While it initially appeared as if there was less at stake in the HITECH Act provision for payors, as the details of healthcare reform have emerged, the links between meaningful use, health IT, nd payor industry business practice reforms are becoming more explicit, according to a report from Computer Sciences Corporation (CSC).
“It’s important for health plans and payors to understand what the meaningful use challenge means to providers and hospitals, if they are to be able to identify the business risks and opportunities that are associated with it,” stated the Falls Church, Va.-based CSC.
According to the report, payors and health plans that ignore the challenges that meaningful use and EHR implementation create for hospitals and providers risk missing significant opportunities.
The report authors stressed five meaningful use considerations that health plans and payors be aware of:
Health IT adoption and its meaningful use will improve the performance of existing payor sector cost and quality programs: Because health plans rely on repositories populated by claims data, this creates data lags and latency issues preventing timely identification and interventions for members at risk for disease. “Widespread adoption of integrated health IT processes by hospitals and providers will certainly make that information easier for providers to obtain,” the report observed.
Implementing health IT and meeting meaningful use criteria will strain the resources of provider organizations and may threaten the stability of plan and payor provider networks: “Most provider organizations will struggle financially and operationally to execute these projects and will have little organizational energy or resources for other initiatives,” stated the authors, noting that collaboration will be difficult in this time among payment and networks arrangements.
There’s no reason to think that Medicare Advantage plans will remain exempt from some level of participation in HITECH and meaningful use: Although the final requirements haven’t been fully written into law, it’s "not hard to imagine" that health IT implementation and meaningful use by Medicare Advantage plan provider networks will become part of the definition of “quality” that triggers bonus payments.
Where Medicare leads private sector health coverage purchasers follow: Because employer purchaser coalitions are becoming strong supporters of the HITECH Act provisions and deadlines, the report stated that those are “strong signals from important customers that health plans and payors would be foolish to ignore.”
Plans and payors have a big stake in making sure that their provider networks are successful in implementing and using health IT: Ensuring provider success with EHR implementation and meeting meaningful use criteria will allow plans capitalize on improvements that health IT and meaningful will bring to existing cost and quality control programs.
“At minimum, plans should use this as an opportunity to reformulate and realign existing pay-for-performance incentives with health IT implementation and meaningful use deadlines,” concluded CSC. “Minimizing differences between plan-sponsored incentive programs and Centers for Medicare & Medicaid-sponsored programs will also serve to simplify compliance and achievement, for provider organizations.”