We need outside innovation to fix our broken system.
Health care administrative costs in United States are out of control; for example, one paper has suggested hospital administrative costs alone amounting to more than $600 per capita. Warren Buffett has even described health care expenses (as a whole) as "the tapeworm of the US economy"’ We have overwhelmed ourselves in so much red tape that is affecting our budgets and the spirits of our practitioners alike and based on indicators of effectiveness, such as access to and equality of care, we have little to show for it.1,2,3
Physicians are burned out with the likes of ICD-10 coding, EMR, and MACRA documentation, and going to trial with the insurance company to fill out prior authorizations and other paperwork for a medication they know their patient truly needs. Pharmacists are burned out guessing patient insurance information or making long phone calls to play their games, like what part of the ID number to put in the ID field or whether or not we need a person, relationship, or residence code.
Everyone is burned out with reams of paperwork to maintain compliance with the alphabet soup of HIPAA, CMS FWA, Boards of Pharmacy/Medicine/Nursing, DMEPOS, TJC, etc. While regulation is a significant part of the issue and overhaul is needed, the way that we process the regulation and maintain compliance is equally broken. Silicon Valley, we need you to take your innovative, groundbreaking, world-changing companies and apply them to our broken health care system.
We know you are working on incredible solutions to fix some of the most pressing treatment options — like Verily, for example, that is working on a wearable device to continuously monitor blood glucose or using data analytics to improve population health. Those solutions are amazing and we are excited to see them.
However, working on technology solutions to simplify and streamline our work so we can get back to our patients will also provide a huge boost in quality and outcomes. For example, maybe for insurance cards you could place a QR or barcode on the card that we could scan and would bring up the most recent insurance? If all major insurance companies participated in such a program it could help patients who didn’t realize, for example, that their employer switched from Humana to Aetna. For Prior Authorizations we do have CoverMyMeds, but maybe we could create a more real-time electronic system with the insurer where we could check status and comments that come directly from the insurance company. That would save us time from having to call the doctor’s office or the insurance company because the patient is in our pharmacy asking about it. Unfortunately, you might not realize, but most of us as pharmacists and pharmacy technicians spend at least 25% of our time handling insurance claims, and some would argue they spend much more time than that. We went to school for way too long for our time to be spent doing that and we want to get back to taking care of patients and improving health care quality.
On our e-Rx’s, one of us has posed the idea of a ‘Return to Sender’ button with comments so that we can put the e-Rx back in the doctor’s office queue for clarification rather than having to call them and interrupt their day and interrupt their crucial time with their patients.4 The current system takes more time for the pharmacist, the medical assistant or nurse, and the doctor. If we could free up time in all our days, imagine what more we could do for our patients.
For insurance companies, what if we had an online database of drugs that were on formulary with a patient’s expected copay? What if we could scan that QR or barcode we talked about earlier, on the patient’s insurance card, into an online system and then type the NDC of the drug, where it would instantly return an expected copay for the patient that took into account their deductible and the tier of the medication, or let us know if a prior authorization was required for the drug? If a prior authorization was required, what if we could then send the request to the physician directly from that website?
Our health care system is ripe with opportunity for these types of low-hanging fruit interventions that are a win-win for everyone. There is nothing political about improving efficiency, reducing cost without compromising quality, and improving satisfaction for the providers and for the patients. Unfortunately, as we address healthcare in this country, very few people are putting the overall cost of healthcare as a top priority in legislation. We spend a lot of time talking about how we will pay for health care, but not much time talking about why we pay what we do. I hope you can help us change that.
1. Gamlin R. Administrative costs are killing US healthcare. Medical Economics 2016 May 21. Accessed online July 8, 2017 at http://medicaleconomics.modernmedicine.com/medical-economics/news/administrative-costs-are-killing-us-healthcare.
2. Davis K, Stremikis K, Squires D, Schoen C. Mirror, mirror on the wall: how the performance of the US healthcare system compares internationally. The Commonwealth Fund 2014 Update. Accessed online July 8, 2017 at http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf
3. Adamopolous H. Why US hospital administrative costs are among the highest in the world: 7 things to know. Becker Hospital Review
4. The Cynical Pharmacist. Electronic prescriptions: return to sender. Drug Topics 2014 June 10. Accessed online July 8, 2017 at http://drugtopics.modernmedicine.com/drug-topics/content/tags/e-prescribing/electronic-prescriptions-return-sender?page=full.