Friday, April 29, 2016

Digital Patient Adherence Strategies for Specialty Pharmacy

Today’s guest post comes from Scott Pribyl, CEO, mRx Ventures. Scott provides a useful primer on how patient care can be improved using coordinated, cloud-based technology. He explains how SamplifyRx, an innovative technology solution for specialty pharmacy, can increase adherence and streamline the patient experience for all stakeholders.

Next week, Scott will be at the 2016 Armada Specialty Pharmacy Summit in Las Vegas. Email him at to learn more about SamplifyRx’s technology and set up an in-person meeting.

Visit for a cool demo that was created using the SamplifyRx API. (Free registration)

Digital Patient Adherence Digital Strategies for Specialty Pharmacy
By Scott Pribyl, CEO, mRx Ventures LLC

Today, patients who require specialty medications to treat complex diseases must navigate a network of healthcare stakeholders (providers, payors, PBMs, pharma companies, etc.) who are trying to deliver coordinated care using uncoordinated technologies.

Taking a specialty patient from a new diagnosis to conquering their disease takes a care team utilizing interconnected portals and the latest in technology to navigate the four main phases:
  • Get the patient on drug: Prior authorization
  • Get the patient drug delivered: Inventory management
  • Keep the patient on drug: Adherence
  • Treat the patient to a goal: Quantify
Utilizing a patient-centric approach with interconnected portals is key to seamlessly moving through these phases. A patient’s specialty prescription information should be in a centralized patient data repository where any care member should have access (based on HIPAA permissions).

Portal vs. Hub

Understanding the difference between a portal and hub is essential to understanding the real workflow:
  • Portal: Allows access to patient-centric record with permissions
  • Hub: Consolidated group of data
In healthcare, HIPAA and data security require access through a portal before accessing any hub service. One benefit of interconnected portals is any care team member can share documents securely without faxes or e-mails with another portal user. You can save a PDF in one portal and in real-time it will show up in the document manager of the other care team’s portal.

The New Standard: API and OAuth2.0

An Application Program Interface (API) connects the backend database to the user interface. Using an API – typically in the RESTful JSON format – will message directly with the backend database without worrying about any changes to the frontend interface. Instead of full “hard coded” integrations with a legacy system, using an API can speed up the time to connect different care team portals.

Technology in specialty is shifting towards the use of an API for retrieving data but HIPAA still requires permissions for patient data. Patients must be able to opt-in and opt-out of sharing patient data. One standardized option is the use of OAuth2.0 for granting permissions using tokens.

The token allows access to protected resources securely. For example, if a patient app wants to connect with Fitbit data, first the two apps must be connected with an API. Then, the patient must enter the OAuth2.0 token to give permission to share data from the Fitbit device with the patient app, which only takes seconds. API plus OAuth2.0 protocols are being used by:
  • Fast Healthcare Interoperability Resources (FHIR) HL7 specification
  • Facebook
  • Google
API Use to Eliminate the Prior Authorization Bottleneck:

During the Prior Authorization (PA) phase, there are two different pathways required for PA approval:
  • Electronic claims or adjudication software (including the switch and D.0 transaction) determines the patient’s benefits and eligibility.
  • Clinical pharmacist approval determines if the drug prescribed is medically appropriate and necessary.
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An API allows everyone to keep their workflow with the switch but remain connected to a standardized platform to expedite the PA approval. Utilizing an API with portal access for prior authorizations allows any care team member to use the SamplifyRx RapidPA electronic library to find a dynamic PA form by entering any of the following search criteria:
  • Payor
  • Specialty Pharmacy
  • ICD-10
  • Drug
[Click to Enlarge]

Engaging the Patient

The specialty pharmacy or Medication Therapy Management (MTM) company can register the patient for an adherence app when the drug is delivered:
  • Pre-load the patient app and assign the prescription to the patient
  • Register the patient for a patient app/portal
  • Provide patient access to all care team members
  • API and OAuth2.0 built into patient app
Making the Patient Data Actionable:

Unless the data collected from a patient app is shared in real-time, the data could be worthless. Using the new, interconnected portal system, a bleed event, for example, could trigger documentation to be sent to the care team coordinator to triage, thereby making data actionable in real-time.

[Click to Enlarge]

Quantifying Data:

Since data is collected from multiple sources through API connections, there are new opportunities to use the data:
  • A decrease or increase in activity level (Fitbit) could show the impact of a change of prescription or dose
  • Performance-based or outcome-based contracts
  • Incentivizing adherent patients with a reduction in premiums
  • New sources of data for population health
Regardless of the digital strategy chosen, SamplifyRx has a solution that can accommodate any company that touches specialty:
  • Private-label all portals and patient app
  • Customize default apps with logos
  • API connectivity and data feeds for any portal or app
  • Framework and API to let digital agency build a user interface (UI)
  • Dynamic Data Aggregator to collect and report data
  • Connect current app into workflow with an API
You can view a demo private-label app at It was created using the SamplifyRx API. The demo shows some data feeds and how connected portals can be built in with permissions. To learn more, contact Scott directly at

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

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