Healthcare IT Implications of Healthcare Reform

I'm often asked how Healthcare Reform will impact IT planning and implementation over the next few years.

First, some background. The Patient Protection and Affordable Care Act (HR 3590) and Health Care and Education Reconciliation Act (HR 4872)  were passed to to address several problems with healthcare in the US.   We're spending 17% of our Gross Domestic Product on healthcare, yet we have worse population health outcomes than many other industrialized societies spending half as much. Healthcare costs are rising faster than inflation. We have significant variation in practice patterns that is not explained by patient co-morbidities nor justified by comparative effectiveness evidence. We want to expand access to health insurance to 95% of the population, lower our spending growth rate, and incentivize delivery system change.

How will we do this?

Health insurance reform expands coverage, makes features and costs of plans transparent, and removes the barriers to enrollment created by pre-existing condition considerations.  

Payment reform transforms the Medicare payment systems from fee-for-service to Value Based Payment - paying for good outcomes rather than quantity of care. Pilot projects will test new payment methods and delivery models. Successful innovations will be widely implemented.

Let's look at the payment reform details that will lead to delivery system reform.

Medicare Initiatives include

  • Medicare shared savings program including Accountable Care Organizations (ACOs)
  • National pilot program on payment bundling
  • Independence at home demonstration program
  • Hospital readmissions reduction program
  • Community-Based Care Transitions Program
  • Extension of Gainsharing Demonstration

Medicaid Initiatives include

  • Health Homes for the Chronically Ill
  • Medicaid Community First Choice Option
  • Home and Community Based Services State Plan Option
  • Hospital Care Integration
  • Global Capitation Payment for Safety Net Hospitals
  • Pediatric ACOs

I believe that Accountable Care Organizations will be the ideal place to host several of these innovations including bundled payments, the medical home, and an increased focus on wellness.

All of this requires innovative IT support.  

Here are my top 10 IT implications of healthcare reform:

1.  Certified EHR technology needs to be implemented in all practices and hospitals which come together to form Accountable Care Organizations. EHRs are foundational to the capture of clinical and administrative data electronically so that data can be transformed into information, knowledge and wisdom.