In order to overcome barriers to interoperability, there need to be meaningful measures and incentives specific to health information exchange (HIE) and HIE-related health outcomes, according to a Health Information Technology Policy Committee report on interoperability barriers sent to Congress this week.
An example of an HIE-sensitive measure would look at medically unnecessary duplicate testing, the HIT Policy Committee report states.
“Payers could provide incentive clout by declining to reimburse for medically unnecessary duplicate testing. Performing well on HIE-sensitive measures of care coordination would require a shared care plan and shared access to all orders and results for an individual patient by all members of the health team,” the HIT Policy Committee report states.
The HIT Policy Committee’s report examined the technical, operational and financial barriers to interoperability and the role that certification plays in advancing or hindering interoperability across various healthcare providers. In response to a request from Congress for the report, as part of a 2014 appropriations bill, the committee created the Clinical, Technical, Organizational and Financial Barriers to Interoperability Take Force and in the past few months that task force developed the report.
In the report, the task force addresses the numerous challenges to interoperability, such as technical and business barriers, complex privacy laws, workflow challenges and misaligned incentives that are slowing progress.
“The greatest challenge is that there is not just one challenge. As a result, the pace of progress in interoperability is not fast enough to meet the needs of delivery system reform or to meet policy objectives of coordinated care leading to better health outcomes,” the report states. The task force also noted that there has been a consistent message from stakeholders that significant business and financial incentives are needed to significantly accelerate the pace of change.
“Certifying or applying incentives to specific components of interoperability has not been effective at engaging and activating the required stakeholders. Because the barriers to interoperability are multi-faceted and involve stakeholders, the incentives must be applied at the global level to motivate the required participants to act together,” the report states.
Specifically, the Health IT Policy Committee task force makes four new recommendations. According to the task force, these recommendations could begin to be acted upon in the next six months and could “set in motion changes that could significantly speed progress towards widespread interoperability by targeting financial and business barriers.”
The four recommendations call for:
- Developing and implementing meaningful measures of HIE-sensitive health outcomes and resource use for public reporting and payment.
- Developing and implementing HIE-sensitive vendor performance measures for certification and public reporting.
- Setting specific HIE-sensitive payment incentives that incorporate specific performance measure criteria and a timeline for implementation that establishes clear objectives of what must be accomplished under alternative payment models.
- Convening a summit of major stakeholders co-led by the federal government, such as ONC and CMS, and private sector to act on the Office of the National Coordinator for Health IT’s Interoperability Roadmap to accelerate the pace of change toward interoperability.
ONC’s National Coordinator for Health IT Karen DeSalvo has made headlines recently for aggressively pushing HIE connectivity within the next year, as previously reported by Healthcare Informatics’ Managing Editor Rajiv Leventhal. In remarks at a Bipartisan Policy Center event, DeSalvo said that her health IT agency’s goal is to connect private and public HIEs in the entire country within a year. In a blog post, DeSalvo said that ONC in 2016 will focus on near-term goals to make electronic health information more accessible. DeSalvo outlines specific goals for health IT stakeholders such as implementing federally recognized, national interoperability standards, policies, guidance and practices for electronic health information.
Within the HIT Policy Committee report to Congress, the task force tackled the issue of developing HIE-sensitive measures. Specifically, the task force said identifying existing meaures or developing new measures that can be applied to providers and are sensitive to interoperability would strengthen incentives in two ways. “First, those who pay for care can incorporate them in new payment models, and second, they can be used in public reporting that would create more transparency regarding which specific provider organizations deliver better coordinated care,” the report states.
And, the task force notes federal funding for HIE-sensitive measure development, testing, and validation would be particularly helpful “since the current pipeline of such measures is scant.” “The federal government has the largest market share and strongest business case for such measures, and should invest in their development and implementation so that other payers may follow suit in the rest of the market,” the task force wrote.
With regard to financial incentives, the task force notes that relying on certification criteria to drive interoperability “has not led to sufficient progress in the field.” “Today, the lack of palpable financial incentives for interoperability favors the status quo,” the task force wrote.
To address that issue, the HIT Policy Committee is recommending the development of specific HIE-sensitive payment incentives along with an implementation timeline and effective dates. Medicare could lead this effort, the task force recommends, particularly as the Centers for Medicare & Medicaid Services (CMS) operationalizes new payment requirements under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
As one example of an HIE-sensitive payment incentive, a payment policy that denies claims for medically unnecessary duplicate testing for high cost imaging would require coordination, or at least awareness, of orders and results by all providers involved in the care of an individual patient. “Providing a roadmap for specific HIE-sensitive performance measures for future payment incentives, with enough lead time, will motivate and catalyze specific actions to speed the pace of achieving effective health information exchange that facilitates high priority use cases,” the task force states.
The task force also addressed the issue of data blocking in the report, but also highlighted that specific information about the problem is lacking.
“While we lack quantitative data about the extent of the problem, reports of information blocking have raised significant concern. In the end, it will be essential to change the culture of healthcare to one that incentivizes information sharing,” the task force wrote.
The HIT Policy Committee says its goal is to accelerate pace of progress towards interoperability and that will require the participation of all healthcare stakeholders aligned in a single direction.
“Recommending a patchwork of individual steps to address interoperability will not work as well as motivating the entire ecosystem to work on the multi-dimensional challenges of achieving interoperability,” the report states.
