“Lack of palpable financial incentives for interoperability favors the status quo,” according to the Health IT Policy Committee.
Pursuant to appropriations legislation, the Health IT Policy Committee (HITPC) has formulated its final recommendations on how to overcome operational and financial barriers to health IT interoperability. The resulting 24-page report was submitted this week by HITPC’s Interoperability Task Force to the chairmen and ranking members of the House and Senate Appropriations Committees and other relevant congressional panels.
HITPC narrowed its recommendations, — which in the committee’s own words “are designed to accelerate the pace of change toward meaningful interoperability that is driven by business and financial incentives” — to the following four action items:
1. Develop and implement meaningful measures of health information exchange (HIE)-sensitive health outcomes and resource use for public reporting and payment. An example of an HIE-sensitive measure would track medically unnecessary duplicate testing; payers could decline reimbursement for testing deemed as such. Care coordination measures in general would be suitable because they “require a shared care plan and shared access to all orders and results for an individual patient by all members of the health team,” the report states.
Appropriate measures could be incorporated in new payment models. They could also be used in public reporting to create greater transparency regarding which healthcare organizations deliver better-coordinated care.
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The report notes that most current measures focus on specific diseases or conditions; specialty societies or associations often fund them. “There has been limited prior work to define cross-cutting, HIE-sensitive outcome measures which capture whether care is well-coordinated and affordable,” the document explains.
HITPC calls for federal funding for measure development, testing and validation.
“The federal government has the largest market share and strongest business case for such measures, and should invest in their development and implementation so that other payers may follow suite in the rest of the market.”
2. Develop and implement HIE-sensitive vendor performance measures for certification and public reporting. HITPC believes that direct measures of HIE-sensitive vendor performance would stimulate market forces behind vendor business practices that promote interoperability.
HITPC advises that “federal resources would help speed progress toward a single set of measures that could be reported on across vendors and shared transparently to drive vendors to more heavily in vest in interoperability capabilities.”
In this area, HITPC provides specific examples of measures that would identify the impact of data exchange on clinical decision-making:
- Number of data exchanges from external sources, which could include other providers, community social-service organizations, consumers, payers and other relevant entities (denominator would measure the ability to exchange data with another electronic system such as an EHR, HIE or consumer app).
- Percentage of external data elements viewed (numerator would measure perceived value of the external data).
- Percentage of external data elements incorporated/reconciled with internal records (which would represent meaningful data).
- Percentage of time viewing of external data changed current activity (e.g., appeared in clinical decision support, led to change in order being written), which would demonstrate impact of external data.
3. Set specific HIE-sensitive payment incentives that incorporate specific performance measure criteria and a timeline for implementation that establishes clear objectives of what must be accomplished under alternative payment models. “Lack of palpable financial incentives for interoperability favors the status quo,” the report states. “To have the desired effect, incentives must be strong and specific, with clearly defined measures and a deliberate implementation timeline and effective dates.”
The report identifies Medicare as “the logical payer to lead such efforts,” particularly as new payment requirements roll out in coming years under the Medicare Access and CHIP Reauthorization Act. HITPC makes a point here that such measures would be integrated across the health and social services continuum.
HITPC also emphasizes that new payment incentives “should incorporate mechanisms that identify and discourage information blocking activities that interfere with providers who rely on information exchange to deliver high quality, coordinated care.”
4. Convene a working summit of major stakeholders, co-led by the federal government and the private sector, to act on the Shared National Interoperability Roadmap to accelerate the pace of progress toward interoperability. The Roadmap, developed by the Office of the National Coordinator for Health IT, would serve as a framework for guiding such efforts, according to HITPC.
“The output of the Summit would be an action plan with milestones and assigned accountabilities for achieving the milestones in the context of this larger interoperability initiative. We expect the compelling call-to-action would engage the stakeholders to continue their activities after the Summit as a way of meeting the payer-driven incentives that reward HIE-sensitive measures of coordinated care.”
Date: December 18, 2015