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April 4, 2022 Readers Write No Comments

Why Data Quality Matters in Price Transparency Workflows
By Cory Deagle

Cory Deagle, is chief product officer of RxRevu of Denver, CO.

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As a healthcare technology vendor, we often hear that data quality is critical. It’s true that without access to reliable data, providers will question or even ignore key notifications, patient information, and clinical data. Now more than ever, vendors have a responsibility to both identify and improve the data flowing through their pipes.

Real-time prescription benefit (RTPB) – one example of an integrated tool that brings patient-specific coverage and cost data to EHR workflows – has been adopted by thousands of health systems, hospitals, and clinics across the country. This technology allows patients to understand the cost of their medications, including if lower-cost alternatives are available, while they are sitting with their care provider. I’m sure many of us have experienced the unpleasant surprise of arriving at a pharmacy only to find out the medication prescribed had an outrageous price tag. As more and more providers adopt RTPB, this should become a thing of the past.

While RTPB has incredible power to transform the patient experience, unless the vendor is providing a heavy dose of quality checks against the data, providers will notice inaccuracies or incompleteness, rendering the tool useless when making prescribing decisions. In order to resolve this, RTPB vendors must work closely with PBMs and EHRs to translate indistinguishable codes, ensure clinical relevance, and filter unnecessary noise, all with the goal of providing meaningful information so that providers can have better cost conversations with patients.

Here are a few examples of data quality steps that can be taken to improve provider trust in RTPB:

  1. Quantity translations. Providers often enter medication quantities in familiar “clinical” terms (4,500 units of a diabetes injectable, for example) instead of entering quantities in “billing” units. Without a correction of the quantity from insulin units to milliliters (the billing unit for this medication), the cost information displayed could be an astounding $101,000. This is due to the fact that the PBM is pricing based on the quantity of insulin units submitted, which can be 100 to 300 times the billing unit. Vendors must be able to translate intended input quantities to ensure an appropriate covered price of $25 is displayed and communicated to the patient.
    Code Mapping: In many cases, drug costs cannot be determined because the National Drug Codes (NDC) used for pricing are obsolete or not recognized by the PBM. In order to receive an accurate price, solutions must automatically find comparable codes to display relevant pricing information.
  2. Clinical logic for improved outcomes. In many cases, solutions cannot display pricing information because of user input error. For example, providers often mis-select the days supply, which can lead to errors such as “maximum dose per day.” Best-in-class vendors are able to leverage intelligence to alter days supply issues and enable transaction success. Clinical expertise and medical literature can also be used to hide erroneous results and prioritize meaningful medication alternatives in the workflow.
  3. Message normalization. Providers want to focus on patient experience, but unhelpful error messages in the EHR (e.g. drug not found), slow down the ordering processes and drive mistrust in integrated tools. Standardizing errors codes from payer and PBM partners allows for actionable messaging (e.g. this medication is not covered at the selected pharmacy, please select a different pharmacy) and can improve the care experience.

It is the combination of these quality-focused tactics that can create a truly exceptional  and reliable healthcare experience. Technology vendors can no longer meet the bare minimum when delivering data. If they do, providers will ignore data presented to them, and patients will no longer trust the healthcare system they rely on. However, superior data and technology enable better decisions and drive real value in healthcare.



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