#JoinTheConversation with Phillip Scott of NCPDP
This #JoinTheConversation series is brought to you by our partner Experian Health and the episodes were broadcast live in Experian Health’s booth (#3503) at the The HIMSS17 Annual Conference and Exhibition. The interviews were recorded and published to the media player on this page. Please read more about why more than 60% of U.S. hospitals count on Experian Health.
Phillip Scott, SVP Business Development, NCPDP
Joe Lavelle 00:30 All right, I am Joe Lavelle and I’m excited to be bringing you “Join The Conversation”, with my better than normal co-host, Dr. Erin Albert.
Erin Albert 00:41 I’ll give you the 20 bucks later for saying that.
Joe Lavelle 00:44 All right, just kidding. Todd had to step out for a bit, and we’re having a blast! We’re going to get right to it though today, I want to introduce our distinguish guest, Phillip Scott, Senior Vice President of Business Development for NCPDP. Welcome to the show, Phillip.
Phillip Scott 00:57 Thank you Joe, I appreciate it. And Erin.
Joe Lavelle 01:01 Could you take a few seconds and tell the audience about you and your background?
Phillip Scott 01:04 Sure. As a NCPDP’s business development guy, I’ve been with them after retirement. I’m one of those failed guys at retirement. I’ve been with them almost 16 years, so at least two careers under my belt, if not more. The background as always been in healthcare and pharmaceutical sales, and then with McKesson on a whole distribution side, and then like I said after retiring there, I ended up working for NCPDP for the last 16 years. It’s kind of a sad story actually.
Joe Lavelle 01:40 Sounds like fun to me.
Phillip Scott 01:41 Well, the boss said, LeeAnn said, why don’t you go work for me in front of my wife, who immediately accepted.
Erin Albert 01:50 She knew who to ask.
Joe Lavelle 01:51 You must not like golf.
Phillip Scott 01:53 Which I pointed it to her she was a terrible negotiator. You should not accept the job before you understand what’s involved.
Erin Albert 02:02 So Phillip for those people who are not aware, can you give us a 10,000 foot overview of what NCPDP is, and what they do?
Phillip Scott 02:10 Sure, NCPDP is an ANSI-accredited, standards development organization. We actually cut our teeth and made our reputation in the pharmacy services sector of healthcare. So in a HIMSS environment, HL/7 sort of concentrates on clinical and institutional side of things, and then X12 is a financial standards group, insurance company financial transactions, and NCPDP concentrates primarily in pharmacy transactions. So our claim to fame would be, being named in HIPAA legislation for the telecommunications standard being required, also ACA, the accountable care act for ePrescribing. So the script standards, which people talk about electronic prescribing, that’s NCPDP standard.
Joe Lavelle 03:05 Awesome, thank you for that. I was fortunate enough to interview Karly Rowe last summer, right when you announced your strategic alliance with Experian Health. Tell us about that alliance and why it’s important?
Phillip Scott 03:19 Well, I have to say with NCPDP’s reputation of neutrality is it’s been a key to our business, our business model. We bring all parties to the table. It’s big in collaboration and all of our standards and best practices come from a consensus building environment. Well, having said that, we have been looking for some time at a relationship that could create a unique patient identifier, at least our version of what that would be.
We vetted a number of different companies and actually started working on this in 2013. The good fortune brought us in touch with Experian, and we come together nicely, culturally. We both spent a tremendous amount of effort working for the common good, and the solution that Experian brought to our vision for what a unique identifier was made for a great opportunity there, and we’ve been very excited about that offering.
Erin Albert 04:21 What is a universal patient identifier, and how does that play a role in patient safety and better healthcare outcomes?
Phillip Scott 04:30 You could probably ask that question, pick a number and you’ll get a different answer. So I can only talk about our version. So for us, and we’ve known this was an issue for a very long time. The need to be able to uniquely identify patients, so that you know that Phillip Scott is in fact the same as Phillip D. Scott, Scott, Phillip, Phillip any iteration that goes along, and working with Experian and their consumer algorithms that they’ve used over the last 40+ years, gives us a great deal of certainty around making sure that that patient is in fact who we say that patient is.
Now what’s important about that is, so often you have misidentification. You get married up with wrong medical records. I know my personal experience of waiting for days to get a prescription filled, only to find out that the prescription had been sent to the wrong physician, who had the same name as my physician, but when it was getting there, that’s not my patient, so they would just not paying attention to it. So if you reverse those roles, we all hear the horror stories about, cutting the wrong leg off and things of that nature. You really just need to make sure that it’s there, and the money that is spent in trying to vet out who that patient is to make sure that it’s the right person is untold billions.
And we think that our solution is very simple. You just take their algorithms, we identify uniquely patient’s coming out of a master patient index if you would, append that patient record with unique a number, and because they have the ability to filter out across any number of variations of naming conventions, they are able to pin down with a significant amount of confidence that this is the right patient. So you take that number, you append it and then push it back to the client with the correct information. And what it does is, it will identify that patient and show you where they’ve been duplicated in the record because of the different naming conventions.
So if you look at the retail pharmacy, for example, large chain, patients we know that patient go to 3 to 5 different pharmacies anyway. Frequently they cross from one brand label to another brand label, or there within the same store environment, they don’t know. So we have one client with 2 million patient records, when they’ve done the mix, it comes back that they were 80,000 of those people that were actually the same person.
Looking at that because of the identifier, they are be able to say, okay this person is this person, and then see where they went across the spectrum of their stores. And choose to, if they choose to they can collapse that information and get it down to one, or if there’s reason to keep it were it is, they can clean up the naming number nomenclatures so that it is the same at all of those stores and keep it that way. But at the end of the day, when we’ve looked at varying techniques, and this is a big industry effort, which is interesting given there was a prohibition, the Federal government said you got to do a naming, a unique naming convention for patients. But we are going to prohibit the government from doing it, so private sector has to.
And when you start looking at that, as many people as there are in this building or probably those companies are working on a different solution to the whole thing. And what we like about ours is that, it’s a vendor agnostic. It follows the NCPDP mantra of neutrality, if you would. So, if you look at a CommonWell or you look at United Healthcare, or you look at a hospital system, where they all have their own different naming conventions, but many of those patients cross all those silos. As long as they have that unique identifier, you can know where they are. But it can still be cross walked back to their own internal number, like at United Healthcare, I have a member ID, it’s unique to me.
That UPI, that universal patient identity, would go to that number and when they marry my prescription or my pharmacy benefits to my medical benefits. Then it can move over and move out of pharmacy and over into the health systems. So not only is it great service, it’s just fun to think about it. So our effort gives you 2 versions of a flavor, we as an American consumers are all about instant gratification, right? So this gives you instant gratification because Experian’s identifying the numbers and identifying those patients uniquely, and sending it back to you, that is an instant gratification.
But what’s even better about that they do that at no charge. It’s not without a cost I mean you have some programming costs, but there is no charge for that service. And you can do it on monthly, weekly, daily or hourly basis. No, not hourly it needs to be a little bit of time, but you could do it near real time if you would and that’s at no cost. And how to populate it on the other side is, and this is the long term, working to this standards, getting it where it can move seamlessly across many different transactions. And of course getting industry acceptance takes a much longer time, so immediate satisfaction, but yet the long haul.
Joe Lavelle 10:88 But I like that you have a solution that works for today’s environment. Maybe this is a dumb question you might even want to hit me. Why can’t we just make a number like a social security number? What’s in the way of that?
Phillip Scott 11:13 Federal legislation that prohibits the use of the social security number.
Joe Lavelle 11:17 I understand that, but is there any way we could create another number?
Phillip Scott 11:22 Well, that’s what this unique patient identifier would do.
Joe Lavelle 11:24 So that’s the idea?
Phillip Scott 11:26 That is the idea. Yes
Joe Lavelle 11:27 Ultimately it will be the one.
Phillip Scott 11:28 And so we’ve made arrangements in the numbers, so that it fits in the NCPDP claims transaction, meets the number of fields so that it can start to move smoothly throughout the transactions. What is sweet about that, is while you’re getting instant gratification over here at the time that it gets appended in a pharmacy claim transaction, that patient is being tied to an actual healthcare transaction in a real time environment.
Erin Albert 11:59 What is your hope for NCPDP with HIMSS 17?
Phillip Scott 12:05 I have to tell you, we love this organization for one thing, and we’ve try to work closely. But the hope for this is to help us spread this particular message. But it’s also to make the efforts at NCPDP better known within the HIMSS community, and so what are the benefits of that? The fact of the matter is pharmacists are being reimbursed in something in a 7 second range since early 1990’s. Today they’re down to 2 seconds, unless there is a problem and then it’s 7 seconds. We’d love to be. and we know how to do that. We’d love to be able to carry that back into the medical side of things because with a physician, waiting 90 to 120 days and that’s if there is no disputes. To be reimbursed. You wonder how they just carried this cash flow.
Joe Lavelle 13:07 What a great perspective to share, 7 seconds to 2 seconds.
Erin Albert 13:11 Yeah, pharmacies always had real time or close to real time adjudification since mid 90’s.
Phillip Scott 13:25 Are you from Alabama?
Erin Albert 13:17 No.
Phillip Scott 13:20 It sounded like home to me there.
Erin Albert 13:22 Really, adjudification?
Phillip Scott 13:23 Adjudication.
Erin Albert 13:24 Adjudication, I can’t say adjudication. Believe it or not, but yeah.
Phillip Scott 13:30 I’m pretty sure I’ve heard that before.
Joe Lavelle 13:32 Adjudication, I do that all the time, I am from Alabama. All right, what can you tell us about your annual conference which is coming up soon, and I understand it’s going to be the 40th anniversary this year?
Phillip Scott 13:46 Oh, it is our 40th anniversary. Thank you for asking. Actually that’s in May every year in Scottsdale, and as I said we’ve done it every year. It’s actually considered one of the premiere pharmacy, managed care environments like that, mainly because it’s fairly small, meaning that we’ll have a thousand people attend our show, and we’ll have 50 vendors. But it’s the one time a year that virtually anyone in the managed markets arena, it’s the time when the High C’s show up because they can come there, and see everyone that they need to see. And while we spend a tremendous amount of time with CE programming, the real event there is the network and it goes on. 80% of our membership say that that meeting and those sub-meetings that there having all day every day is the primary reason for their membership, because they get so much done there.
Joe Lavelle 14:50 Erin we’re going to have to figure out how to take our show there this May.
Phillip Scott 14:53 Yeah.
Erin Albert 14:53 Absolutely.
Joe Lavelle 14:54 That would be awesome.
Phillip Scott 14:55 We could talk about that.
Joe Lavelle 14:57 That would be awesome. All right, Phillip, looks like we’re going to run out of time here. Before we let you go, where can people go to learn more about NCPDP?
Phillip Scott 15:05 Well, our website is of course is www.ncpdp.org, and in that website of course is all of the executive team for NCPDP, it also shows all the board members. And we pride ourselves on providing direct contact information, so when you look at our website, if you want to talk to someone specifically, it’s there. And if you’re a member in our membership database, and this is one of the great things, if you have any questions regardless whether a competitor, friend or foe, if you pick up the phone, the number and the contact information rings on their desk, and we don’t have a secret password, but we do have a phrase. “You may not know me, but I’m a NCPDP member and I have a question that I think you can help me with”, and it usually gets like a 100% response. We’re excited about that, it is just the paternal nature of the organization as well.
Joe Lavelle 16:00 That’s great. Phillip, it’s such a great pleasure having you on this show. Thanks for making the time today.
Phillip Scott 16:04 Thanks for asking, I appreciate your invitation.
Joe Lavelle 16:05 Sure thing.
Erin Albert 16:05 Thank you.
Joe Lavelle 16:06 That wraps our live broadcast from HIMSS. Again we want to have a quick shout out to our friends at Experian Health. On behalf of our guest, Phillip Scott and our co-host Dr. Erin Albert, I’m Joe Lavelle and we hope you’ll stay tuned for more of “Join The Conversation” from Orlando.
Multi-stakeholder, Problem-solving Forum for Healthcare
NCPDP is a not-for-profit, multi-stakeholder forum for developing and promoting industry standards and business solutions that improve patient safety and health outcomes, while also decreasing costs. The work of the organization is accomplished through its members who bring high-level expertise and diverse perspectives to the forum.
Standards for Electronic Exchange of Information
As an ANSI-accredited Standards Development Organization (SDO), NCPDP uses a consensus-building process to create national standards for real-time, electronic exchange of healthcare information. Our primary focus is on information exchange for prescribing, dispensing, monitoring, managing and paying for medications and pharmacy services crucial to quality healthcare.
Best Practices for Patient Safety
Through our collaborative problem-solving forum, we also develop and standardize best practices for product labeling, dosing instructions, patient communication/education and other practices important in safeguarding patients.
Advisor to Policymakers
NCPDP standards are named in federal legislation, including HIPAA, MMA, HITECH and Meaningful Use (MU). We advise regulatory agencies and actively participate in the rule-making process. We educate legislators about NCPDP’s problem-solving forum and consensus-based solutions, and serve as a resource to policy makers.
About Experian Health
More than 60% of U.S. hospitals count on Experian Health. These providers—along with thousands of medical practices, labs, pharmacies and other risk-bearing entities—are making smarter business decisions, boosting their bottom lines and strengthening patient relationships. Our clients have discovered the value of our revenue cycle management, identity management, patient engagement and care management solutions to power opportunities in the new era of value-based reimbursement.
Experian Health is powered by the strong healthcare heritage of our legacy companies, plus the deep data and analytics capabilities of Experian. This unique combination positions us well to help you succeed.
Revenue cycle management solutions automate orders, patient access, contract management, claims management and collections to improve efficiency and increase reimbursement.
Identity management solutions match, manage, and protect patient identities to enable accurate patient information and to safeguard medical information.
Patient engagement solutions connect patients with personalized portals to create price estimates, apply for charity care, set-up payment plans, combine payments to hospitals and physicians and schedule appointments.
Care management solutions organize and enable sharing of post-acute patient care information to help providers succeed in the new era of value-based reimbursement.
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