Humana and health tech company DrFirst are joining forces in a bid to close gaps in care for people with chronic health needs.
The program's initial launch focuses on boosting the use of statins among eligible members, which can improve care for people with cardiovascular conditions or diabetes while also meeting a key Medicare metric set by the Centers for Medicare & Medicaid Services.
DrFirst's prescription orchestration platform is embedded in the provider's workflow, and through it, Humana can send the clinical team prescription recommendations for high-risk patients. Should they agree with the suggestion, the provider can then with one click submit a script and document why the care was necessary.
"I think it's a very simple and very elegant way of helping the insurer and the provider get on the same page without requiring external workflows, external portals, external faxes," Colin Banas, M.D., chief medical officer for DrFirst, said in an interview with Fierce Healthcare.
He said that providers prefer notifications that are simple, unobtrusive and embedded in the workflow. Pings that do not create a significant interruption in the patient visit, and programs that ease the burden imposed by more traditional, lower-tech methods like fax, are more likely to garner adoption.
In addition, this particular program also allows docs that determine a recommended intervention is not necessary to document why for the future. For example, if the patient has taken a statin before and had a poor reaction to it, the doctor can note that in the system.
Morgan Bojorquez, associate vice president of pharmacy business development at Humana, told Fierce that since the program's launch about a week ago, the team has gained a treasure trove of feedback on the reasons why a provider may not elect to prescribe a statin for their patients. And that's data that the insurer can use to build critical insights and further personalize care for members.
In addition, in the more traditional fax methods of communication, there is no "read receipt" confirmation that a provider even saw the recommendation, he said. The quick prompt to explain why they're declining the suggestion helps confirm that they've engaged with it.
"That is just powerful data," Bojorquez said. "Our teams internally are reviewing these reason codes, for lack of a better word, as to why not, and I'll be very honest, it's a little overwhelming trying to comb through the data. We're getting a lot of insights, which is something that we've never had before."
He added that in addition to a closer look as to why providers may choose not to prescribe the recommended therapy, in early days they're seeing anecdotal evidence of prescriptions being shipped off in real time.
Humana and DrFirst have a long-standing relationship, and this new offering builds on a decade of collaboration. In 2015, they worked together to launch the first real-time prescription benefits tool, which offers providers key information on coverage and costs at the point of care.
Banas said the new program has been in the works for a long time, and seeing it come to fruition to a full launch is gratifying. The team is also looking to build out capabilities to other chronic needs and medications.
Bojorquez said a clear future use case is for patients with congestive heart failure, who often need to take a quadruple therapy to manage their condition. Humana is already looking into how the platform could be used for recommendations around those therapies. He also said that team is considering ways these recommendations could be deployed to assist patients who may have a shift in coverage or changes to their formularies, suggesting alternatives that may be more in line with their benefits.
It could also be used proactively, so if a patient is going to see a significant change in their benefits in the beginning of the year, their provider can get ahead of it.
"So another use case that we thought about is, 'what if we leverage this new solution to recommend the therapy change for an existing Humana member in fourth quarter to prevent disruption?'" Bojorquez said.
Both older initiatives and this new launch aim to boost interoperability and data sharing between providers, pharmacies and payers to address gaps in care. Bojorquez added that Humana's work doesn't necessarily stop with DrFirst, and they're looking engaging with other health tech and electronic health record companies to continue building out real-time tools.
"Anywhere that we can bring all that together and do it in a sort of frictionless, or at least reduction in friction, that is exactly the sweet spot for DrFirst as a company," Banas said.