How Medication History for Populations improved Baptist Health’s value-based care workflow

When Nilesh Desai joined Baptist Health as Chief Pharmacy Officer a few years, ago, part of his mission was to improve value-based care workflows. At the time, the hospital relied on a single pharmacist to manually compile medication adherence information for use in patient outreach.

Adherence data was managed through spreadsheets based on information provided by payers monthly, which meant it could be weeks out of date by the time the team received it. Pharmacists often had to make multiple phone calls to confirm whether a patient was taking a critical medication such as a statin, creating extra work and a disjointed patient experience.

Incomplete data can also affect payer reimbursements. The hospital needed to be able to demonstrate its success on adherence-related measures to earn high star ratings and higher payments.

But with outdated data and inconsistent patient adherence, the hospital was struggling to keep up. “We wanted a real-time solution,” said Desai.

Desai wanted a solution that could integrate directly with Compass Rose, an application within Epic that the hospital uses for value-based care coordination. He also wanted something customizable with comprehensive, trustworthy data.

Surescripts Medication History for Populations checked all of his boxes.

It fit easily into the hospital’s existing workflows and made it possible to sort data the same way the hospital tracked its patient populations—by payer, not by disease state.

When providers request patient panel data for their at-risk patients, Surescripts performs a match across a master patient index of more than 99% of the U.S. population, covering the vast majority of Baptist Health Louisville’s patients.¹

Next, Surescripts initiates requests for claims and fill data using its connections with virtually every pharmacy and pharmacy benefit manager in the country. Within 24–36 hours, a comprehensive panel history file consisting of records for each patient is delivered and incorporated into Baptist Health Louisville’s system. The information is sorted by payer and includes comprehensive medication fill records, including cash-pay prescriptions.

Then, Desai explained, the pharmacists get to work. “They'll work through that list to say, ‘Okay, who's a priority? Who do I need to call?’”

Baptist Health Louisville was one of the first hospitals to use Medication History for Populations within Compass Rose, and it was an easy implementation process. After a few weeks of fine tuning to verify that the integration was working as expected, “it was smooth sailing,” said Desai.

He and his team now receive medication history for 95% of the patients on their uploaded population lists.

Whenever possible, keep clinicians in one workflow.

While Desai knew third-party tools were available, he strongly preferred to avoid pulling pharmacists away from Epic—where other patient information was stored—to consult yet another screen. Integrating Medication History for Populations with the team's existing Epic workflow cuts down on clicks and helps the team work more efficiently.

Leverage the most current data to enhance value-based care reporting.

Baptist Health Louisville uses Medication History for Populations to not only spot adherence issues, but to demonstrate success in improving adherence that might not show up in payer data. Along with tracking patient outreach, they can see with high accuracy whether patients contacted went on to fill their medications.