1. EHR-integrated Benefit Design
Jake Halpert, Clinical Programs
1

2. Solution Overview
 High Level Solution Description:
• SampleRX lets healthcare payers provide virtual sample
closets for physicians at the point of care. The health plan
decides what drugs can be trialed for its members, and these
are displayed in the physician’s EHR during patient exam.
Medications are e-prescribed to retail or mail-order with a $0
patient copay during trial period (typically a 30-day supply).
 Healthcare/Business problem addressed:
• Rising pharmaceutical costs (for insurers and patients)
 The application developed addresses the following
category:
 Innovative approaches to addressing value-based care
imperatives.
2

3. Improvements in Care
 Quality of Care  Treatment initiation is smoother,
easing the patient’s financial and psychological
commitment to a new prescription while drug
effectiveness and tolerance is being established
 Cost-Efficacy  The most value-based medication
options are promoted at the point of care, reducing
drug expenditures for both the patient and the payer
3

4. Usability and Design
Provider Workflow
 1—The provider is in the patient’s EHR chart documenting a new
diagnosis and deciding on treatment options.
 2—In the Sample Closet tab (integrated into the EHR), the provider can
view medications—generic and brand—sponsored by the health plan.
Samples are sorted according to condition.
 3—The provider can select one or multiple medications, which are e-
prescribed to retail or mail-order with a proprietary insurer voucher
code automatically attached on the backend for $0 patient copay.
 4—The e-prescription is saved automatically to the EHR, and the
provider returns to the native EHR.
4

5. Usability and Design
Figure 1. Provider-facing drug selection screen
5

6. Usability and Design
 In the separate payer-facing portal, the plan’s
formulary administrators have controls to:
1) update what medications are sponsored to trial for plan
members
2) target specific medication promotions to certain patient
segments based on demographic and diagnostic criteria
3) analyze physician-usage metrics in real-time
6

7. Integration Description
 SampleRX operates as a web-based application. For
integration with the Allscripts Enterprise EHR, a UAI
Command button (“Sample Closet”) is created on the
Clinical Desktop that links to the application. To give the
physician flexibility within his prescription workflow,
additional hooks can be placed in EEHR medication-
related views according to client specifications as
allowable by the Allscripts integration API.
 Web service calls utilized:
GetPatientFull, GetPatientPharmacies, GetPatientProblems,
GetRXFavs, GetUserID, SaveRX, SaveSimpleRX, SearchPharmacy
7

8. Development Stage
 The product is currently in the prototype phase, with
sponsored partnerships with HMOs and ACOs rolling
out in late 2013.
8

9. Go to Market Plans
 Our pricing for healthcare payers is based on a
$PMPM model. We target a 3-4% reduction in
pharmaceutical spend per client from value-based
drug promotion and take a 30% share of savings.
 The product is being rolled out in large integrated
payer-provider systems, starting with HMOs and
ACOs.
• Next, we are approaching PPOs and large third-party insurers
with network providers. We sell to large organizations with at
least 1000 physicians and 100,000 members due to the fixed per-
group implementation costs necessary for secure EMR
integration and admin setup.
9

10. Video Demonstration
 Short demo video
 This video illustrates the points of integration with
Allscripts, sample selection process, and sample
formulary administration.
10

11. Recap
 EHR-integrated value-based benefit design
SampleRX encourages physicians and other providers to
select medications based on value, as opposed to drug
sampling promotion strategies around expensive or recent
brand-name drugs. This saves money for both the patient
and the insurance plan and leads to better patient
adherence with the drug regimen, further improving overall
care. This has earned SampleRX the following moniker
from the director of one of the largest ACOs in the U.S. –
“the white knight of drug promotion.”
11

12. Thank you for your time.
12