We are in an unprecedented moment in history. The COVID-19 pandemic has rearranged lives and shifted priorities across the globe, and healthcare is at the center of the whirlwind.

But American healthcare is used to rapid change. Throughout 2019, market forces, government activity, and the expectations of new generations of patients and clinicians were already speeding us toward a world in which our industry must evolve quickly to succeed.

It’s a world that’s pushing us to share information more efficiently, securely and transparently. As part of the 21st Century Cures Act, the federal government drafted new rules on information blocking and interoperability. The latest data from the Office of the National Coordinator for Health Information Technology shows just 46% of U.S. hospitals and 10% of office-based physicians are able to electronically find, send, receive and integrate patient health information from outside sources.^{1, 2} Clearly, there is more work to be done as provider organizations and technology vendors focus on meeting these new regulatory requirements throughout 2020.

With drug pricing a hot topic across the nation, the federal government also issued a rule requiring that Medicare Part D plans adopt real-time prescription benefit tools by 2021. Patients and prescribers too are demanding prescription price transparency: 4 in 10 providers say prescribing would be more efficient with more information at their fingertips, particularly cost and coverage data.³ Meanwhile, 61% of patients say they’d be willing to spend extra time, effort or money in order to have informed prescription cost conversations with their doctor—one signal that consumerism is finally taking hold in U.S. healthcare.⁴

It’s also a world where healthcare costs, data and outcomes are more intertwined than ever. One insurer predicts that 59% of healthcare payments will be value-based by 2021.⁵ But as of 2017, 24% of healthcare executives said they lacked the external interoperability needed for value-based care.⁶

Controlling costs is further complicated by the rise of specialty drugs, which now account for nearly half of prescription drug spending.⁷ And cost is not the only barrier for the patients who need them. For many critical specialty medications, treatment can be delayed by days or weeks due to factors such as prior authorization.

As you navigate our 2019 National Progress Report, you might ask: Are we ready to navigate these changes and see our way through to better, safer, less costly care?

What I see indicates that we are making true progress on each of these fronts. Through a robust and trusted network, continual innovation and the deep engagement of partners across the Surescripts Network Alliance™, we are delivering actionable intelligence to transform more healthcare interactions and patient outcomes than ever before.

Thank you for joining us as we explore how we enhanced prescribing, informed care decisions and advanced healthcare together in 2019.

SPOTLIGHT: ELIGIBILITY & FORMULARY

By giving providers the ability to check a patient’s insurance and prescription benefit coverage, Eligibility & Formulary serves as the foundation for many Surescripts solutions, including E-Prescribing, Real-Time Prescription Benefit, Electronic Prior Authorization, Medication History and Record Locator & Exchange.

• 3 billion eligibility responses (+14% in 2019)

An earlier version of the 2019 National Progress Report inadvertently listed eligibility response volume as 2.8 billion (+4% in 2019).

Since 2016, our Critical Performance Improvement program has convened the Surescripts Network Alliance to improve the accuracy of e-prescriptions. Surescripts Sentinel^® analyzes electronic prescriptions and identifies opportunities for improvement.

In 2019, we recognized 12 health systems, EHRs and pharmacy industry leaders with the Surescripts White Coat Award for their work optimizing e-prescribing.

Throughout 2019, we guided the industry’s migration to the National Council for Prescription Drug Programs SCRIPT Standard Version 2017071, required by the Centers for Medicare and Medicaid Services as of January 1, 2020. Through hundreds of improvements to e-prescribing transactions, the new standard will:

• Reduce manual processes that disrupt provider and pharmacy workflows
• Let pharmacies electronically request prescriptions for medications they have not previously dispensed and readily transfer prescriptions to other pharmacies
• Enrich medication history with additional data elements
• Serve long-term and post-acute care settings with transactions that lend long-awaited clarity, automation and efficiency to this unique market

The majority of Surescripts Network Alliance participants that use E-Prescribing and Medication History had certified to the new standard by the end of 2019, ahead of the Surescripts sunset date for SCRIPT v10.6. They included organizations responsible for:

• 43.5% of e-prescriptions sent from EHRs
• 89.4% of e-prescriptions sent by health systems
• 99.9% of e-prescriptions processed by mail-order pharmacies
• 92.2% of e-prescriptions processed by retail pharmacies

The number of prescribers utilizing E-Prescribing increased more than 8% in 2019.

In 2019, we saw more and more clinicians implementing workflow and technology changes, like the CancelRx transaction, to improve prescription accuracy and patient safety. By using CancelRx, prescribers can securely and reliably notify the pharmacy of the need to cancel a prescription, which stops automatic refills and eliminates the need for time-consuming phone calls and faxes.

Pharmacists often play a critical role in optimizing medication therapy, and RxChange gives them a quicker, easier way to collaborate with prescribers. In 2019, the Surescripts network saw considerable growth in the use of RxChange, particularly three unique use cases, including RxChange for Prior Authorization, RxChange for Therapeutic Interchange and RxChange for Generic Substitution.

In 2019, more healthcare professionals saw the safety and efficiency benefits of EPCS—and put it into action for their patients. Compared to 2018, 51% more prescribers were enabled for EPCS.

Family practice saw the largest increase, growing more than 7% in 2019.

With 13 states enacting e-prescribing requirements in 2019, more than half of all states now require e-prescribing for opioids, all controlled substances or all prescriptions. As provider enablement for EPCS rises in these states, we can also expect further advances spurred by the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which requires that controlled substance prescriptions covered under Medicare Part D be transmitted electronically as of January 1, 2021.

New York, Maine and Connecticut started the year with mandates in place. So did Minnesota, though its requirement has no specific penalties for noncompliance.

Pennsylvania's mandate took effect October 24, 2019.

Arizona, Florida, Iowa, North Carolina, Oklahoma and Rhode Island had mandates set to take effect January 1, 2020.

In 2019, Surescripts continued to focus on improving the prior authorization experience by streamlining workflows and expanding our network to include new data suppliers.

We also worked closely across the industry to build alignment around automating and improving the process for patients and providers. Just after the new year, America’s Health Insurance Plans announced that it would leverage Surescripts Electronic Prior Authorization as part of its Fast Prior Authorization Technology Highway (Fast PATH) initiative, with the potential to benefit the 60 million patients covered by participating plans.¹⁰

• 132% increase in prior authorizations processed electronically
• PBMs and health plans representing  95% of U.S. patients have contracted to provide data for the service
• 82% of U.S. prescribers are served by EHRs contracted for the service
• 58% increase in provider adoption

Patients and clinicians value prescription price transparency, and data shows that far more of them experienced it firsthand in 2019.

• PBMs and health plans covering 79% of U.S. patients have contracted to provide data for the service
• 88% of U.S. prescribers are served by contracted EHRs (+10% in 2019)
• <2 seconds average time for prescribers to receive cost and coverage data in their EHR

Medication History for Populations lets healthcare providers proactively access medication history via their EHR or analytics platform to help identify and close gaps in care, uncover medication non-adherence and manage at-risk patient populations.

Insights for Medication Adherence provides patient insights with data from PBMs and others. For instance, if a patient filled prescriptions for opioid analgesics from at least three prescribers in the last 90 days, Insights for Medication Adherence could help clinicians recognize suspicious prescribing activity and intervene. It was also used to spot unsafe overuse of certain therapies, such as flagging a patient with a supply of benzodiazepines, muscle relaxants and opioids in the last 45 days.

In 2019, Insights for Medication Adherence supported more than 120,000 clinical interventions.

We entered 2019 well aware of the complexity of specialty prescribing, and further research illuminated the particular challenges prescribers face when prescribing specialty drugs. We surveyed healthcare providers about their experience writing specialty prescriptions and identified two primary pain points: a lack of key information in drug selection and the burdensome manual prescribing process.¹²

On average, providers spend more than three hours a week on paperwork—not including charting—in order to start a patient on a specialty medication. The time and administrative burden has a domino effect: Nearly 40% of providers said it typically takes one to two weeks to actually get that medication to the patient.

Unsurprisingly, only 29% of providers are extremely or very satisfied with their organization’s efficiency when prescribing specialty medication. This inefficiency can also result in wasted work for pharmacies. When physicians encounter barriers to prescribing, two-thirds simply change or reroute their orders.

Taken as a whole, our research shows ample opportunity for improving how we handle specialty prescriptions, where the costs are often as high as the impact on patients’ lives. We are already incorporating these insights into the solutions we build, and we look forward to seeing statistics like these shift as better processes take hold across the Surescripts Network Alliance.