CATALYST CORNER: November/December 2013

New Resources Highlight Trends

A number of interesting resources have made their way into my email news during the last few weeks that I thought would be of interest to ComputerTalk readers. I also wanted to share some IT-related observations from my participation in a recent American Pharmacists Association (APhA) Foundation Project ImPACT: Diabetes Community Champions event held during American Pharmacists Month.

First, the Kaiser Family Foundation has created a Web-based interactive tool that allows users to examine how the Affordable Care Act (ACA) may affect various groups of uninsured people. The Uninsured: An Interactive Tool allows analysis of how many people are uninsured, why they lack coverage, and how they may gain coverage under the ACA. Last year 47.3 million nonelderly people were uninsured. The ACA has the potential to reach a broad range of groups through expanded coverage. Various subgroups are listed at right.

Through an easy-to-navigate format, a click on each area provides details on the number of people in the category, reasons they are uninsured, where they may gain coverage through the ACA (through Medicaid or health exchanges), and related resources. I found it of interest in understanding a part of the population that may benefit from the new health exchanges. The tool is accessible at http://kff.org/interactive/the-uninsured-an-interactive-tool/.

Expanding Coverage
The subgroups of uninsured nonelderly people who will potentially have new health insurance coverage under the ACA.
■ Self-employed
■ Works for a small business
■ Part-time worker
■ Unemployed
■ Young adult
■ Near-elderly
■ Has a pre-existing condition
■ Living with a mental illness
■ Living with a disability
■ Living in a rural area

The controversy over the rollout of the federal health exchange and the KFF site reminded me that I had yet to visit the Minnesota health exchange, MNSURE, to see if I might find a better health plan as a self-employed consultant. The MNSURE site had its share of issues during its opening weeks, primarily due to the volume of people trying to access it. In about 30 minutes, I was able to quickly compare plans to my present coverage. However, to see if my particular physicians and other providers were in-network, I had to visit each insurer’s website. Additionally, quality ratings have not yet been added to the site. The bottom line is that most plans were slightly more expensive than my current coverage, with a couple of exceptions that could net about a $23-per-month savings. Those plans, however, did not include all my providers in their network. My current plan is changing based on ACA requirements related to mental health and substance abuse coverage and out-of-pocket limits. I have quite intentionally held my premiums down with high-deductible, catastrophic coverage. Unfortunately, because of the out-of-pocket deductible limit requirement, my monthly premium will increase $17 per month, while the deductible is being reduced by $400 per year. Given the hassle of applying for new insurance, I’ve decided to remain with my current coverage. But I can see where, for many, the new exchange will be of value.

One of the things I really like about my current provider is that it was one of the first to provide patient access to an electronic medical record (EMR) system. I can access my physician and other providers via secure e-mail, make appointments, and get referrals and all my health information. I can’t imagine not having it anymore, given how convenient I have found it during the last several years. Apparently, I am not alone in the desire to access personal health records electronically. In mid-October, Health Information Network (HIN) blogger Jackie Lyons posted results from a new Accenture “infographic” based on its Consumer Survey of Patient Engagement. Accenture found that 84% of consumers in the United States believe they should have full access to their electronic medical records, and 41% said they would be willing to switch physicians to gain online access. Fully 95% of consumers surveyed believe they should have some access to their online records, with 71% saying they should be able to update their record with personal information and medication side effects. Interestingly, only 34% of physicians shared the belief of patient online access to the EMR. I can vouch for that based on a straw poll I conducted while participating in a primary-care physician program shortly after the survey was released. Attendees were a bit surprised by the trend; whether it will impact their desire to implement more electronic HIT remains to be seen. The Accenture infographic also highlights global EMR trends, identifies other important services reported by consumers (making appointments, ordering refills, etc.), and reviews current access to electronic records. You may access it at http://hin.com/blog/2013/10/18/infographic-patientswant-access-to-their-electronic-medical-records/.

Pharmacists Can Make a Difference

Finally, as I mentioned, I had the good fortune to participate in a meeting of the APhA Foundation’s Project ImPACT: Diabetes Community Champions held in late October during American Pharmacists Month. Launched in 2010 in partnership with the Bristol-Myers Squibb Foundation’s Together on Diabetes initiative, Project IMPACT: Diabetes is the first national research initiative to improve people’s health by integrating pharmacists into diabetes care teams in communities that are underserved or highly affected by diabetes. According to the Project ImPACT website, more than 2,000 patients have engaged in one-on-one consultations with pharmacists who help them better manage their disease through appropriate medication use, exercise, nutrition, and other lifestyle changes. Integrating the APhA Foundation’s proven patient-centered model of collaborative care into participating communities enables local healthcare teams to better address the diabetes epidemic they are facing within populations that are uninsured, underinsured, or poverty stricken, or that have a high incidence of the disease.

Interim project results (all statistically significant related to improved blood glucose, blood pressure, cholesterol, and body mass index) were released in conjunction with American Pharmacists Month, and community champions used the opportunity to advocate for pharmacist-provided patient care services on Capitol Hill. In addition, the community champions had the opportunity to share best practices, challenges, and plans with each other during the meeting.

A consistent theme that emerged across all the sites, regardless of practice setting (clinic, community pharmacy, etc.), was the need for a more integrated way to document clinical data between the pharmacy management system and the physician’s/clinic’s electronic health record (EHR) system, as well as to the research project’s data collection mechanism. In order to sustain and build these innovative practices, clinical and dispensing data integration between the pharmacy and EHR systems is needed and necessary. It’s a theme I echoed during the June 2013 ASAP midyear conference and one I will continue to explore at future conferences. The Pharmacist Collaborative, formerly PSTAC, has developed a document to support this integration, HL7 EHR-System for a Pharmacist/Pharmacy Electronic Health Record Implementation Guide for Community Practice. You can learn more about the collaborative by going to http://www.pharmacyhit.org. CT


Marsha K. Millonig, R.Ph., M.B.A., is president of Catalyst Enterprises, LLC, located in Eagan, Minn. The firm provides consulting, research, and writing services to help industry players provide services more efficiently and implement new services for future growth. The author can be reached at mmillonig@catalystenterprises.net.




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