The health reform bill signed into law last week by President Obama relies on health information technology to improve access to care and the efficiency and quality with which such care is delivered.
The 906-page law–known as the Patient Protection and Affordable Health Care Act–contemplates meeting these objectives by implementing state-run insurance exchanges, beefing-up reporting of quality measures, closing loopholes in HIPAA and improving utilization of HIT by long-term care facilities. We’ll cover the first 2 in this post, and the others on Wednesday.
Health Insurance Exchanges
The law requires that health insurance exchanges be designed as Web portals that will be managed by each state. The exchanges, as the president outlined in a letter last summer to the late Senator Edward Kennedy, will create a “market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that’s best for them.”
Small businesses and uninsured people will use the portals to determine whether they are eligible to participate, and sift through quality, satisfaction and cost data on plans the states have certified as “qualified.” The exchanges also will serve as a guide to Medicare and Medicaid coverage for those who are eligible. In theory, the portals will let Americans compare health insurance policies as easily as they price and reserve hotel rooms.
The law tasks the Department of Health and Human Services to create a “model template” Web portal by 2014. The template will include a model rating system for insurance plans based on quality and price. Each state can modify the template as it sees fit.
Quality Measurement & Reporting
The Patient Protection and Affordable Health Care Act also contemplates new, expanded quality reporting by providers that will be carried out electronically. The reporting will involve both electronic health records and health information exchanges. The purpose of the reporting system is to capture information that links provider behavior and treatment strategies to medical outcomes, and eventually to link payment to such outcomes.
The law also contemplates formation of an interagency working group that makes recommendations to the HHS secretary regarding national strategies and priorities for quality improvement.
The above-mentioned quality reports will expand on HITECH provisions that provide incentive payments through CMS for providers who meaningfully use electronic health records. To demonstrate meaningful use under HITECH for example, providers will soon be required to collect and transmit patient demographic data like body mass index and smoking history, as well as performance data modeled after Medicare’s PQRI quality reporting system.
The New Law Extends HITECH as Follows:
Demographics data will be used to:
- Establish national priorities for quality improvement
- Establish health-risk assessments and severity adjustments to normalize provider data on quality and performance
Provider quality data will be:
- Linked to payment, as many private insurers already do
- Made available through the above-mentioned portals
Reporting will be expanded to:
- Cover patient safety issues, which are not well covered by HITECH
- Improve transparency, especially regarding physician ownership of medical facilities
There will be a greater emphasis on the detection and prevention of fraud.
In conclusion, many observers characterize the Patient Protection and Affordable Health Care Act as incremental, rather than sweeping change to our health system (for better or worse). That accurately describes the new law when it comes to HIT. The law extends HITECH in areas where improvements were clearly needed, and it relies on HIT to perform well in areas where it seems capable of doing just that.
Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs, Practice Fusion
