Healthcare technology, also called “healthtech,” refers to any IT tools or software designed to improve any aspects of the healthcare system from telehealth to robotic-assisted surgery. Healthtech can boost hospital and administrative productivity, give new insights into medicines and treatments, and improve the overall quality of care provided. Today’s healthcare industry is a $2 trillion business that is currently bogged down by high costs and red tape. The healthcare industry is looking for ways to improve in every possible area. Tech-infused tools are being integrated into every step of our healthcare delivery experience to counteract two key problematic areas: quality and efficiency.1
There are several trends in the use of technology systems that impact drug access.
First is the rise of genomic testing. Personalized medicine continues to edge closer to the forefront of the healthcare industry. Tailoring treatment plans to individuals and anticipating the onset of certain diseases offers promising benefits for healthcare efficiency and diagnostic accuracy. Pharmacogenomics could help reduce billions of dollars in excess healthcare spending due to adverse drug events, misdiagnoses, readmissions, and other unnecessary costs.
Before a full-fledged system of pharmacogenomics can come to fruition, the healthcare industry needs a tool that can aggregate and analyze all the big data and digital health information to match up information at the population, individual, and macro levels. The ability to compare these data is going to be valuable as we move forward to make sure that the prescribed medications will work for said individual.2
For Precision clients, perhaps the greatest barrier to access are payer restrictions.
Payer intelligence is a nebulous concept comprising many highly fragmented information sources, including coverage and payment policies, formulary lists, coverage criteria, such as step edits and prior authorizations, coding guidelines, and fee schedules. Most of these source documents can be found in the public domain, but sometimes they are buried deep within the thousands of payer and pharmacy benefit manager (PBM) websites. Once these documents are located, it can be extremely frustrating to interpret them.
As regulatory agencies have accelerated approval of new medicines, health plans and benefit administrators have increased the frequency with which they are creating and revising policies to address coverage for these new products and indications.
The increasing prevalence of newly published policies and coverage criteria, coupled with the frequency in which these payer documents are being revised, further emphasizes the need for a centralized knowledge base that provides real-time payer intelligence.
With hundreds of payers administering thousands of plans, it is nearly impossible to manually stay on top of all the published policies and coverage criteria. Technology, like Policy Reporter’s Bumblebee software, can help. Bumblebee’s patented algorithms have automated the real-time monitoring, collection, and indexing of most payer and PBM websites to ensure manufacturers remain aware of the policy changes that directly impact patient access to their products and services.
While utilizing technology to aggregate and monitor payer documents is critical, using artificial intelligence (AI) to mine these documents and extract relevant coverage information is where the true value lies. Similar to how payers use AI for managing claims, companies like Policy Reporter are leveraging patent-pending AI algorithms to extract formulary data and coverage criteria into searchable data fields. Enriching this payer intelligence with other third-party data sources, such as pricing files, National Drug Code crosswalks, and compendia listings, allows for an even deeper analysis of how products are accessed and covered.
Organizations such as TrialCard are developing an integration with Policy Reporter’s software that will enable a manufacturer’s hub case manager to electronically link a patient’s insurance coverage to the exact medical policy and prior authorization form/criteria for their prescribed drug. This type of integration not only enhances the accuracy of a benefit investigation, but it can streamline communication between the hub and payer, resulting in increased speed to therapy. These organizations are experts at using payer intelligence to improve patient access.3
With the growing trend toward health-systems–based specialty pharmacies, manufacturers will be reliant on even more systems, such as EPIC and Cerner, to get their data. The hub software programs will need to integrate with these EHRs for successful manufacturer data capture and timely benefits verification. New software organizations like Trellis Rx, a technology-enabled specialty pharmacy services provider is assisting health-systems in meeting the complex data challenges of providing specialty medications.4
Lastly, even regulators are jumping into the healthtech fold. The US Food and Drug Administration (FDA) last month released its first AI and machine learning action plan, an approach designed to advance the agency’s management of advanced medical software. The action plan aims to force manufacturers to be more rigorous in their evaluations, according to the FDA. This could possibly result in quicker drug approvals by the agency.5
- Healthcare technology. Accessed March 24, 2021. (link)
- 10 biggest technological advancements for healthcare in the last decade. Becker’s Health IT. Updated September 17, 2015. Accessed March 14, 2021. (link)
- Fein AJ. What is payer intelligence—and can it be combined with technology to enhance patient access? Published April 17, 2020. Accessed March 24, 2021. (link)
- Trellis Rx home page. Accessed March 27, 2021. (link)
- Landi H. Healthcare AI investment will shift to these 5 areas in the next 2 years: survey. Published March 9, 2021. Accessed March 27, 2021. (link)