• Background
  RxHub is an innovative technology company connecting the healthcare industry by sharing prescription and benefit information.
• Challenge
  Develop a nationwide information exchange that enables physicians to access patients’ drug benefit coverage information via a single prescribing technology.
• Solution
  Leverage Initiate software’s master data management engine with Initiate’s advanced analytical capabilities.
• Results
  A universal framework fosters new levels of affordability and patient safety for approximately 150 million individuals, quickly and accurately linking doctors, pharmacists and prescription benefit managers.

With increasing costs of prescriptions, rising medication errors, and the responsibility for providing safer patient care, the healthcare industry in the United States has faced daunting challenges over the last decade. The need to address the inefficiencies and information gaps that jeopardize patient safety and create unnecessary costs for physicians, hospitals, pharmacies, benefit providers and patients was confirmed by 1999 Institute of Medicine findings:

• Over $77 billion spent yearly in drug related morbidity and mortality costs
• Over $1 billion wasted yearly on physician and hospital visits resulting from medication errors
• $5.6 million estimated yearly, per hospital, for medication errors and adverse drug effects
• 10 - 14% estimated annual increase in pharmaceutical spending

Beyond dollars, the astronomical toll inflicted on patient health and safety due to medication errors and non-compliance: 770,000 injuries, disabilities or deaths approximated for U.S. hospitals annually.

The prescription management dilemma. Prescriptions have become increasingly expensive to manage, consuming a large percentage of health plan dollars. Most plans outsource prescription management to specialists known as pharmaceutical benefit managers (PBMs). The PBMs administer a formulary of approved drugs for each plan, but a physician typically doesn’t know a patient’s specific formulary, which often results in prescribing a drug not on the plan. When visiting the pharmacy, the patient learns that a plan-approved medication is less costly. The patient must then notify the physician whose productivity, along with the pharmacist, is diminished due to rewriting and refilling the prescription; the patient is inconvenienced and doesn’t receive medication in a timely manner. Everyone loses; no one wins.

In response to these challenges, RxHub was founded in 2001 with the vision of creating a nationwide electronic information exchange to share prescription and pharmacy information. The founders, already pioneers in advanced patient record-matching solutions on a smaller scale, recognized that universal connectivity through a common hub would increase efficiency, reduce costs and improve patient safety. The major challenge was developing a common foundation that would enable physicians and participants in the prescription creation and delivery process to access patient information from a single point-of-communication. In pursuit of this mission, RxHub gained consensus from and sought collaboration with the three largest PBMs, an imperative because they represent 75% of the commercial marketplace.

RxHub selected Initiate software as the high-performance technology to meet its requirements and tackle the complexity of matching and linking more than 150 million records.

Initiate’s solution turned in the best performance in the benchmarking tests. The PBMs supplied actual data for the trials, participating in and adding greater value to the vendor selection process. Initiate software outperformed all other potential vendors. Best matching rate, fastest loading and processing time.

This implementation would enable RxHub to dynamically link and match–on demand–billions of customer records from constantly changing databases, avoiding the substantial costs associated with establishing and maintaining unique keys. Initiate software recognizes patients by name, not numbers, eliminating time spent searching for or entering customer data. Furthermore, Initiate’s algorithms for record linkage create a solid and predictable foundation for patient data integration, and generate levels of speed and accuracy simply not found in other technology, meeting RxHub’s mission-critical objectives:

• Complete accuracy in data matching and linking–there is no room for error in the identification of patients and their relevant information
• Fast performance and provision of complete patient history–inquiring doctors need comprehensive drug history for each patient in real time, based on all benefit claims
• Support of formulary capability–because physicians are limited to brands that are negotiated daily by insurance providers for different patient conditions, they require complete display of formulary benefit information showing the unique brands falling under each patient’s co-pay coverage

As the implementation progressed, it focused intensely on the kind of data that the PBMs provide, analyzing all elements of a patient’s record and how to uniquely identify each individual. By applying its analytic capabilities, Initiate identified the key elements most common in the data sets and manipulated those values through algorithms to determine ambiguous matching such as: John Smith vs. Jon Smith vs. Jonathon Smith. Additional ambiguities could also be resolved, including those between trading partners, so that when a doctor doesn’t know which PBM represents a patient, eligibility or prescription coverage information is accessible through the network.

Seamless and simultaneous processing. One of Initiate software’s many robust features is its ability to enroll and update records while other transactions are running without interruption. This advanced transaction switching capability is particularly critical during periods of open enrollment, enabling updates to the MPI for potentially millions of records per day with no downtime.

The electronic prescribing framework, supported by Initiate’s technology is up and running. RxHub is extending universal, standardized communication that links prescribers, pharmacies, PBMs and benefit plans. Approximately 150 million individuals with insurance coverage are represented within the new system–beyond that, for each person there are multiple records, sometimes as many as 30 per individual. The matching and linking capability is incredibly large-scale and sophisticated as the system identifies the correct person, finds the exact records for that unique individual, and pulls them together without missing any records or including any incorrect records.

Quantifiable measures of success

• The major PBMs feed their membership rosters to RxHub containing up to 50 million member records. Through Initiate’s customized process RxHub loads 50 million records in approximately 2 hours.
• The database searches, scores and links records for unique matches in 250 milliseconds or a quarter of a second per record.
• During periods of open enrollment, RxHub processes as many as 3 million records per day per PBM–and accomplishes that in the span of an hour.
• Response time is now less than four seconds, from initial request until complete information is provided to a physician or certified staff member using the network to securely access prescription benefit information.

The partnership with Initiate has more than met RxHub’s ambitious business objectives and technology goals. The targeted outcomes are tangible for network participants:

• Improved safety, convenience and satisfaction for patients
• Reduced costs for employers, benefits plans and PBMs
• Increased efficiency in the prescription creation and delivery process

Benefits to physicians and the industry. Access to more accurate information and complete medical histories empowers doctors to provide faster, high quality patient care. They can now check eligibility, formulary benefit information or concurrent medications in support of writing a formularycompliant prescription the first time. Physicians and caregivers alike are empowered with the knowledge that they are avoiding drug duplication. A corollary benefit of the universal framework stems from RxHub’s collaboration with PBMs to fully use and enhance industry standards.

The future. Initiate software provides a solid foundation from which RxHub can launch future initiatives, further revolutionizing the prescribing process in a variety of healthcare venues. The availability of new types of data, evolving analytical requirements, emerging HIPAA policies and participation from the remaining PBMs will drive RxHub’s full leverage of Initiate’s capabilities in the future.