Q&A with Michael Ross MD, MHA
Following a recent webinar on "Optimizing Medication Management with Meds 360°," Michael Ross, MD, MHA, chief medical officer for Cureatr, was asked several questions by participants. Here are those questions, along with Dr. Ross's responses, summarized for readability.
Q: What data sources does Meds 360° pull from?
Dr. Michael Ross: We have most of the pharmacy data management (PDM) claims data, such as Express Scripts, CVS Caremark, OptumRx, and Humana's pharmacy claims. Missing from our paid claims are state Medicaid data and the U.S. Department of Veterans Affairs.
Our point-of-sale data feeds come from CVS, Walgreens, Walmart, all the big box retailers such as Costco and Sam's Club, and grocery store retailers such as Publix, Safeway, Giant, Wegmans, and Acme Markets. Our supplemental feeds will also support Kroger, for those of you in the Southeast. We also have many independent pharmacies that accept electronic prescriptions included in our data. Recently, we’ve added vital national prescription drug monitoring program (PDMP) data to combat the opioid epidemic via a partnership with Prescription Advisory Systems & Technology (PAST) (https://pastrx.com/).
Q: How is this different from the Surescripts data available in the prescription history of many EMRs?
MR: Many, if not most organizations, have a Surescripts acute medication feed in their EMR. Unfortunately, as most people find, attempting to access this is challenging, if not impossible. It is literally a static list of each medication written in the past 36 months. There's no organization by therapeutic category. It requires a manual analysis to determine fill gaps, therapeutic switches, duplications, and the like. Many of the pharmacists participating in medication reconciliation go through the effort of downloading this and then comparing it to the medication list in the EMR generated off the prescribing data, but it's painful and time consuming.
Q: With the Centers for Medicare & Medicaid Services (CMS) announcing data liberation as a goal to ensure patient safety, price transparency, and better care, do you think this will create greater opportunity for the provision of your types of services? If so, in what way?
MR: We certainly hope so. I think that CMS's patience with interoperability and the related challenges has worn thin, hence the new set of recently issued recommendations. That should help us in extracting data from EMRs, but it is going to take a while; I believe that, by CMS's own admissions, it could be 3-5 years. But I think the other thing that's really interesting is how the proposed legislation addresses consumer/patient engagement.
For those scenarios where Apple's Gliimpse initiative is in the mix and patients themselves can access portal data, including medication data, and potentially provide us with those data sources, that is indeed an opportunity to fill some of the information gaps and overcome many interoperability challenges. But I think time is of the essence. The problem of medication management is of such a high magnitude that it's the reason why solutions such as Meds 360° are going to be important in the meantime.
Q: Does Meds 360° show specialty medications?
MR: It does, as long as those prescriptions are paid for through the pharmacy benefit rather than the medical benefit, a.k.a, the so called "J-codes." We don't see office dispensed specialty medications paid for through the medical benefit. They will not be included. But more and more medications are flowing through the pharmacy benefit. For any that do, we can access and manifest them in Meds 360°.
Q: What prescriptions are in the medication reconciliation view?
MR: Ambulatory prescriptions with available days supplied within 30 days of the date of when the medication reconciliation view is accessed will be viewable within the current prescription view. Those prescriptions without days supplied within the 30-day window but that have been paid for within the past 12 months will be categorized and incorporated into the past medications portion of the medication reconciliation view.
Q: How real-time is the information in Meds 360°?
MR: One of the beautiful things about our data sources is that they really are near real-time based on adjudicated or paid-for prescription data. Once that script is paid for, it's literally just minutes before that information becomes available in Meds 360°. The timeliness of this data is such vital. Many of the other solutions that providers and payers tend to work with use pharmacy claims supplied on a once monthly or biweekly basis, depending on state mandates. In Meds 360°, it's virtually instantaneous.
Q: Is Meds 360° a web-only solution or can I use it on my mobile phone?
MR: Cureatr is a mobile-first solution. Six years ago, the focus on developing mobile-first solutions is where this company began. That is still such an important piece of the puzzle. But we're sensitive to the fact that many clinicians still do a majority of their work on desktops. We really want to provide these users with the convenience of accessing Meds 360° either through web browsers or their mobile device, depending on where they are and their established workflows.
It is also important to note that Cureatr can be accessed directly through an EMR. Many of the health systems with whom we deploy our secure messaging and clinical event notifications launch those directly out of their EMR in a view-only mode. Meds 360° will be similarly available within the EMR, view-only, so it will be a two-screen solution.
Q: Is your claims data sufficient to help patients reach their clinical goal, which is the real goal of comprehensive medication management (CMM)?
MR: I think that it is really the combination of paid pharmacy claims, retail data, point-of sale data, deduplicated and presented in Meds 360°'s unique interface that supports the goals of CMM. I think it provides visibility for clinicians participating in the CMM process into significant behaviors that complicate both prescriber and patient behavior. The ability to really look at those medications in their therapeutic categories, see the changes in them over time, highlight inadequate dosing, missing or inappropriate medications, drug-drug interactions and identify patients who are not filling their prescriptions in a timely fashion will enable an intervention, a discussion with patients about what is making it hard for them to follow their regimen. This will better enable both stakeholders in the CMM ecosystem to achieve optimal clinical outcomes. Relative to currently available tools, this is a quantum improvement.
Q: Do you envision managed care organizations using Meds 360°?
MR: We are in the process of sorting through this exact issue but let me throw out some considerations for a managed care or health plan implementation of Meds 360°. If it were to be launched in a view-only mode, in a payer's care management system, care managers would have immediate access to a 12-month historical view of all of a new enrollee's medications including cash paid transactions. That enables care managers to target patients for program enrollment and identify potential targets for adherence intervention to optimize the Star scores. New enrollees are one use case where there's not a lot of historical data or claims data traveling with a patient, thus allowing them to be triaged appropriately and more quickly than waiting for the initial few months of claims to roll in.
Secondly, the way that medications are grouped by therapeutic category in Meds 360° enables rapid insights for care managers into therapeutic substitutions, duplications, and fill gaps. In addition, the care management team at a health plan would now be able to see cash paid transactions, which represents around 17-18% of the total medications picture.
Thirdly, information about the appearance of the most recently dispensed national drug code (NDC) enables easier conversations between care and case managers and patients and family caregivers, particularly those patients who identify medications by color and shape rather than name. The alerting and notification capabilities embedded within Meds 360° highlight things like nefarious opioid activity, excess MEDs, drug-drug interactions, primary and secondary nonadherence, and the like could also be of value.
We are working on a patient view of the timeline within Meds 360°. It will be a user-friendly version that a care or case manager at a plan could potentially share with a member when discussing the medication regimen.
Finally, for those plans lacking pharmacists who can be used as clinical resources to help optimize a patient's medication management, we can support those efforts as well.