A recent study published in JAMA Network Open is a valuable teaching tool for technology-focused health insurance executives. The study, titled “Prescription Use and Spending After the Introduction of a Real-Time Prescription Benefit Tool,” sheds light on the challenges and shortcomings involved with introducing an innovative tool designed to provide a meaningful impact on both patient outcomes and the bottom line.
The Unexpected Findings
The study, which analyzed the prescribing habits of clinicians serving 2.8 million Medicare Advantage beneficiaries, found that simply providing access to a real-time prescription benefit (RTPB) tool did not lead to the anticipated reductions in prescription costs for patients or health plans. Despite the tool’s ability to show clinicians lower-cost, medically appropriate alternatives at the point of prescribing, its impact was surprisingly minimal.
The researchers found the tool’s design and implementation actually hindered its use by requiring an extra click by the clinician to access the information. It also did not function with commonly used free-text prescriptions.
The study confirmed that anything that disrupts a busy clinician’s workflow faces significant barriers to adoption.
Leveraging Price Transparency with Greater Clinician Adoption Rates
This study is not a failure of the RTPB concept. It actually provides a valuable blueprint for how health insurance executives can move past basic implementation to truly leverage price transparency for their networks and their members.
Prioritize Seamless Integration Over Simple Deployment
This study underscores why the user experience (UX) for clinicians must be the top priority. By working with electronic health record partners to embed RTPB information directly into the prescribing workflow, the need for extra clicks can be removed. It is critical for the information to be seamlessly integrated into the process, rather than being a separate task.
To combat alert fatigue, configure the tool to provide “smart” alerts only when there is a significant cost-saving opportunity. This ensures that when an alert does appear, it is meaningful and actionable and captures the attention of the clinician.
Broaden the Scope and Target High-Value Areas
The study noted a small, but significant, change in spending for lipid-modifying agents, a drug class where the tool frequently suggested alternatives. This highlights the importance of strategic targeting and the need to ensure your RTPB tool can analyze a wider range of medications, especially those that are high-cost or have frequent low-cost alternatives.
It is also critical to leverage network intelligence to identify prescribing patterns where a simple switch to a lower-cost alternative could have the greatest impact on both patient out-of-pocket costs and overall plan spending.
Cultivate Trust and Collaborative Partnerships
The study also suggests that clinicians may hesitate to switch medications due to a lack of familiarity with alternatives or a concern about the accuracy of pricing data. Inaccurate or outdated pricing information will quickly erode clinician trust and render the tool useless. When introducing the RTPB tool, clinicians must be made aware that the tool is backed by the most precise and up-to-date provider and pharmacy data.
Build trust by personalizing the implementation process and working with providers to help them understand the clinical and financial benefits of the tool. Payers may also want to consider incorporating tool usage into quality and cost metrics within value-based care contracts to align incentives with better patient outcomes and lower costs.
The success of any price transparency tool ideally hinges on its ability to efficiently solve problems for the clinician and the patient, not just for the payer. By focusing on a collaborative, data-driven approach that ultimately overcomes workflow barriers, health insurance executives can successfully transform RTPB tools from a regulatory requirement into a powerful asset.