Nationwide Insights on Trusted Health Intelligence Sharing

Making an impact across healthcare requires the infrastructure and partnerships to reach millions of healthcare professionals and hundreds of millions of patients.

The Surescripts Network Alliance brings together nearly all electronic health records (EHR) vendors, pharmacy benefit managers (PBMs), pharmacies and clinicians—plus health plans, long-term and post-acute care organizations, specialty pharmacy organizations and veterinary technology vendors across the country. Surescripts also innovates in partnership with standards bodies and governance frameworks including Carequality, DirectTrust, HL7, the National Council for Prescription Drug Programs, The Sequoia Project and the Trusted Exchange Framework and Common Agreement^TM (TEFCA^TM).

Innovations stemming from these partnerships reached healthcare professionals and patients across the U.S. in 2024.

Prescribing is complex. Workflow interruptions and inefficient communications burden care teams and put patients at risk.

Efficient prescribing became more important than ever in 2024 as pharmacy closures left fewer pharmacists available to serve patients. Adding to the 2,600 stores slated for closure by just three large pharmacy chains, 32% of community pharmacy owners said they were considering closing.

In 2024, we worked to deliver timely prescriptions across care settings by infusing more intelligence, automation and collaboration into the prescriber and pharmacist experience—as well as more safety for all. We partnered with CLEAR to enhance identity proofing, helping combat prescriber identity theft and fraudulent prescribing. This adds to a toolbox of other fraud and abuse prevention technologies, including deploying machine learning to monitor network activity for signs of data misuse.

Just 55% of Americans reported that they could readily access and afford their prescribed medicines in one 2024 survey. In another, 1 in 5 said they had not filled a prescription and 1 in 10 reported splitting or skipping doses because of the cost. Even when cost and coverage issues don’t harm adherence, they often trigger extra phone calls, faxes, research and rework across the care team.

The Network Alliance worked together to deliver more timely, affordable care to more patients in 2024. By sharing accurate prescription benefit and price intelligence at the right time, we made it far easier for clinicians to choose the best medication option for each patient.

Prior authorization is used to protect patient safety and support cost-effective care in an era of rapidly rising healthcare costs. But cumbersome manual processes undercut these goals and stoke frustration across healthcare.

One survey in 2024 found that the average medical practice completed 43 prior authorizations per physician each week, often requiring dedicated staff. When prescriptions reach the pharmacy with incomplete prior authorizations, pharmacies can’t fill them. Manual processes raise administrative costs for PBMs and health plans, too.

Most importantly, prior authorization delays and barriers can throw treatment off track for patients. For 44% of patients who said they experienced prior authorization delays in 2024, wait time was a week or longer. Other research has found that approximately 40% of prescriptions delayed by manual prior authorization are abandoned.

As policymakers sought to address prior authorization challenges with legislation in 2024, the Network Alliance was already working together to transform the process on a faster timeline—making it simpler and less costly for payers and providers to get patients started on the best treatment path without delay.

When patient information is out of reach or out of sight, danger emerges. Incomplete clinical history can interfere with making the correct diagnosis. Medications that care teams are not aware of can cause adverse drug events. Trouble accessing the patient data needed for administrative tasks can delay care.

Beyond the immediate clinical impact, interoperability limitations block opportunities to move healthcare forward. When pharmacists are kept out of the loop of clinical communication, they can’t work as effectively to fill gaps in access to care. Unless organizations can easily track incentivized care activities and avoid low-value or duplicative ones, value-based care will remain a far-off goal for health systems, pharmacists, PBMs and health plans.

Building genuine nationwide healthcare interoperability—and delivering on the promise of value-based care—requires both innovation and collaboration. These were in strong evidence across the Surescripts Network Alliance in 2024.

Surescripts Health Information Network^TM, a subsidiary of Surescripts, prepared to participate in TEFCA as a Qualified Health Information Network® candidate. Surescripts and The Sequoia Project also prepared to launch a pharmacy interoperability workgroup designed to develop practical solutions to pharmacies’ clinical data exchange challenges.

Meanwhile, Network Alliance participants continued leveraging a variety of tried-and-true tools to access clinical data and coordinate care nationwide. Together, we helped inform care teams and bring value-based care success closer by delivering more timely patient insights and better communication channels.

When new medications gain ground, the effects can clearly be seen across the Surescripts network—and so can the impact of health intelligence sharing throughout the care journey, from the point of prescribing onward.

For example, one major life science development of recent years is the use of GLP-1 agonists (GLP-1s) to treat both Type 2 diabetes and obesity. Often facing high costs and high rates of nonadherence, patients taking GLP-1s may especially stand to benefit when their care teams have access to intelligent prescribing and care management tools. In 2024, we saw not only a rise in these prescriptions, but a rise in the use of Real-Time Prescription Benefit to help patients find affordable options and use of Medication History for Populations to aid adherence.

Ambulatory care: Care delivered in an outpatient setting. Medication History for Ambulatory is used by clinicians in these care settings to inform prescribing decisions.

Chronic disease management: The process of helping patients manage long-term conditions (such as diabetes, hypertension or asthma). This can include education, regular monitoring and personalized care plans.

Controlled substances: Substances that are regulated under federal law based on the substance’s medical use, potential for abuse, and safety or dependence liability. Electronic Prescribing for Controlled Substances includes safety and security measures to help meet regulatory requirements around these substances.

Eligibility: Provides information about a patient’s prescription benefit coverage. Eligibility is also used to help identify patients in order to exchange a wide variety of other health intelligence.

Formulary: Provides data on medications covered by a patient’s prescription benefit plan. This includes information on formulary tiers—with higher or preferred tiers having the best coverage and lowest cost to the patient—as well as coverage requirements such as prior authorization and step therapy.

Interoperability: The ability of different information technology systems to work together. In healthcare, interoperability makes it possible to exchange information such as clinical records and price and benefit data among different parties—such as providers, pharmacies, PBMs and health plans—that use different technology platforms.

Long-term & post-acute care: Care delivered outside of acute care settings to patients who need significant support with rehabilitation, recovery or ongoing assistance with daily living. This can include skilled nursing facilities, long-term care hospitals, nursing homes and assisted living facilities as well as home healthcare services.

Master Patient Index: A database of patient data that makes it possible to identify healthcare information for the correct individual. The Surescripts Master Patient Index uses referential matching to capture and merge identifying information from different sources in order to create more complete records for higher accuracy.

Medication adherence: The extent to which patients take their medications as prescribed. Nonadherence can happen when a patient doesn’t pick up a prescription (known as primary nonadherence) or doesn’t take all doses as prescribed (known as secondary nonadherence). Real-Time Prescription Benefit can help avoid cost-related nonadherence of both kinds by sharing price information and less costly alternatives. Medication History can help address primary nonadherence by identifying when prescribed medications were not picked up.

Medication management: The process of optimizing a patient's medication regimen. Pharmacists and other healthcare professionals often work with patients and their doctors to ensure that medications are safe, cost-effective and aligned with patients’ health needs.

Medication reconciliation: The process of identifying all the medications a patient is taking so that appropriate medication therapy can be administered, typically during hospital admission or other transitions of care.

Network uptime: The percentage of time that a network can be accessed by users. Average network uptime is calculated by first taking the mean of each day's uptime to calculate a monthly average, then taking the mean of each month's uptime to calculate an average for the year.

Primary coverage indicator: A feature of Surescripts Eligibility that indicates which benefit plan should be used first when patients have multiple coverages.

Prior authorization: The process of obtaining approval from a payer before a specific treatment can be provided and covered. For prescriptions, prior authorization typically requires clinical information to help confirm that the medication is necessary and appropriate for the patient.

Qualified Health Information Network (QHIN™): A health information network that has been approved to support nationwide health information exchange through TEFCA. Organizations such as health systems, public health agencies, payers and health IT vendors can connect to a QHIN of their choice in order to exchange health information with those participating in any other QHIN.

RxRenewal Request: An E-Prescribing message sent from a pharmacy requesting that a prescriber renew a patient’s prescription. Sig IQ makes this process easier by keeping the pharmacist from having to re-enter Sig information.

Sig: Directions that tell patients how a medication should be taken (such as “Take one capsule by mouth daily”). The Sig is typically printed on the prescription label.

Specialty medications: A category of medications defined by high costs and often high complexity. Specialty medications may require extensive clinical documentation as well as special protocols for administration, handling and storage. As a result, they often must be filled by specialty pharmacies equipped to manage these medications. Different organizations define specialty medications in slightly different ways. Surescripts identifies specialty medications based on a specialty medication compendium created by internal experts in alignment with industrywide definitions.

Structured & Codified Sig: A standardized, machine-readable format for patient directions defined by the National Council for Prescription Drug Programs. Use of Structured & Codified Sig helps reduce ambiguity and errors that could disrupt prescription workflows and harm patient safety.

Transaction: An individual instance of sending or accessing information via the Surescripts network. Transactions may be triggered by an individual or automated by a connected system.

Value-based care: An approach to assessing and reimbursing care that is based on measures of quality, instead of being tied only to services delivered. Quality measures may incorporate factors such as medication adherence, patient outcomes and patient experience. Value-based care programs are often centered on specific chronic conditions, such as diabetes or heart disease.