clinical health information technology: progress and barriers the intersection of business strategy...

Clinical Health Information Technology:

Progress and Barriers

The Intersection of Business

Strategy and Public Policy

The Health Strategies Consultancy

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Clinical IT Environment

• Reimbursement is the key driver• Private sector models are proliferating

– Proof statements are lacking

• 2003 was a good year for legislation and granting at the federal level– But we lack political will and commitment

• Public sector models will guide future

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Private Sector Models Are Sprouting

• Research by Health Strategies for Foundation for E-Health Initiative under HRSA grant

• Goals of the Project:1. Understand the range of HIT payment and financial

incentive models in place

2. Identify advantages and disadvantages associated with various approaches

3. Consider models that can be applied at the provider and/or community level that promote HIT adoption and improve quality through financial incentives

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Literature: Great Quality Case, Theoretical Business Case

• Scientific/Scholarly literature– Bates, Birkmeyer, CITL, IOM, AHRQ, MedPAC

• Gray literature– Balit, Hewitt, First Consulting (CHCF)

• Industry press– Health Data Management, Healthcare Informatics, HIMSS

• Popular press– New York Times, WSJ

• Company/Product-specific literature– Company/Product websites (e.g., RelayHealth),

press releases

Very Active Space

http://www.empireblue.com/index.shtml

http://www.anthem.com/

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Current Environment: Program Categories

Program Type Description

Payment Differentials Bonuses or add-on payments that reward providers and/or delivery systems for adoption and diffusion of HIT directly or for improved quality, where HIT is a necessary tool and resource

Cost Differentials Differences in consumer co-payments or deductibles that vary based on predetermined quality measures, intended to steer consumers to providers that have adopted HIT or achieved certain quality outcomes

Innovative Reimbursement

Reimbursement for a new category of care or service that is directly related to the use of HIT (e.g., email communication, virtual provider-patient visit)

Shared Risk Withholding a certain amount of fees or delaying rate increases contingent on technology implementation or quality improvements.

Combined Programs Combination of two or more of the above often with the included benefit of public disclosure of provider progress/ outcomes.

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Active Space and Potential for Long Term Impact

• Developmental, Iterative, Dynamic – Multiple programs and approaches are being implemented

in public and private sector, but no single model○ Different strategies, different incentives, different stakeholders○ Too early for formal evaluation results

• Healthcare is local: may be issue of Adaptability not Replicability

• Anecdotally: positive response• Current success criteria = program participation• Long term success = decreased costs, increased

quality, workforce efficiencies, better business... But it’s too early to tell

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2003: A Good Year (Legislative)

• Research by Health Strategies under a stipend from IBM (in press for February)

• MMA Activity– E-prescribing – Management Performance Demos– Commission on Systemic interoperability– Council for Technology and Innovation– Extension of the telemedicine demos– Chronic care improvement

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2003: A Good Year (Executive)

• Major Granting Initiatives– AHRQ– AHRQ with VA, NIH– HRSA– NIH NLM– NIH, CDC, FDA

• Interest at CMS in CAG, Carriers

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Prospects for 2004

• SOTU line – will there be follow-up?• Legislative fragments

– HR 3035 / S 1729 – medical errors reduction– HR 663 / S 720 – patient safety improvement– S 1374 – Better HEALTH – HR 2915 – National Health Info Infrastructure

• Interest in specific technologies• Difficult budget situation• Skepticism on generalized value

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Possible Entitlement Program Models

• Encouraging adoption of technology that is not 100% clinically proven– Medicaid 90% match for IT upgrades– CAG technology decisions sometimes lack data

• Medicare payment systems push hospitals and physicians in desired directions– Conditions of participation mandate quality– Inpatient PPS bundling with incentives

• Higher bar can be articulated if desired– Inpatient DRG add-ons and OPPS

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When Will We Achieve the Vision?

• No meaningful central policy focus• Little dedicated budget

– CIT Investment in UK○ $17 Billion / 10 Years○ Full EMR by 2005○ Full E-Prescribing by 2008

• Pluralistic health system skews alignment• No interest in mandates• Slowness in standards adoption

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Our Panel

• Focus on clinical applications– Likely progress in 2004– Not dependent on legislative process

• Policy focus– Helen Burstin, AHRQ

• Commercial focus– Reggie Groves, Medtronic– William McIvor, Accordant

clinical health information technology: progress and barriers the intersection of business strategy...

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