The PBM Shortcut

What IntelliScript and medication claims reveal about a possible future of patient access.

We’re going through a heck of a lot of sweat, blood, and tears trying to give patients access to their health data from providers, but what if there’s an easier way? What if we just pulled from the PBMs?

I’ve been lucky enough to try out a number of the apps on market for individual access (Fasten Health (Techstars ‘24), HealthEx, Flexpa) in the past few weeks and months. It’s been tremendous to see the rapid progress in the “identity proof and pull across TEFCA” flow that underpins them.

I had a dozen Epic sites and even one eClinicalWorks provider (my dermatologist). This means we have almost all the big EHRs (Epic, MEDITECH, athenahealth, eClinicalWorks) all on TEFCA with their providers making data available via the IAS flow. If Oracle Health can get it together, we’ll pretty soon be at 70% or more coverage.

On the other hand, there’s a long slog ahead in terms of getting the many, many long-tail providers to participate, many of whom are specialists (oncology, PT, home health, dentistry) using systems so disconnected from national exchange that it could take a decade before they meaningfully participate.

But I had a different consumer medical history experience this week that made me stop and think: couldn’t we plug the gap (at least in a broad way) simply by pulling medication and encounter history straight from the PBMs?