The American Recovery and Reinvestment Act of 2009, or ARRA, may be the driver for connecting HIEs to P4P, said Janet Marchibroda, chief healthcare officer for IBM.
Marchibroda spoke March 10 at the Fourth National Pay-for-Performance Summit in San Francisco. She was a member of a panel that discussed the role of health information exchanges, or HIEs, in pay-for-performance, or P4P, programs.
ARRA is “game changing in ways we quite don’t know yet,” she said. Over the next 10 years, $19.2 billion worth of incentives will be distributed to hospitals and healthcare professionals who implement qualified electronic health records and utilize them in a meaningful way. While the terms “qualified” and “meaningful use” still need to be defined, Marchibroda noted that ARRA has “an enormous impact on how providers can use healthcare IT infrastructure and standards for pay for performance.”
With AARA’s grants, loans and technical assistance bringing $300 million to regional and local HIEs, the time is ideal to bridge healthcare IT and quality, she said. One interpretation of the meaningful use of a certified EHR would be to exchange health information and report on quality measures, she said.
eHealth Initiative’s annual survey released in early September 2008 showed a 31 percent increase in operational HIEs, up from 32 in 2007 to 42 in 2008. Furthermore, 29 reported reductions in healthcare costs, 22 reported positive impact on healthcare delivery and 29 reported a positive financial return on investment for participating stakeholders. These numbers bode well for HIE development, said Marchibroda. For added value, the data flowing within the HIE – lab, outpatient lab results, outpatient episodes, radiology results, inpatient episodes, emergency department, dictation and transcription – can also be used for pay for performance, she said.
HIEs are a great foundation for pay for performance, said Marc Overhage, MD, president and CEO of the Indiana Health Information Exchange. The Indiana HIE has been in pilot mode the last two years and has been reporting on one million patients, he said. This year, the Indiana HIE will take its functionality statewide.
Overhage pointed to Indiana HIE’s abilities to provide transparency, value in and metrics for clinical data, and scalability to accommodate a large population. The Indiana HIE is already a trusted entity in the market because of its appropriate use of data by payers, providers and patients, making it an ideal vehicle for P4P, he said.
Minnesota kicked off its health information exchange efforts in November 2008, but that hasn’t stopped the state from being able to engage in P4P, said Linda Davis, consultant for the Buyers Health Care Action Group, a nonprofit organization representing employers throughout the Midwest. Working with Bridges to Excellence, BHCAG has been engaged in mature public reporting since 2004, with direct data submission by physicians, many of whom belong to small practices. Groups reporting have doubled, from 30 in January 2007 to 60 in January 2008. Data for the 2008 year encompasses 77 groups totaling 450 practices.
Davis said it was a myth that an HIE is needed as a vehicle to collect data for measurement and public reporting. Provider-driven data submission is another means of collecting data. That said, interconnection is required to get data in and do data integration and data structuring, she said.
When the Minnesota HIE does get underway, the next task would be how to merge the HIE and the BHCAG’s direct-provider submission for measurement and public reporting, Davis said.
Marchibroda reiterated that ARRA may provide enough financial incentive to accelerate that process for physicians and HIEs.