Using Tech To Provide Healthcare Price Transparency

Increasing access to information on the costs of medications is a dramatic improvement for UCHealth doctors and patients, says CT Lin, chief medical information officer.

UCHealth in Denver Colorado is actively partnering with tech startups to provide more transparency in the pricing of the medications its doctors provide, says Dr. CT Lin, chief medical information officer.

Lin spoke with StrategicCIO360 about what he looked for in a tech partner, what UCHealth needed to do to make the partnership work and how the changes are impacting care.

Where have you seen inefficiencies or gaps in the software that health systems are using?

The U.S. spends more money on prescription drugs than any other country, so there is a clear need for pricing and coverage data within the electronic health record (EHR) system that will help patients and physicians make informed decisions on their prescription drugs. 

At UCHealth in Colorado, we conducted a survey through our CARE Innovation Center and found 80 percent of the prescriptions written by UCHealth doctors were being filled out-of-network. By simplifying our prescribing process and making drug pricing data more transparent, we saw an opportunity to mitigate out-of-network prescriptions and better control safety, quality and adherence by our patients. 

Our survey found providers often prescribed medications without confirming formulary or insurance coverage. Physicians also had to spend valuable time on the phone with pharmacists to find pricing information, or on the phone with insurance companies who needed to receive prior authorization before paying for a drug. In many cases, physicians manually researched drug alternatives or coupons outside of their health system’s EHR. All of those tasks are extremely inefficient. 

What are the key characteristics you look for in a software partner, specifically as it relates to the needs of a large health system?

Large health systems need effective and easy-to-use software design within the EHR. To truly influence prescribing behavior, the software has to be reliable and integrated into the workflow. If the software slows physicians down, they simply will not use it.

The interrupted workflows, many of which involve phone calls and manual searches outside of the EHR, are not sustainable. A physician population already strained by burnout and understaffed facilities must have streamlined software solutions that solve more problems than they create.

Can you share a specific use case of a successful software implementation? What made it go well? 

In addition to conducting surveys, the CARE Innovation Center identifies promising startup companies in the region for health systems to partner with. They pointed us to Denver-based Arrive Health (formerly RxRevu), which offered a price transparency solution that fit perfectly with the needs of our prescribers and their patients. By giving physicians access to comprehensive data in real time at the point of care—including cost, coverage and formulary data—we can empower them to find the most cost-effective medication options at the time of prescribing.

Our implementation of Arrive Health’s solution was simplified by the fact that all the facilities in our health system use Epic as our EHR—that includes 16 hospitals and 1,000 clinics in the Rocky Mountain region. We rolled out real-time prescription benefits for the entire health system at once, making timely cost and insurance coverage data available to all and providers across each of our facilities.

UCHealth physicians use Arrive Health’s technology every day and are taking advantage of opportunities to save money for their patients. In 2021, about 4,500 providers within the health system had access to real-time prescription benefit cost and coverage data. We saw that data used in over 2,000 prescription transactions per day, or over 250,000 patient interactions total.

As an example, I’ve seen a prescription inhaler that would have cost the patient $145 out of pocket for a 30-day supply. But the Arrive Health platform showed two alternatives that cost only $15 each for the same quantity—saving the patient $130 for the month and more than $1,500 for the year. Additionally, the software helped us to avoid about 5 percent of prior authorization requests by finding alternative medications, allowing patients to start their therapy as quickly as possible. We also achieved a success rate of over 98 percent in prescription transactions between pharmacy benefit managers and our EHR.  

What advice would you offer a colleague looking to make a similar implementation?

Successful technology implementations have to be as seamless as possible, and in our case, we fully integrated the technology into our EHR to optimize workflow. We knew that if the solution interrupted physician workflows, they would not use it.

We also saw the need for a strong support system. We continue to work closely with Arrive Health to identify areas of need and the functions that work well. We can measure changes in prescribing behavior and medication switches within the platform so we know where to focus our efforts and can see how physicians use it.

Even a relatively seamless implementation requires training initiatives to drive adoption and utilization. At UCHealth, we achieved a high rate of adoption through regular training, including sessions at specific clinics, providing informational materials and facilitating Q&As to help providers understand how to use the technology.

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