Add another word to the evolving lexicon of health IT: "systemness." So far, it's not part of any acronym, but stay tuned.
"We're getting a lot of grief for that word," Dolores Yanagihara, manager of Integrated Healthcare Association's pay-for-performance program in California, said. "But the ideas behind it are really crucial."
IHA -- an Oakland, Calif.-based not-for-profit -- designed and now manages a pay-for-performance program for California physicians, the largest nongovernmental physician incentive program in the U.S.
Since IHA invented the word, it's only fitting that the group has a say in defining the term. Yanagihara explained the new word during the third National Pay for Performance Summit last week in Los Angeles.
"The IT-enabled systemness domain looks and acts like a single, integrated organism -- like a system working together, rather than a bunch of separate pieces going their independent ways," Yanagihara said.
A lot of things have to come into play before a health care entity can claim to have achieved systemness, according to IHA's rulebook. Systemness is related to another popular buzzword in the health IT field -- "interconnectivity" -- but the term implies maturation beyond just interconnectivity.
"Systemness means shifting decision-making responsibility and authority away from the subsidiary operating units to the corporate level and centralizing or standardizing key management systems and processes," according to IHA's handbook.
A big part of systemness is data flow, making sure information of all kinds - clinical, administrative, financial -- is moving in the right direction in a timely fashion. Yanagihara said one of her most urgent projects is to get data flowing in both directions between providers and insurers.
"We've arrived at a point now where physicians groups are collecting data and using it, but that data is not being passed to health plans," Yanagihara said, adding, "We're working with CAPG (California Association of Physician Groups) to create a systematic process for getting data flow and data process information to health plans. We're trying to get data flowing both ways, and there aren't systems in place to do that right now. That's kind of our next big effort."
Broad Appeal for Systemness
Whether they used the new word or not, many of the workshops and presentations at the third national pay-for-performance summit aimed to help organizations move toward systemness. Sessions explored performance measurement, data collection, public reporting and incentive design.
Several presentations and panel discussions were devoted exclusively to exploring and enhancing health IT's role in pay-for-performance programs. But even when the session's title didn't specifically mention health IT, technology was usually a focal point in the discussion.
"You can't separate health IT and pay for performance," Yanagihara said. "They are growing up together and because of that, they're both maturing more quickly than they might otherwise."
In their latest surveys, IHA researchers found that about two-thirds of the physician groups in California have "some IT capabilities, and about half of those have what we'd call pretty robust use of technology," Yanagihara said.
This is compared with 2003, when surveys found that "only a handful of groups had any access to technology and what was in place was used sparingly," according to Yanagihara.
"Pay for performance is acting as an accelerator, speeding up the IT adoption rate," Yanagihara said. "Maybe for some groups, P4P has actually caused them to go there, but mostly what we're finding is that physicians groups and other providers are on their way to integrating IT. Pay for performance adds that extra incentive."
Putting the 'Pay' in Pay for Performance
To help nudge providers along in their journey toward systemness, IHA uses the fundamental tool of the trade -- pay. On the first day of the three-day summit, IHA announced bonuses paid for care delivered in 2007.
Those bonuses, paid by health plans and administered by IHA, amounted to $65 million for California medical groups last year, about $10 million more than bonuses distributed in 2006.
The 2007 payments were distributed in last year's third and fourth quarters, reflecting the 2006 performance of medical groups and individual practice associations that serve HMO members.
Payments are typically based on how well a physician group performs compared with its peers, but groups that show significant improvement over prior years are also rewarded. Participating health plans have been encouraged to allocate 20% of 2008 bonus payments for physician groups that make the most significant improvements.
Another incentive to promote improved physician group performance involves public reporting. In California, performance results for each measure are reported by physician groups on a Web site managed by the California Office of the Patient Advocate.
"Public reporting is an important motivator for California physician groups, who take great pride in both the care they deliver and the perceptions of patients about their care experience," Wells Shoemaker, medical director of the California Association of Physician Groups, said.
Pay-for-performance programs, still in their infancy, so far have reported only small gains in clinical and satisfaction surveys.
California's pay-for-performance results for 2006 showed participating physician groups improved on clinical measures by 2.6% over the prior year. In IHA's "patient experience of care" category, groups improved an average of 0.4%, according to the IHA survey.
Government's Role Explored
The summit also explored government's role in encouraging the use of health IT on several fronts -- at national and state levels and as active and passive participants.
"The state has an important leadership role in pursuing IT-enabled health care," Cindy Ehnes, director of California's Department of Managed Health Care, said. "We do a lot of things, but I think our most important role is bully pulpit, championing the progress of information technology in health care."
Ehnes led the summit workshop, "Advancing Health Information Technology: The Role of State Government."
"IT-enabled health care should be the standard, and we're finding that large providers -- Kaiser and Sutter for example -- are increasingly advancing health care IT as the standard of care, based on medical appropriateness," Ehnes said.
"The state has an important interest in this in many ways. First, we're a large purchaser of that health care, and we want to make sure we're making a good investment. But we're also concerned with looking out to make sure everyone advances equally," Ehnes said.
She added, "We know that rural areas and smaller providers have a harder time moving forward with IT, and one of the state government's goals is to help the transition proceed as smoothly and evenly as possible. I call it, 'floating all boats.'"
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