Frank Harvey, CEO of Surescripts, not too long ago spoke with Healthcare Innovation a few vary of problems, together with a up to date acquisition, the opportunity of pharmacists to play a bigger function on number one care groups, and why Surescripts Well being Data Community LLC is making use of to turn out to be a Certified Well being Data Community (QHIN) beneath the Relied on Alternate Framework and Not unusual Settlement (TEFCA). 

Harvey succeeded Tom Skelton as CEO in 2022. A pharmacist himself, Harvey has held management positions within the healthcare generation, pharmacy and pharmaceutical sectors. He joined Surescripts from ATLS Investments LLC, the place he led personal fairness making an investment in healthcare generation firms.

Healthcare Innovation: May just you communicate just a little bit about how the function that pharmacists play within the healthcare ecosystem is evolving? 

Harvey: There are two primary issues that we are dealing with. One is the silver tsunami. At the moment now we have 58 million folks elderly 65 and older. Through 2030, it is estimated that we will have 70 million folks. Through age 65, 80 % of folks have a minimum of one power situation and 60 % of folks have two power prerequisites. As well as, you’ve got the burnout that clinicians are feeling as a result of the pandemic — however it isn’t simply the pandemic. It is all this administrative burden that we’ve got placed on physicians, pharmacists and all of the care group. It is estimated that 20 % of physicians plan to retire within the subsequent two years. So you have got an getting older inhabitants, and you have got an estimated scarcity of about 135,000 number one care physicians by means of 2034.

We aren’t changing them unexpectedly sufficient. In order that actually forces us to have a look at the care group construction — how they paintings in combination, and who can select up a few of that slack. Whilst you have a look at the care group, pharmacists have the scope of coaching to select up numerous that first stage of number one care. They wish to do this and it is going to lend a hand with one of the vital pharmacist burnout we’ve got noticed, too. Pharmacists are burning out similar to physicians as a result of they are targeted at the menial duties that they will have to be got rid of from so they are able to focal point on extra of the main care-focused spaces.

HCI: In lots of spaces, the impartial pharmacies have in large part disappeared and the huge retail chains dominate. Can the pharmacists in the ones retail environments take in this function? And are the ones chains fascinated about seeing their pharmacist tackle that function?

Harvey: Completely. I believe if you happen to have a look at all of the primary chains, they are already acknowledging the desire for the pharmacist activity to conform, together with doing immunizations that we did one of these nice activity of all the way through the pandemic. We need to turn out to be power care managers, this means that we need to let pharmacists do this decrease stage of number one care to alleviate a few of that burden from the doctor. There’s actually a three-legged stool. One is generation. That’s the function of Surescripts, ensuring we’ve got were given the precise scientific knowledge within the palms of the pharmacist or the doctor when they are making the ones care choices. A pharmacist or a health care provider does not have all day to learn via a 300-page scientific chart, so our generation is helping boil that right down to a abstract.

Every other leg of the stool is the repayment coverage. We need to amend repayment coverage each on the CMS stage and on the well being plan stage to pay pharmacists for this extra job. There may be were given to be reimbursement for that or they are able to’t manage to pay for to do it. 

The 3rd piece is we want legislative adjustments around the U.S. and within the states. Right through the pandemic, HHS gave pharmacists broader privileges and so they prolonged that via December of 2024. I believe we want to make the ones privileges cross on from there. As a result of states are answerable for licensure and tracking, numerous the states must move regulation to acknowledge the scope of the pharmacists’ coaching and empower them to supply the ones purposes. The research we’ve got finished have proven that physicians are in desire of a pharmacist doing extra as a part of a collaborative care group and it actually opens up their talent to concentrate on the issues which might be on the best in their their coaching.

HCI: Surescripts does surveys of pharmacists about their best demanding situations, and a up to date file stated they spoke in regards to the want for digital get admission to to scientific knowledge, get advantages eligibility knowledge, and digital prior authorization. How tough is it to assemble that knowledge and provide it to them on the level of care? 

Harvey: It is not that tough in any respect. As an issue of reality, we do this at the moment via their pharmacy running programs. I believe one in all your articles within the ultimate day or so was once about some statistics in regards to the burden of prior authorization. It is one of the vital burdensome factor for the doctor’s place of business. It is not most effective administratively burdening for the doctor, however it additionally delays handle the affected person.

We now have an digital prior authorization resolution that is proactive. So when the doctor is writing the prescription, our resolution is going out instantly fairly than having to take two or 3 days to head via a procedure. As well as, with the Surescripts real-time prescription get advantages product, the doctor pulls up what drugs he needs to present that affected person, and it presentations him healing possible choices. It presentations him and the affected person what their get advantages covers. It presentations them what the prices shall be at retail. Virtually 20 % of sufferers will cross to the drugstore, after which the drugstore has to name again to mention ‘hello, this affected person can not manage to pay for this. What are you able to do? Are you able to alternate it?’ You get that looked after proper on the doctor’s place of business.

HCI: Surescripts not too long ago purchased an organization referred to as ActiveRadar. Are you able to provide an explanation for what was once horny about that corporate?

Harvey: We checked out all of the firms in the market and we actually felt like ActiveRadar had the most efficient healing choice resolution to be had. The entire well being plans and all PBMs must have a healing PMT committee that comes to a decision what medication are interchangeable. It’s a actually pricey proposition, in particular for smaller regional plans. Via their generation, ActiveRadar form of does that paintings for for the plans and for the PBMs. That lets them say, ‘K, I’m going to simply use yours fairly than having to make use of these kind of further people to do it.’ It creates extra consistency throughout all of the other plans as smartly. 

In case you have a look at real-time prescription get advantages, ensuring the precise healing possible choices are offered as part of that resolution is vital as smartly.

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

Harvey: The pharmacies, the labs, PBMs, the well being plans. We’re the biggest interoperability corporate within the nation already. We did 22 billion transactions ultimate 12 months. Simplest about 2.35 billion of the ones are in reality prescriptions. The remainder is all of the scientific information. 

We’re very assured that we will serve everybody around the spectrum of healthcare. And if you happen to consider the Certified Well being Data, Networks in TEFCA, it actually does turn out to be a community of networks, as you’ll, as a result of every one goes to achieve success bringing in individuals who shall be their consumers. We actually suppose the group at ONC has finished a good looking activity. In case you consider what is the significance of this, it comes again to the affected person’s talent to ensure they are getting the precise remedy when they are in entrance of a care supplier, as a result of with an incomplete scientific file, they’re by no means positive that the precise choices are being made.


HCI: In September, the corporate named Lynne Nowak, M.D., its first leader information and analytics officer. Why did Surescripts see a necessity for that function? And what are one of the vital issues that she and her group are operating on?

Harvey: Smartly, a really perfect instance is that ActiveRadar goes to be part of her group. We all know the knowledge has energy to ensure that we’re targeted at the issues that may be making improvements to the standard of care, making improvements to affected person protection and decreasing the price of care. You probably have 22 billion transactions, there’s such a lot of issues that may pop out of that, having a look at that knowledge, looking to determine the ones issues which might be perfect for the affected person. We consider there is a important alternative for Lynne and our information scientists to actually construct out the issues that can strengthen the ones core portions of our undertaking.

HCI: Taking a look forward to 2024, are there some other plans you need to speak about?

Harvey: We are taken with looking to take the executive burden clear of the care suppliers as a result of we actually do see it as a disaster while you see the pharmacists taking turns happening strike, if you’ll, as a result of their operating prerequisites and they are no longer in a position to concentrate on the issues that they wish to. So our goal is to appear throughout all the issues we offer and proceed to best them. Within the ultimate 4 years, we’ve got progressed the standard of e-prescriptions by means of over 200 %. We’re operating on ensuring that our scientific direct messaging product is in the market and pervasive via healthcare so the pharmacist can message the doctor, the doctor can message the pharmacist proper in workflow, taking away the executive burden of getting to ship a fax. Healthcare is almost definitely one of the most ultimate bastions of the fax gadget. We’d actually like to look an finish of that fax gadget and we consider numerous our applied sciences shall be useful in that finish.

HCI: Are there many ways that each one this pleasure and building round synthetic intelligence and massive language fashions can observe to the paintings you guys do?

Harvey: Other people every so often combine up gadget studying and generative AI. Now we have been the use of gadget studying because the very starting inside of our merchandise. We are beginning to have a look at generative AI. We do suppose there are a few things we will put it to use for. Then again, I’m going to say we are being actually wary as a result of there are nonetheless numerous unknowns about generative AI and it has hallucinations. When you are coping with the affected person’s file, you’ll be able to’t have hallucinations. So we are having a look at it, we are checking out it, doing numerous pilot issues round it, however till we are completely positive that it is what it must be, we’re no longer going to roll it out into our general portfolio.