WASHINGTON -- This week, health care experts from the private and public sectors highlighted the critical intersection between health IT adoption and health care delivery and payment system reform.
HHS Secretary Kathleen Sebelius helped kick off the National Health IT and Delivery System Transformation Summit and the Second National Accountable Care Organization Summit on Monday, saying there is "no question that electronic health records ... must play a key role" in health care reform efforts.
She added that "it doesn't make sense" that the current health care delivery system "primarily rewards for the number of procedures" conducted. Sebelius said the U.S. instead needs to focus on approaches that simultaneously improve care and reduce costs, noting that the federal government is committed to rewarding innovation.
Sebelius touted the meaningful use incentive program for driving adoption of EHRs. She said that physicians and hospitals now are receiving incentive payments, adding that the program "already [is] seeing results."
Richard Gilfillan -- acting director of the Center for Medicare and Medicaid Innovation -- took the stage on Tuesday, the final day of the conference.
Echoing Sebelius' remarks from the day before, Gilfillan said, "The [health care] system is clearly unsustainable." He said the piecework payment system has led to "a siloed, fragmented health care system."
Gilfillan said public and private payers "need to start paying and supporting the system in a different way."
He said, "There's no shortage of innovation in health care," but he explained that most innovation thus far has focused on "delivering more care, more goods at a higher cost" rather than "better care, better health at a reduced cost."
CMMI has been allocated $10 billion in funding to test innovative payment models that lead to better care, better health and reduced costs.
Gilfillan said that delivery system reform cannot be successful without an IT-enabled health care system, but he warned that IT adoption "needs to be consciously directed towards these goals -- better care, better health and reduced costs" -- or it will end up increasing U.S. health care spending.
He said that CMMI is interested in proposals "that are heavy on IT" but that such proposals "must address the [center's] three-part aim."
National Coordinator for Health IT Farzad Mostashari told the audience that there is no direct link between health IT and improved health. Instead, health IT adoption needs to be combined with new payment systems, care delivery innovation transformation and consumer engagement.
In Defense of Meaningful Use
Mostashari urged conference attendees not to view the meaningful use incentive program as a "distraction or bureaucratic list of hoops to jump through" to get payments. Instead, he said the program should serve as a "roadmap" for providing higher quality care, while mitigating some of the costs for doing so.
He noted that EHR adoption is increasing significantly and that 5,000 to 10,000 health care providers apply each month to participate in the meaningful use incentive program.
Mostashari said, "We have the will. We have the means. We have the alignment and coordination." Still, Mostashari told the audience, "If we are not succeeding, if [meaningful use] is a distraction -- we need to change it." He said that the Office of the National Coordinator for Health IT wants to hear from stakeholders directly about how to make the program "more aligned with care transformation."
Mostashari said ONC and CMS are busy reviewing the recommendations from the Health IT Policy Committee on Stage 2 of the meaningful use program. He predicted that the final rules will "look a lot like" the policy committee's recommendations but that "they will not be identical."
He said the government is on track to release the final rules on Stage 2 of the meaningful use program and standards and certification criteria in 2012.
Warnings of Measure Overload
At the two-day summit, private-sector stakeholders offered insight into their experiences using health IT in new care delivery models. Most speakers agreed with the federal health care leaders that health IT is essential to care delivery transformation.
However, some stakeholders warned that the federal government might be at risk of measurement overload.
Keith Figlioli -- senior vice president of Healthcare Informatics at Premier -- said that "where we should start managing a bit more is the madness that is measures." He explained that health care providers are being called on to report many different measures for a variety of programs, from the meaningful use incentive program to the shared savings program to private payer pay-for-performance programs.
He said, "Think about the time and energy that we're putting into this." According to Figlioli, the proposed rule governing accountable care organizations is a "no-win" for health care providers because the savings resulting from forming ACOs will be offset by the extra work required for reporting on more than 65 measures.
Mark Segal -- vice president for Government and Industry Affairs at GE Healthcare IT -- said, "It's clear you have to measure to manage, but you have to use measures that really matter" at both national and local levels.
To help prevent "measure fatigue," William Bria -- chief medical information officer at Shriners Hospital for Children and chair of the Association of Medical Directors of Information Systems -- said it is important to ask clinicians what they want to measure and what they are interested in learning.
Segal said, "As a vendor, we talk to our customers," adding, "We ask them, 'What's important to improve the user experience of our product? What are the data elements that you need?'"