Mostashari on IT, delivery system reform

Richard Pizzi, editorial director at MedTech Media, spoke Thursday with Farzad Mostashari, MD, National Coordinator for Health Information Technology, at the Healthcare Unbound conference in San Francisco. Among other things, they discussed the importance of healthcare IT to the development of a reformed care delivery system.

Q. Do you believe that new healthcare delivery models, along with new models for reimbursement, are inevitable in U.S. healthcare?

A. I do. These models, like ACOs, are good for patients. But in order for them to be good for providers’ bottom lines, the providers are going to have to learn how to do some things differently. Those include, for instance, population health management. I recently attended the 200th anniversary of the Massachusetts General Hospital’s internal medicine program. Mass General was just named the top hospital in the country in the U.S. News rankings. At the event, the hospital’s president said that the institution’s number one priority was population health management. This is Mass General – they name their price in fee-for-service because they have so much clout as part of Partners Healthcare system in Boston. But nevertheless they are leading the way in figuring out how to work within new care delivery models.

There is a lot of uncertainty right now among providers, particularly regarding the regulations and quality measures that will be part of new care delivery models. Providers don’t know exactly what Medicare, state Medicaid programs or private payers are going to do. In that uncertainty, some providers feel paralyzed. My message to them is that the meaningful use of health IT is going to be the foundation of their ability to deliver better and safer care, and to thrive in these new care delivery models.

Q. How do you feel about the development of the national healthcare IT infrastructure in advance of changes to the delivery system?

A. I am pretty pleased with the uptake that we’ve had among hospitals. It’s quite encouraging. It’s not just the incentive payments or the penalties to come. I do think providers see health IT adoption as foundational.

Q. The meaningful use stage 1 rule was published two years ago this month. Are we where you thought we’d be at this point?

A. We were a little slower than I had hoped, in terms of the vendor upgrades rolling out. About a year ago I was worried whether we were going to see availability of products for docs and hospitals to move forward. But since then the progress has been quite good. Numbers tell the story – attestations, registrations. My main concern now isn’t whether people go for meaningful use, but how deeply do they incorporate the functionality into their workflows. Do they embrace the intent, the spirit of the rule, rather than simply doing the minimum to qualify for the payments? That’s what we need to work on now. There are examples of those who have really made the effort. Some hospitals have used IT tools successfully to engage patients. There is so much value to be achieved – don’t simply see the meaningful use of IT as a requirement to be achieved. If you treat meaningful use as make work, you won’t get much out of it.