How Prisma Health Integrates Medication Affordability into their Pharmacy Programs

Video Transcript

Look at the healthcare costs and things that are barriers for patients to improve their healthcare outcomes. In addition to that is the experience. It’s not just about quality and safety. If we want to have patients continue to show up at our door, how do we improve that experience for them?

When I look at the patient population in South Carolina and in our new region in Tennessee, we see lots of patients who have no insurance or are underinsured. For geographical reasons as well as financial reasons, medication access—particularly with the rising cost of medications—is something that we continuously struggle with for patients.

We haven’t found any good solutions, until starting to actually work with this one, that were consistently providing accurate results for patients. I will admit that even though we had really great work already with CipherHealth on our patient experience side—the discharge outreach—when we first started this conversation with CipherHealth we thought, “Should we do this?”. We were a little skeptical and we were a little slow to get started because of our lack of success with other programs.

For our objectives, we really wanted to make sure we were improving our quality and outcomes for our patients. Medication adherence, obviously, is very important to help compliance and quality outcomes. We have some disparate processes already in place and manual processes, and we wanted to align those. Equity for patients, if we’re using manual processes and based on referrals, every patient is not getting the same opportunity to have access to a medication affordability solution. Providing something that is happening all the time for every patient provides equity for all of our patients to access a medication affordability solution. That is very important.

We did put together a multidisciplinary team that was acute and ambulatory. We had pharmacists, nurses, case managers, providers, our patient experience team, administrators—the whole group of subject matter experts that we could imagine—that got together to start talking about how we should administer this program. What we came up with was that we really wanted to start with our outpatient area, our medical group practices, instead of inpatient. We wanted to go very intentionally and very slowly, to make sure that it was going to work well. Even though CipherHealth is the tool that is running this in the background, it’s branded as Prisma Health. If we’re going to stamp our name on a program, we really wanted to make sure it was being done right so that our patients see our name as something that’s helping them.

We rolled it out in three phases. We started phase one with just 5 of our practices, and we picked practices that we knew we had champions within that practice who would help us troubleshoot any issues. We rolled that out for a couple of weeks where we had enough time to get feedback, and it worked really well. The implementation went very smoothly and really quickly, and it is providing great value to our patients in the ambulatory space.

We’re excited to get it rolled out on our inpatient side. We do have a big Meds-to-Beds program across the majority of our campuses. And that’s one of our biggest challenges in that rollout is how we make sure that we maintain the integrity of our Meds-to-Beds program and provide these messages to the appropriate patient there. Maybe after we get that live, I’ll be back to talk about that. That, in my opinion, is our next big hurdle, and something that I would love to be able to work through seamlessly. I’m excited to be able to expand this to all of the prescriptions that are generated through our Epic® system, to make sure that we’re still providing this seamless care to our patients.