Entering a new era of population health
In the six years since it became law, the HITECH Act has done much to advance the use of health information technology. And although the process of collecting and sharing health data has not yet significantly impacted care costs or quality, it has laid an important foundation for us to move toward population health management.
[See also: Population health success depends on good data]
There are important discussions underway to determine what's needed to leverage health data to improve clinical outcomes and lower costs, and to extend those benefits across entire patient populations. Intelligent tools for population health will enable improvements in care quality, clinical outcomes and care cost.
Working through issues around health data exchange and patient engagement indicate the next challenges. We must construct a platform that will enable innovation in population health and analytics to thrive.
[See also: Pop health analytics top ACO priority]
Federal entities responsible for overseeing health and the healthcare industry in general are advancing rapidly toward a vision of interoperability and data sharing.
Congress taking a look
Congress is taking both near- and long-term actions regarding health IT innovation and standards. Near-term examples include recently directing the Office of the National Coordinator to report progress around interoperability and data sharing, and asking the Government Accountability Office to report on health information exchanges.
Congress has also launched the "21st Century Cures" initiative to help laws keep pace with health innovation. Among other measures, this initiative would consolidate meaningful use, quality reporting and value-based payments into one program – potentially the most significant move related to population health by Congress to date.
Federal Health IT Strategic Plan and Interoperability Roadmap
This past December, the Department of Health and Human Services released the Federal Health IT Strategic Plan, a coordinated effort among more than 35 federal departments and agencies to advance the collection, sharing and use of electronic health information – the cornerstones of population health management.
The HHS plan's data-sharing section references the ONC's Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0, which was released at the end of January. The roadmap advances the ambitious goals to be reached by the end of 2017, including:
- Establishing a coordinated governance framework and process for nationwide health IT interoperability;
- Improving technical standards and implementation guidance for sharing and using a common clinical data set;
- Enhancing incentives for sharing electronic health information according to common technical standards; and
- Clarifying privacy and security requirements that enable interoperability.
In announcing the roadmap, HHS Secretary Sylvia Burwell called for "an interoperable health IT system where information can be collected, shared and used to improve health, facilitate research and inform clinical outcomes. This Roadmap explains what we can do over the next three years to get there."
ONC Annual Meeting
At the February 2015 ONC Annual Meeting, titled "Interoperable Health IT for a Healthy Nation," National Coordinator Karen DeSalvo, MD, told attendees that the agency's focus is moving beyond meaningful use, toward interoperability and outcomes. This includes building out the IT infrastructure that will support health reform and enable better population health management.
A highlight of the ONC Annual Meeting was having all of the former national coordinators talk about the national state of health IT in the past, present and future.
David Brailer, MD, the nation's first national coordinator, said the industry won't be able to accomplish appropriate risk management, population health management or payment reform without interoperability. The ONC leaders shared a strong consensus that the intelligent use of technology will prevail in realizing population health goals.
Meaningful use is not dead
Despite the notion that it may be time to move beyond meaningful use, the program continues to drive electronic health record adoption, organizations have built incentive payments into their IT budgets and we continue to see program improvements.
At the time of this writing, proposed rules for Stage 3 meaningful user and 2015 Edition Standards and Certification Criteria were at the Office of Management and Budget for final review. The OMB announced of the proposed rules that "Stage 3 will focus on improving health care outcomes and further advance interoperability." Additional recent policy adjustments instituted or proposed include:
- Simplifying satisfaction of the requirement for summary of care transmissions;
- More realistic measures around the availability and actual viewing of patient information to satisfy patient engagement requirements; and
- A potential new requirement to send electronic notification of significant patient health care events to patient care teams.
Measures such as these point to the importance of data sharing and enable achievable and meaningful progress toward population health management.
Payment models increasingly emphasize population health
Payers are primary drivers toward PHM, and the Centers for Medicare & Medicaid Services is accelerating its timeline for shifting Medicare to a value-based system. By the end of 2016, at least 30 percent of fee-for-service Medicare payments will be tied to value through alternative payment models such as accountable care organizations or bundled payment arrangements. By the end of 2018, that will increase to 50 percent.
As recently as 2011, Medicare made almost no payments through alternative payment models.
Among private payers, a group of major providers and insurers have formed the Health Care Transformation Task Force to shift 75 percent of operations to contracts designed to improve quality and lower costs by 2020. These very important public and private payer initiatives strongly underscore the need for critical health IT enablers of effective PHM.
Welcome to the new PHM era of health IT
We have reached an inflection point in the history of health IT, as we move beyond the HITECH era into this new era. We have come a long way in capturing health data, yet have only begun to share that data among providers, patients and payers. The opportunity ahead of us is to take major strides toward using that data to improve care and lower costs for the populace in general. We have been through an incredible decade of health IT. There is no sign of it slowing down.