1. 03-23-05 August 2008 page 1 Arkansas Medicaid ePrescribing Project Overview

2. August 2008 page 2 ePrescribing Project Introductions and Responsibility HP - Program management and oversight for the ePrescribing implementation; Medicaid program data provider SureScripts-RxHub - Patient identification and information routing Point Of Care Partners - ePrescribing program consultants QSource/Buccaneer - Provider outreach and program evaluation

3. Arkansas Medicaid ePrescribing Project Overview August 2008 page 3 HP Project and Program Management System Connectivity to SureScripts-RxHub Building transactions to provide program data –Eligibility –Medication History –Drug Coverage Data

4. Arkansas Medicaid ePrescribing Project Overview August 2008 page 4 SureScripts-RxHub The ePrescribing Advantage

5. Arkansas Medicaid ePrescribing Project Overview August 2008 page 5 SureScripts-RxHub Formation SureScripts: industry owned LLC formed by the pharmacy associations representing nation’s 57,000 pharmacies –Incorporated August 2001 –Mission: improve the prescribing process through a focus on Safety, Efficiency and Quality RxHub: formed and owned LLC by the 3 largest PBMs and now representing more than 200M covered lives –Incorporated February 2001 –Mission: improve patient safety and reduce healthcare delivery costs Together, SureScripts-RxHub provide physicians with secure access to 200 million covered lives and have connected over 95% of the nation’s pharmacies through proven industry transactional standards.

6. Arkansas Medicaid ePrescribing Project Overview August 2008 page 6 SureScripts-RxHub Benefit The merger provides a single, nationwide network that enables more clear, accurate and efficient communications between prescribers, pharmacists, and payers. The merger makes available critical information that every physician should have in front of them when they prescribe and, in doing so, accelerate the country’s transition toward a paperless prescription process that will save billions of dollars and thousands of lives. Streamlining the individual processes of the legacy organizations will save the industry time and money and give physicians more information needed to provide quality care to their patients.

7. Arkansas Medicaid ePrescribing Project Overview August 2008 page 7 SureScripts-RxHub AR Information RxHub Certified Technology Partners offering services within the State as of first quarter 2008: © SureScripts-RxHub, 2008 Proprietary and Confidential RxHub has a relationship with HP for the Fee-For-Service lives and e-Prescribing can be enabled. RxHub has access to some Medicaid Managed Care lives covered by PBMs and Payers connected to the RxHub National Patient Health Information Network.

8. Arkansas Medicaid ePrescribing Project Overview August 2008 page 8 Clinical Decision Support Information Payers provide real-time access to patient pharmacy eligibility, benefits & formulary, and medication history at the point of care for more than 200 million patient records. Physicians utilize RxHub certified technology applications to review real- time decision support information and electronically transmit prescriptions to the patient’s choice of pharmacy. Patients provide consent for use of their data for healthcare treatment and select pharmacies to fill prescriptions. Pharmacists utilize RxHub certified technology applications to process electronic prescriptions and request refills directly from physicians offices which improves patient safety and processing time. Healthcare Data Sources Technology Applications Patient Eligibility Data Name, Address, Date of Birth, Gender, Cardholder, Group, Health Plan, Retail Benefit Status, Student Status Patient Formulary Data Formulary Status, Alternatives, Drug Coverage Patient Medication History Data Date Range, Drug Name, Oldest Fill Date, Most Recent Fill Date, Number of Fills, Days Supply, Quantity Dispensed, Pharmacies/Prescribers 70% of safety and savings advantages of e-Prescribing result from Decision Support Information

9. Arkansas Medicaid ePrescribing Project Overview August 2008 page 9 Informed ePrescribing Process Patient Uniquely Identified in Master Person Index Patient Selects Pharmacy Patient 1 2 34 6 Collects Patient:  Consent  Name  Date of Birth  Gender  Zip Certified Physician Applications 5 Electronic Dr./Patient Information Validation SureScripts-RxHub provides secure access to more than 200 million patient records AND returns patient clinical decision support information in less than 2 seconds. © SureScripts-RxHub, 2008 Proprietary and Confidential Certified Retail Networks Certified Payers Provides Patient: Eligibility Benefit Formulary Medication History

10. Arkansas Medicaid ePrescribing Project Overview August 2008 page 10 SureScripts-RxHub Objectives Open to all ePrescribing stakeholders to ensure fastest route to widespread adoption and cost effective healthcare delivery Utilizes and develops industry transactional standards to securely communicate consenting patient information in real- time between e-Prescribing stakeholders (ASC X12, and NCPDP) Provides clinical decision support information - patient eligibility, benefits, formulary, and medication history - for more than 200 million patients to physicians at the point-of-care Delivers real-time, informed electronic prescriptions to pharmacists in the retail setting Does not alter clinician/patient relationships, or business relationships between payers, pharmacies, and technology vendors Operates as a Cost Recovery Model

11. Arkansas Medicaid ePrescribing Project Overview August 2008 page 11 Physician Access to Real Time Information Person Index: Access to more than 200M members uniquely identified using demographic elements. Patient Eligibility: Patient eligibility, benefit and coverage, and formularies for authorized clinicians at the point of care. Patient eligibility is also available to pharmacists at the point of dispensing. Patient Medication History: Drug history for all patient coverages. Includes original prescription and refills. Data can indicate: Patient Prescriptions: Bi-directional electronic delivery of prescriptions between physicians and retail pharmacies.  Patient compliance with prescribed regimens  Therapeutic interventions  Drug-drug and drug-allergy interactions  Adverse drug reactions  Duplicate therapy

12. Arkansas Medicaid ePrescribing Project Overview August 2008 page 12 ePrescribing Readiness  National infrastructure is secure and established  Transaction standards are approved and have been used for 6+ years  Technology partners are certified on transactions and data usage  Proven ability to improve patient safety and quality of care

13. Arkansas Medicaid ePrescribing Project Overview August 2008 page 13 Point of Care Partners (POCP) ePrescribing Program Consultants

14. Arkansas Medicaid ePrescribing Project Overview August 2008 page 14 Point of Care Partners Who Are We? Health Information Technology (HIT) strategy and management consulting firm with active practices in: –ePrescribing –Chronic Care Management in the context of EHRs Focus is on subject matter, not stakeholder segment Boutique consulting firm regarded as experts in ePrescribing What is Our Role? Provide overall ePrescribing program advice and counsel Advise on PR, media and marketing components of the project Offer advice and direction on program parameters Provide program management assistance

15. Arkansas Medicaid ePrescribing Project Overview August 2008 page 15 POCP Client List Employers General Motors, Ford, Chrysler Content Companies Thomson Healthcare PDR MICROMEDEX Wolters Kluwer Health MediMedia Government Natl. Library Of Medicine Department of Defense AHRQ PBMs Medco Express Scripts CVS Caremark MedImpact Providers Cleveland Clinic Henry Ford Health System Health Plans BCBS Florida – Navigy Group Health Inc. (GHI) BCBS Michigan Cigna Connectivity Companies Availity RMD Networks eRx Network Technology Companies AthenaHealth Epocrates

16. Arkansas Medicaid ePrescribing Project Overview August 2008 page 16 Anthony J (Tony) Schueth, MS – CEO and Managing Partner, 17-year health care veteran, and nationally recognized expert in ePrescribing. Project manager for SEMI. Project lead for the RAND New Jersey ePrescribing Action Coalition, one of five MMA pilots. Previously at Merck- Medco, IMS MEDACOM, IU Medical Center and Baxter Healthcare. Project Role: Executive Oversight and Overall Responsibility David S. Green – Senior a 20-year healthcare veteran. Most recently with the ePrescribing companies, Prematics and Zix, he spent 16 years prior to that with Express Scripts and AdvancePCS (now CVS Caremark) in ePrescribing-related roles. He has been involved in numerous ePrescribing initiatives in both business development and operational roles and has assessed many business opportunities and markets for his employers. Project Role: Consulting Lead and Key Contact Other Executives – POCP has a portfolio of other consultants with whom we work on a case-by-case basis based on skills. They include: Kurt Andrews, PhD, epidemiologists and outcomes researcher; Connie Sinclair, RPh, clinical pharmacist and HIT strategist; Michael Solomon, HIT Strategist; Lynn Offenhartz, implementation and operations guru Project Role: As Needed and Where Have Expertise Experienced, Successful Team

17. Arkansas Medicaid ePrescribing Project Overview August 2008 page 17 Recent Projects Project manager for the Southeastern Michigan (SEMI) ePrescribing Initiative funded by General Motors, Ford, DaimlerChrysler and BCBSM ePrescribing planning and feasibility study for the state of Vermont Subcontractor to the RAND corporation on: –the New Jersey ePrescribing Action Coalition, one of the four 2006 MMA eRx pilots –The eRx Toolset, an AHRQ-funded program to build a toolset for ePrescribing based on best practices, lessons learned and critical success factors –A pilot for Structured and Codified Sig, RxNorm AHRQ subcontractor leading the business case and standards development efforts around electronic prior authorization Assisted a large regional health plan to determine an ePrescribing strategy and level of investment using POCP’s proprietary ROI model Led initiative to analyze clinical decision support language for the Agency for Healthcare Research & Quality (AHRQ) Evaluation, analysis and recommendations for leading ePrescribing solutions for various clients

18. Arkansas Medicaid ePrescribing Project Overview August 2008 page 18 QSOURCE Provider Outreach and Program Evaluation

19. Arkansas Medicaid ePrescribing Project Overview August 2008 page 19 Who We Are QSource of Arkansas is a healthcare consulting firm Our parent company is headquartered in Memphis with a satellite office in Nashville QSource created a subsidiary organization in Little Rock called QSource of Arkansas in March 2008 Nancy Archer, QSource Executive Director

20. Arkansas Medicaid ePrescribing Project Overview August 2008 page 20 Valuable Partnership QSource integrates partners into our work to maximize the skills & services available to our customers Buccaneer Computer Systems & Service, Inc. (BCSSI) is partnering with QSource in delivering superior information systems (IS) and analytical support. BCSSI is a national leader in IS design and implementation and is expert in claims analysis, data mining and reporting. Nena Sanchez will lead BCSSI’s work with QSource.

21. Arkansas Medicaid ePrescribing Project Overview August 2008 page 21 QSource Project Role QSource will provide expertise in the technical aspects of adoption and use of electronic clinical information; specifically e-prescribing, such as: Facilitating and coordinating intra/inter office workflow redesign toward maximization of health information exchange among providers regarding continuity of treatment Quality Improvement and Patient Safety as it relates to e- prescribing

22. Arkansas Medicaid ePrescribing Project Overview August 2008 page 22 A Hybrid Model Existing Medicaid regional and statewide meetings and publications Academic detailing: onsite visits to participating physician practices

23. Arkansas Medicaid ePrescribing Project Overview August 2008 page 23 Outreach Team Contact PCP sites and gauge their interest in pursuing assessment, planning, and implementation of e-prescribing functionality by: Examining the technical specifications of any current product(s) Analyzing communication and transmission capabilities Identifying the pharmacies they routinely utilize on behalf of their patients

24. Arkansas Medicaid ePrescribing Project Overview August 2008 page 24 Program Evaluation Evaluation of the Arkansas Medicaid e-prescribing initiative will be accomplished through 3 recommended methods based on the principle objective of this initiative: Facilitate adoption and utilization of e-prescribing among primary care physicians. Improve the quality, safety, and coordination of care provided to Arkansas Medicaid beneficiaries.

25. Arkansas Medicaid ePrescribing Project Overview August 2008 page 25 Program Evaluation Methods Real time feedback from the stakeholder organizations and the providers Monthly reports of number of participants & status of adoption A provider survey of satisfaction with the e-prescribing initiative, including: –Tools and resources available –Usage estimates –Recommendations for future Medicaid technology initiatives

26. Arkansas Medicaid ePrescribing Project Overview August 2008 page 26 Communication Information sharing across provider associations Quarterly written updates for all stakeholders Regional and state wide meetings and publications will be used to introduce the initiative and offer ePrescribing assistance Exhibits and presentations at consumer, stakeholder and medical community events, such as professional provider organization conferences and coalition meetings Because ePrescribing is a state wide effort and will involve many groups, associations, stakeholders, physicians, pharmacists, providers and more, communication is vital to project success. Some forms of communication will include:

27. Arkansas Medicaid ePrescribing Project Overview August 2008 page 27 Communication Arkansas Medicaid Website Provider newsletter Regional meeting presentations Journal articles and ads Project status reports, face to face meetings and teleconference calls between project team and core stakeholders

28. Arkansas Medicaid ePrescribing Project Overview August 2008 page 28 THANK YOU QUESTIONS?