it to collect that information and present it to them at the point of care?
Harvey: It’s not that difficult at all. In fact, we do it right now through your pharmacy operating systems. I think one of his articles from the last day was about some statistics on the burden of prior authorization. It is one of the most onerous things for the doctor’s office. Not only does it place an administrative burden on the doctor, but it also delays patient care.
We have an electronic prior authorization solution that is proactive. So when the doctor writes the prescription, our solution comes out immediately instead of having to take two or three days to process. Additionally, with the Surescripts real-time prescription benefits product, the doctor selects which medication he or she wants to give that patient and shows him or her therapeutic alternatives. It shows him and the patient what his benefit covers. He shows them what the retail costs will be. Almost 20 percent of patients go to the pharmacy and then the pharmacy has to call back to say, “Hey, this patient can’t afford this.” What can you do? You can change it?’ This is solved directly in the doctor’s office.
HCI: Surescripts recently bought a company called ActiveRadar. Can you explain what was attractive about that company?
Harvey: We looked at all the companies out there and truly felt that ActiveRadar had the best therapeutic alternative solution available. All health plans and all PBMs are required to have a therapeutic PMT committee that decides which drugs are interchangeable. It’s a really expensive proposition, particularly for smaller regional plans. Through its technology, ActiveRadar does that work for plans and PBMs. That allows them to say, “Okay, I’ll use yours instead of having to employ all these extra people to do it.” It also creates more consistency across all the different plans.
If you look at the benefit of real-time prescribing, it is also important to ensure that appropriate therapeutic alternatives are presented as part of that solution.
HCI: Surescripts Health Information Network has just announced that it will apply to be a QHIN under TEFCA. Who would be the logical partners to be subparticipants under the TEFCA?
Harvey: The pharmacies, the laboratories, the PBMs, the health plans. We are already the largest interoperability company in the country. We did 22 billion transactions last year. Only about 2.35 billion of them are actually recipes. The rest is all the clinical data.
We are very confident that we can serve everyone across the spectrum of healthcare. And if you think about the Qualified Health Information Networks at TEFCA, it really becomes a network of networks, as it will, because each one will be successful in bringing in people who will be their customers. We truly believe that the ONC team has done a wonderful job. If you think about the importance of this, it all comes down to the patient’s ability to make sure they are getting the right treatment when they are in front of a healthcare provider, because with an incomplete medical history, you are never sure. that the right decisions are being made.
HCI: In September, the company named Lynne Nowak, MD, its first chief data and analytics officer. Why did Surescripts see the need for that role? And what are some of the things she and her team are working on?
Harvey: Well, a great example is that ActiveRadar will be part of your organization. We know that data has the power to ensure that we focus on the things that could improve the quality of care, improve patient safety, and reduce the cost of care. When you have 22 billion transactions, there are so many things that can come from that, looking at that information, trying to identify those things that are best for the patient. We think there’s a significant opportunity for Lynne and our data scientists to really develop the things that will support those core parts of our mission.
HCI: Looking ahead to 2024, are there any other plans you want to talk about?
Harvey: We’re focused on trying to ease the administrative burden on care providers because we really see it as a crisis when you see pharmacists taking turns going on strike, so to speak, because of their working conditions and they’re not able to focus on things. what do they want. So our goal is to examine all the things we offer and continue to refine them. Over the past four years, we have improved the quality of e-prescriptions by more than 200 percent. We are working to ensure that our direct clinical messaging product is available and ubiquitous in healthcare so that the pharmacist can send messages to the doctor, the doctor can send messages to the pharmacist directly in the workflow, eliminating the administrative burden of have to send a fax. Healthcare is probably one of the last strongholds of faxing. We would really like to see the end of that fax machine and we believe that many of our technologies will be useful to that end.
HCI: Is there any way all of this excitement and development around artificial intelligence and large language models can be applied to the work you guys do?
Harvey: Sometimes people confuse machine learning and generative AI. We have been using machine learning from the beginning within our products. We’re starting to look at generative AI. We think there are a few things we can use it for. However, I will say that we are being very cautious because there are still many unknowns about generative AI and it has hallucinations. When it comes to the patient’s history, you cannot have hallucinations. So we’re looking at it, testing it, doing a lot of piloting things around it, but until we’re absolutely sure that it’s what it needs to be, we won’t implement it into our overall system. briefcase.
