Healthcare has a transparency problem. In the first blog of this series, we looked at this challenge through the patient lens. Now, we pivot to look at how this lack of transparency impacts providers. Namely, providers don’t have decision-support tools capable of optimizing patient care. It’s a lose-lose situation – and it plays out every day in thousands of encounters nationwide.

Let’s take a quick look at how a trustworthy decision-support tool can make all the difference for providers, as well as for the patients in their care.

What price transparency makes possible

Recently enacted policies such as hospital price transparency rules, the No Surprises Act, and real-time benefit tool rules intend to make patient data more accessible while promoting interoperability among healthcare’s big players – PBMs, health plans, EHR vendors, and health systems. These policies have undoubtedly driven progress. But they have also brought about an unintended consequence – a data overload that neither health systems nor providers anticipated.

Given this influx of data, many health systems leverage Real-Time Prescription Benefit (RTPB) to surface patient-specific coverage and cost information at the point of care. And while RTPB primarily functions as an EHR-integrated solution, the future of RTPB is evolving, with data being made available to providers, care teams, and patients at various points in the care journey.

• Before the appointment: Facilitates pre-visit planning between the provider and clinical staff. Primes the patient to have a proactive conversation with their provider around cost.
• At the point of care: Arms the patient and provider with accurate data reflective of the patient’s care plan, coverage, and preferred location.
• Appointment follow-up: Drives patient follow-through on their care plan because they’ve been part of the decision-making process. Supports messaging to highlight payment options and drive adherence.

Sounds ideal, doesn’t it?

A powerful tool with significant potential

While RTPB has the potential to solve many prescribing pain points, low-quality solutions have made finding the right information difficult. This ends up negatively impacting RTPB’s utilization and overall satisfaction. In a survey of providers regarding their historic use of prescription decision support tools, they said the following:

• 78% of providers who have access to coverage information don’t find the information reliable.
• 72% of providers don’t discuss medication prices with their patients.
• 77% of providers say they’ve had to change, manage, or resend a prescription order once it has been sent to the pharmacy.

So, where’s the disconnect between potential and reality?

Many RTPB vendors offer solutions that display estimated cost information, erroneous errors, or no information at all. This drives a negative provider experience that doesn’t support patient encounters. What is needed most is accurate cost estimates that are specific to an individual patient – and meaningful alternatives when lower-cost, convenient options are available.

Fulfilling the promise

For a high-value patient encounter, providers need to see reliable, accurate, and timely coverage and cost data in the EHR. And by displaying meaningful alternatives in workflow, providers can work with patients to weigh tradeoffs and determine the best option for their care.

Arrive Health aspires to make RTPB a comprehensive and useful service for health systems by:

1. Ensuring accurate, real-time cost and coverage information is presented in every patient encounter.
2. Displaying meaningful alternatives that support low-cost prescribing.
3. Supporting all stakeholders with data throughout the care journey, including providers, care teams, and patients.

Trustworthy price transparency tools are critical in putting actionable data in the hands of providers. And as we’ve already seen, it’s equally important for the patient. But how do these tools benefit the health systems that invest in them? Stay tuned for the third and fourth blogs in this series where we’ll look at how technology unifies the pharmacy experience.

The Academy extends its appreciation to Arrive Health for their sponsorship of this article.