EHR Trends: PA patterns in situ. Evan Grossman Vice President Integration Services
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1 EHR Trends: PA patterns in situ Evan Grossman Vice President Integration Services
2 A physician-centric data asset that is accessible, structured, and real- time Procedures Diagnoses Charges Contracted Amounts Payers Pay for Performance Days in Accounts Receivable Denial History Collection Method Collection Rate Documentation Tasks Administrative Work Practice Provider Patient Medication History Lab Values (e.g. A1C, LDL, BP, etc.) Problem List Payer Vitals (Height, Weight, Gender, Age) Orders and Referrals Notes Ambulatory Solo, Groups, Surgical Centers, Ambulance, Hospitals, Retail Clinics Payers Commercial, Blues, Medicare, Medicaid, Self-pay, Legal NATIONAL Broad view of outpatient activity Healthcare in the wild Robust representation across demographic segments UNIFIED Single cloud-based technology Single database with clinical, claims, and operational data Standardized measurement and reporting INSTANTANEOUS To-the-second activity documentation Real-time data availability Data exchange with 3rd parties ADAPTIVE Decision support functionality Client directed quality programs Test and learn with population management campaigns 2
3 athenahealth EHR Data: Unique dataset of physician trends 100K+ providers 9,910 lab and imaging endpoints 13% of Americans seen by athenahealth providers last year 99.5 M New Rx /year 317K MDs served on Epocrates 152K total network endpoints >2800 Cardiology prescribers
4 In 2017, providers have fewer encounters per patient but slightly larger panels Visits, Panel Size and Visits per Patient Number of people 2, , , , Patient Visits per Provider Patients per provider Visits per Patient per year 1.0 4
5 Providers are tasked with more paperwork, with more new RXs requiring prior auths New Prior Auths, New Prescriptions per provider (per year) Number , f 1,400 1,200 1, PA per Provider Rx per provider New RX per provider 1,159 1,208 1,263 1,357 PA per New RX 1.1% 1.1% 1.1% 1.4% Rates of Growth: CAGR Encounters 0.2% Panel size 4.8% New Rx 6.9% Prior Auths 12.8% 5
6 Top Medications requiring Prior Authorizations over the past 4 years Ranked by Prior Authorization Volume Eliquis (8.6%, 54.0%) Eliquis (6.6%) Eliquis (8.2%) Xarelto (7.9%) Entresto (15.9%, 53.7%) Entresto (21.8%) Xarelto (6.4%) Eliquis (10.9%) Xarelto (6.4%, 48.8%) Xarelto (5.5%) Crestor (3.3%) Crestor (3.7%) Repatha Sureclick (31.7%, 42.5%) Crestor (2.5%) Pradaxa (5.0%) Pradaxa (5.6%) Bystolic (4.3%, 49.0%) Repatha Sureclick (43.0%) Livalo (14.2%) Ranexa (4.5%) Ranked by Prior Authorization Request per New Rx (Percent) Repatha Sureclick (31.7%, 42.5%) Repatha Sureclick (43.0%) Repatha Sureclick (81.6%) Livalo (14.0%) Praluent Pen (26.4%, 45.7%) Praluent Pen (38.1%) Entresto (24.0%) Eliquis (10.9%) Corlanor (21.3%, 46.5%) Corlanor (21.9%) Livalo (14.2%) Xarelto (7.9%) Lovaza(18.7%, 60.0%) Entresto (21.8%) Cialis (9.5%) Pradaxa (5.6%) Entresto (15.9%, 53.7%) Livalo (15.4%) Eliquis (8.2%) Ranexa (4.5%) Medication Name (%PA, epa submission rate [2017 only]) 6
7 New therapies have gone from 17% to 40% of Cardiologists PA Volume Share of Cardiologist Prior Authorization Volume Percent 45% 40% 35% 30% 25% 20% 15% 10% 10.4% 4.6% 9.2% 2.2% 2.3% 2.4% 4.2% 7.4% 7.4% 16.2% 5% 0% 3.4% ELIQUIS ELIQUIS ENTRESTO ENTRESTO XARELTO XARELTOREPATHA REPATHA SURECLICK SURECLICK PRALUENT PRALUENT PEN PEN PRADAXA PRADAXA CRESTOR 7
8 60% Prior Authorization Request Rate Percent 50% PA rates decrease in early years then stabilize in the 5-10% range 40% 30% 20% 10% 8 0% REPATHA SURECLICK 51.9% 31.7% PRALUENT PEN 48.3% 26.5% ENTRESTO 29.3% 22.8% 15.9% ELIQUIS 12.7% 12.2% 9.2% 7.1% 8.6% PRADAXA 6.8% 6.7% 5.2% 5.7% 7.3% XARELTO 9.9% 9.1% 6.6% 5.9% 6.4%
9 New therapies have slightly lower submission rates than other PA requests Prior Authorization Electronic submission rate Percent 60% 55% 50% 45% 40% ELIQUIS n=830 ENTRESTO n=283 XARELTO n=418 REPATHA SURECLICK n=153 PRALUENT PEN n=92 PRADAXA n=67 %epa submitted Mean of PAs for 73 Drugs 9
10 No apparent correlation between questions asked and epa submission rate epa Submission Rate vs. median Questions asked Percent, Number of Questions 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% ELIQUIS 54.0% ENTRESTO 53.7% PRADAXA 47.8% PRALUENT PEN 45.7% REPATHA SURECLICK 42.5% XARELTO 48.8% 10
11 The number of questions answered varies significantly by payer and/or form epa Questions answered Number 11
12 Large variation in the percent of time a PA is required, even within the same payer PA Requests by Insurance Percentage 12
13 13 Real time benefits info/ prior auth at point of prescribing
14 Co-author credits: Ola Canty Michelle Ho, PharmD, BCACP, CPS Thank You
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