ComputerTalk senior editor Will Lockwood caught up recently with Marc Cohen, senior director of marketing for RelayHealth, to talk about what's happening in the world of claims processing and switching services.
It turns out that there are some interesting new additions being made that build on the transactional expertise and connectivity that are the core elements of these services.
CT: Marc, most pharmacists likely view their switching service as a tool, the main function of which is to facilitate getting claims paid.
Is that a fair assessment?
Cohen: It's true that people think of a switch as just a claims adjudication network designed to get a claim from the pharmacy to the payer, maybe provide a message in response, and confirm whether the claim is going to be paid or not. And that's what switching is at its foundation, at its simplest. But what we are doing at RelayHealth is making this process more intelligent, creating what we call an intelligent network, if you will. What this means is that we can do a lot of things with a claim. We can maximize reimbursement. We can do clinical, financial, and administrative edits. And with a new service we're offering called NotifyRx, we can further impact patient safety by providing pharmaceutical manufacturer messaging.
CT: So the switch is now a resource to help pharmacists with patient safety. How does this work?
Cohen: We've been offering safety-oriented services, for example with our RxSafety Advisor program the pharmacy has the ability to look at a claim and recognize look-alike and sound-alike drug pairs. NotifyRx adds another layer of protection for patients. This service will return patient safety and process efficiency messaging - for example, because of a product recall, withdrawal or disposal, or changes such as product name, formulation, approved uses, black box warnings, patient education, formulary, and clinical relevancy. Pharmacists get important information that they can pass on to their patients immediately and that does not disrupt their workflow because the messaging occurs at data entry. We've designed NotifyRx to help ensure that the patient is getting the right medication, the safest medication, and the safest process.
CT: Can you give me an example?
Cohen: A really good example is work that we've been doing with Reliant Pharmaceuticals. They have a drug called Omacor, which the FDA decided was too similar in name to another drug. Reliant needed a way to notify pharmacies and the public that they changed the name to Lovaza. We are able to offer a very efficient way to accomplish this by messaging the pharmacy at the time a claim is submitted. This prevents things like polypharmacy where someone might get two different prescriptions, getting Omacor the first time and Lovaza the next.
CT: You mentioned earlier that this messaging is designed not to disrupt workflow. Tell me more about that.
Cohen: The process uses hard stops or edits. This means that when a pharmacist transmits a prescription for a drug that has messaging associated with it, NotifyRx will immediately return a message that requires action on the part of the pharmacist in order to continue processing the claim. In the case of Omacor, first the messages informed the pharmacist that the name would be changing in a specified number of weeks. Then the message became "the name has changed." Finally the message read "Lovaza was formerly Omacor." Based on the message and program, the pharmacist may verify the drug, educate the patient to changes, or take other required actions.
If there's a voluntary FDA product recall, the message would say, in effect, ‘voluntary recall, please notify the patient, do not dispense.' Because these are patient and medication safety issues, they require hard stops. This helps pharmacists be more efficient because they won't have to touch a prescription with a safety issue multiple times. They'll know not to dispense it in the first place. A great example of this is one voluntary FDA recall when NotifyRx made something like 13,000 hard stops in the first 12 days. That means that 13,000 prescriptions for this particular recalled drug did not get into patients hands. That's a tremendous addition to safety and dispensing efficiency.
CT: Do customers of what I'll call your basic switching service need to opt-in to intelligent network services such as NotifyRx?
Cohen: Yes, anyone who switches through RelayHealth is eligible for these and a variety of other products and services that we offer, of which NotifyRx is the newest along with a medication history product called IntegrateRx. This allows pharmacies, physicians, and hospitals to transmit prescription information if someone is admitted to the emergency room.
CT: It sounds like there's a lot happening when it comes to building on the connectivity that a switch provides.
Cohen: Absolutely, and it is important to us because our goal is to bring value to the pharmacy from both a financial and a patient safety perspective. In turn, the pharmacist gains time to spend counseling, getting involved in medication therapy management, and staying profitable. A pharmacist is an important part of the healthcare continuum and we want to make them as value as possible by allowing them to spend time with patients and not having to spend all their time doing a lot of mundane tasks.
CT: Thanks for you time, Marc.