Q&A: Surescripts CEO Frank Harvey

Frank Harvey, CEO of Surescripts, lately spoke with Healthcare Innovation a couple of vary of points, together with a latest acquisition, the potential for pharmacists to play a bigger function on main care groups, and why Surescripts Well being Info Community LLC is making use of to develop into a Certified Well being Info Community (QHIN) beneath the Trusted Change Framework and Frequent Settlement (TEFCA). 

Harvey succeeded Tom Skelton as CEO in 2022. A pharmacist himself, Harvey has held management positions within the healthcare know-how, pharmacy and pharmaceutical sectors. He joined Surescripts from ATLS Investments LLC, the place he led non-public fairness investing in healthcare know-how corporations.

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

Harvey: There are two main issues that we’re dealing with. One is the silver tsunami. Proper now we’ve got 58 million individuals aged 65 and older. By 2030, it is estimated that we’ll have 70 million individuals. By age 65, 80 % of individuals have at the least one power situation and 60 % of individuals have two power situations. As well as, you’ve the burnout that clinicians are feeling due to the pandemic — but it surely’s not simply the pandemic. It is all this administrative burden that we have placed on physicians, pharmacists and your entire care workforce. It is estimated that 20 % of physicians plan to retire within the subsequent two years. So you’ve got obtained an growing old inhabitants, and you have got an estimated scarcity of about 135,000 main care physicians by 2034.

We’re not changing them quickly sufficient. So that basically forces us to have a look at the care workforce construction — how they work collectively, and who can choose up a few of that slack. If you take a look at the care workforce, pharmacists have the scope of coaching to choose up numerous that first degree of main care. They wish to do this and it’ll assist with a number of the pharmacist burnout we have seen, too. Pharmacists are burning out similar to physicians as a result of they’re targeted on the menial duties that they need to be faraway from to allow them to give attention to extra of the first care-focused areas.

HCI: In lots of areas, the impartial pharmacies have largely disappeared and the big retail chains dominate. Can the pharmacists in these retail environments tackle this function? And are these chains inquisitive about seeing their pharmacist tackle that function?

Harvey: Completely. I believe in case you take a look at all the key chains, they’re already acknowledging the necessity for the pharmacist job to evolve, together with doing immunizations that we did such an important job of through the pandemic. We now have to develop into power care managers, which suggests we’ve got to let pharmacists do this decrease degree of main care to alleviate a few of that burden from the doctor. There’s actually a three-legged stool. One is know-how. That’s the function of Surescripts, ensuring we have got the suitable medical data within the arms of the pharmacist or the doctor after they’re making these care selections. A pharmacist or a doctor does not have all day to learn via a 300-page medical chart, so our know-how helps boil that right down to a abstract.

One other leg of the stool is the reimbursement coverage. We now have to amend reimbursement coverage each on the CMS degree and on the well being plan degree to pay pharmacists for this extra exercise. There’s obtained to be compensation for that or they can not afford to do it. 

The third piece is we’d like legislative modifications throughout the U.S. and within the states. Throughout the pandemic, HHS gave pharmacists broader privileges and so they prolonged that via December of 2024. I believe we have to make these privileges go on from there. As a result of states are liable for licensure and monitoring, numerous the states should cross laws to acknowledge the scope of the pharmacists’ coaching and empower them to supply these capabilities. The research we have carried out have proven that physicians are in favor of a pharmacist doing extra as a part of a collaborative care workforce and it actually opens up their skill to give attention to the issues which are on the high of their their coaching.

HCI: Surescripts does surveys of pharmacists about their high challenges, and a latest report stated they spoke concerning the want for digital entry to medical data, profit eligibility data, and digital prior authorization. How tough is it to assemble that data and current it to them on the level of care? 

Harvey: It isn’t that tough in any respect. As a matter of truth, we do this proper now via their pharmacy working techniques. I believe one in every of your articles within the final day or so was about some statistics concerning the burden of prior authorization. It is probably the most burdensome factor for the doctor’s workplace. It isn’t solely administratively burdening for the doctor, but it surely additionally delays take care of the affected person.

We now have an digital prior authorization answer that is proactive. So when the doctor is writing the prescription, our answer goes out instantly reasonably than having to take two or three days to undergo a course of. As well as, with the Surescripts real-time prescription profit product, the doctor pulls up what treatment he needs to offer that affected person, and it exhibits him therapeutic options. It exhibits him and the affected person what their profit covers. It exhibits them what the prices might be at retail. Nearly 20 % of sufferers will go to the pharmacy, after which the pharmacy has to name again to say ‘hey, this affected person cannot afford this. What are you able to do? Can you modify it?’ You get that taken care of proper on the doctor’s workplace.

HCI: Surescripts lately purchased an organization known as ActiveRadar. Are you able to clarify what was enticing about that firm?

Harvey: We checked out all the businesses on the market and we actually felt like ActiveRadar had the most effective therapeutic various answer out there. All of the well being plans and all PBMs should have a therapeutic PMT committee that decides what medication are interchangeable. It’s a extremely costly proposition, significantly for smaller regional plans. Via their know-how, ActiveRadar form of does that work for for the plans and for the PBMs. That enables them to say, ‘Okay, I am going to simply use yours reasonably than having to make use of all these further people to do it.’ It creates extra consistency throughout all of the totally different plans as nicely. 

For those who take a look at real-time prescription profit, ensuring the suitable therapeutic options are introduced as part of that answer is vital as nicely.

HCI: Surescripts Well being Info Community simply introduced it is making use of to be a QHIN beneath the TEFCA framework. Who could 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 firm within the nation already. We did 22 billion transactions final 12 months. Solely about 2.35 billion of these are literally prescriptions. The remaining is all of the medical knowledge. 

We’re very assured that we are able to serve everybody throughout the spectrum of healthcare. And if you concentrate on the Certified Well being Info, Networks in TEFCA, it actually does develop into a community of networks, as you’ll, as a result of each goes to achieve success bringing in individuals who might be their prospects. We actually assume the workforce at ONC has carried out a beautiful job. If you concentrate on what is the significance of this, it comes again to the affected person’s skill to ensure they’re getting the suitable remedy after they’re in entrance of a care supplier, as a result of with an incomplete medical report, they’re by no means certain that the suitable selections are being made.


HCI: In September, the corporate named Lynne Nowak, M.D., its first chief knowledge and analytics officer. Why did Surescripts see a necessity for that function? And what are a number of the issues that she and her workforce are engaged on?

Harvey: Properly, an important instance is that ActiveRadar goes to be part of her group. We all know the information has energy to ensure that we’re targeted on the issues that might be bettering the standard of care, bettering affected person security and decreasing the price of care. When you’ve 22 billion transactions, there’s so many issues that may come out of that, that data, making an attempt to determine these issues which are finest for the affected person. We imagine there is a vital alternative for Lynne and our knowledge scientists to actually construct out the issues that can assist these core components of our mission.

HCI: Looking forward to 2024, are there another plans you wish to discuss?

Harvey: We’re targeted on making an attempt to take the executive burden away from the care suppliers as a result of we actually do see it as a disaster whenever you see the pharmacists taking turns happening strike, if you’ll, due to their working situations and so they’re not in a position to give attention to the issues that they wish to. So our goal is to look throughout the entire issues we offer and proceed to good them. Within the final 4 years, we have improved the standard of e-prescriptions by over 200 %. We’re engaged on ensuring that our medical direct messaging product is on the market and pervasive via healthcare so the pharmacist can message the doctor, the doctor can message the pharmacist proper in workflow, eradicating the executive burden of getting to ship a fax. Healthcare might be one of many final bastions of the fax machine. We would like to see an finish of that fax machine and we imagine numerous our applied sciences might be useful in that finish.

HCI: Are there some ways in which all this pleasure and growth round synthetic intelligence and enormous language fashions can apply to the work you guys do?

Harvey: Folks typically combine up machine studying and generative AI. We have been utilizing machine studying because the very starting inside our merchandise. We’re beginning to have a look at generative AI. We do assume there are some issues we are able to put it to use for. Nonetheless, I am going to say we’re being actually cautious as a result of there are nonetheless numerous unknowns about generative AI and it has hallucinations. If you’re coping with the affected person’s report, you may’t have hallucinations. So we’re it, we’re testing it, doing numerous pilot issues round it, however till we’re completely certain that it is what it must be, we’re not going to roll it out into our general portfolio.