From one day to the next, a prescription for Bruce Miller’s regular medication shot up by a factor of five, to about $250. The drug price hike’s cause was no mystery: His wife had recently retired, and this was his first refill since starting Medicare coverage.
A few things can happen in such cases. The patient can dig deeper into his pocketbook. Or the patient, who typically learns of a drug’s cost when ordering online, on the phone, or while standing at the pharmacy counter, can reach out to the physician and see if there isn’t a different, less-expensive drug that might do the trick. Or the patient can shake his head and decide not to fill the prescription just yet – or perhaps ever – given the cost.
None of these outcomes are ideal. The last of them can be life-threatening. Fortunately, Miller’s internal medicine physician, Dr. CT Lin of the University of Colorado School of Medicine, took a few moments to access Arrive Health, formerly RxRevu, a clinical decision support application integrated with UCHealth’s electronic health record. It’s essentially a comparison-shopping tool that let Lin scroll comparable medications and their retail prices based on Miller’s insurance coverage. The now-pricier medication in question came in tablet form, Lin noted, but there was also a capsule version of the same drug. For Miller, the capsule would be about $200 cheaper, four times a year.
“It definitely saved me some money,” he said.
Arrive Health helps save money on prescriptions
It has saved a lot of patients a lot of money: Arrive Health is available to the roughly 4,000 drug-prescribing providers in the UCHealth system and 300,000 providers around the country capable of serving 150 million patients.
Lin was more familiar with Arrive Health than most of those providers. In addition to seeing patients, Lin serves as UCHealth’s chief medical information officer, and he has worked with Arrive Health since the Denver-based health-IT firm signed on with UCHealth’s CARE Innovation Center in 2016.
Back then, RxRevu had a great idea: Give physicians and patients a clear window into prescription-drug costs and options while still in the clinic. That information could then influence what drugs get prescribed and cut prescription costs. But as Arrive Health CEO Kyle Kiser described it, the then-startup faced a dilemma involving multiple parties with different aims. Physicians understand what the patient needs and what medications can meet those needs. Pharmacies understand the medications, the costs, and how they’re delivered. And health insurers and the pharmacy benefit managers that manage prescription drug benefits for those insurers understand health-plan designs and costs. Physicians wouldn’t be interested until the pharmacies, insurers, and pharmacy benefit managers were on board – and vice-versa.
“We realized we were building a multisided network, and anyone who’s tried to build a multisided network is faced with a daunting chicken-or-egg problem,” Kiser said.
Prescription drugs are complicated, partnerships help
To solve that problem, Arrive Health partnered with UCHealth’s CARE Innovation Center and CU Innovations, the CU School of Medicine’s innovation incubator. For Arrive Health, UCHealth’s and CU’s scale and financial backing was such that the multisided network’s various parties took it seriously. Arrive Health also gained vital access to a user base of physicians and advanced care providers who could offer feedback on what they liked and what they felt needed work.
“That gave us insight that we could have never gotten on our own: What’s important to the actual user, which is incredibly meaningful when you’re building software,” Kiser said.
From UCHealth’s perspective, Arrive Health fits nicely into its innovation portfolio from practical as well as philosophical perspectives. Lin, who has worked with the company since the partnership began, says it’s about improving information transparency to patients and giving them access to their own health status to encourage collaborative, patient-centered care.
“The thinking was, with price and copay information about patient prescriptions, patients and doctors can make better decisions as we move forward,” Lin said.
Even as Arrive Health’s prescription benefit solution has taken off, the now 80-employee company and UCHealth have continued to co-innovate. One example relates to high-cost medications that stand likely to trigger a health insurer’s request for more information from a physician before agreeing to pay for the drug. The tool has historically been optional for UCHealth providers, and that makes sense in many cases: Why force a routine, low-cost drug prescription through a decision-support system? But if a prescription is going to require prior authorization, Arrive Health flags it and alerts the provider. It also suggests alternative medications that could also work, the final decision being up to the provider.
UCHealth is also working with Arrive Health as the company harnesses its ability to combine diverse data sources to enable better health care choices to move beyond pharmacy into clinical care.
“They’re our early adopter at every opportunity,” Kiser said. “I really think of UCHealth as an extension of our product organization. They’re a place where we validate and investigate these things we’re trying to solve.”
Written by Todd Neff for UCHealth, UCHealth Today.