Back in March, crowds of people gathered outside the Supreme Court building to proclaim their support for or opposition to the Affordable Care Act.
Stakeholders on one side of the political spectrum touted the law's current and future benefits, while stakeholders on the other side called for a complete repeal of the legislation.
But despite the heated rhetoric, experts note that one component of the health reform law has had a steady stream of support from across the political spectrum: health IT.
Health IT in Health Care Reform
About a year before the passage of the Affordable Care Act, President Obama took one of his first steps toward reforming the U.S. health care system by signing the 2009 federal economic stimulus package. The package's HITECH Act authorizes Medicaid and Medicare incentive payments for health care providers who demonstrate meaningful use of certified electronic health record systems.
Janet Marchibroda, chair of the Health IT Initiative for the Bipartisan Policy Center's Health Project, said that the HITECH Act -- and particularly the EHR incentive programs -- "really laid the foundation for a number of the delivery system and payment reforms that are addressed in the health reform law." She added that the HITECH Act and the health reform law "share common goals around improving quality, improving cost effectiveness and even improving access to care."
To achieve these goals, the Affordable Care Act relies on several initiatives that have a strong health IT component. For example, health IT plays a role in provisions of the reform law related to the creation of state health insurance exchanges and accountable care organizations.
States Building IT Infrastructure for Health Insurance Exchanges
To build the statewide health insurance exchanges mandated by the reform law, states will need to invest in IT infrastructure. According to an interactive map from the Kaiser Family Foundation, 15 states as of mid-April had established a health insurance exchange and three additional states had plans to do so.
A January report from the National Conference of State Legislatures found that state officials are prioritizing efforts to establish insurance exchanges to meet the January 2013 deadline for having some infrastructure in place.
Laura Tobler, program director of NCSL's Health Program, said in an email, "States will need upgrades to their existing Medicaid eligibility systems as well as new information technology systems to support exchange functions. Some states are looking at or may have already solicited subcontractors to upgrade or build the necessary IT system[s]."
Tobler added that establishing the exchanges will require overcoming certain IT-related challenges, such as outdated existing state IT systems, the cost of developing new IT infrastructure and the timeline for completing work on the exchanges.
New York state Sen. Kemp Hannon (R) -- chair of the state Senate Standing Committee on Health -- said that health insurance exchanges will need to have a strong digital infrastructure to allow state computer systems to communicate with federal and county systems about Medicaid eligibility and other issues. "There's an immense amount of software development that's needed," Hannon said.
How Supreme Court Ruling Could Affect Insurance Exchanges
According to Hannon, the Supreme Court's consideration of the health reform law hasn't stopped New York from moving forward with its health insurance exchange. He said, "People in New York, we're tending to proceed, without worrying about the details of the Supreme Court decision."
Although a ruling against the reform law might affect federal funding for state health insurance exchanges, Hannon said, "We won't know until we see the decision." He added, "This is all part of the great mystery of the Supreme Court."
Tobler said that if the high court struck down the reform law, states likely would face a range of options for how to maintain -- or unwind -- their progress on health insurance exchanges. "Continuing to work a state-based exchange or beginning that work would be options for states to consider," she said.
ACOs To Leverage Health IT for Care Coordination
The health reform law's ACO program offers incentives for groups of medical professionals who provide every aspect of a patient's care. If ACOs are able to reduce costs, CMS will reward the providers with a portion of the savings.
According to Marchibroda, effective ACOs should make it possible for all members of a patient's care team to access information about a patient. She added that patients also should be able to participate in their care through online patient portals, personal health records or other tools.
"In order to achieve the outcomes in quality and cost effectiveness, accountable care organizations need to be very well-connected with the patient, not just during the visit, but between visits," Marchibroda said.
Jennifer Covich Bordenick, CEO of the eHealth Initiative, said, "Accountable care organizations are all about looking at data to improve care. And you can't look at data unless you have data. And you can't have data unless you have an infrastructure that collects it and analyzes it. And that's really what health information technology does, it gives you a platform to look at the information about patients, and it gives doctors the mechanism to look at data about their patients and figure out how to use it and improve care."
How Supreme Court Ruling Could Affect ACOs
Marchibroda said that a Supreme Court ruling against the health reform law would not put the brakes on the health care industry's movement toward accountable care. She noted that several major health insurers -- as well as smaller, local health plans -- are funding their own accountable care initiatives that are similar to the health reform law's ACO program. Marchibroda said she thinks those initiatives will continue, regardless of how the high court rules.
"I believe there is consensus across folks both in the private sector and the public sector, across the payer community and the provider community ... that the current trajectory on health care is unsustainable, in terms of cost," she said.
Covich Bordenick noted that many successful health care organizations -- such as Geisinger Health System -- already have ACO-like qualities.
She said, "This is the way that we've been moving before health care reform and it's going to be the way that we continue to move, because it's really going to be the only way to control costs."
Carla Smith -- executive vice president of the Healthcare Information and Management Systems Society -- said that no matter how the high court rules, health care organizations will continue to "harness the power of information technology to realize improvement in care."
Reform Law Ruling Could Create Confusion Around Meaningful Use Program
According to Smith, the Supreme Court ruling will not affect the meaningful use program because the 2009 HITECH Act is an entirely separate piece of legislation from the 2010 Affordable Care Act.
Marchibroda noted that the HITECH Act recently celebrated its three-year anniversary and that implementation already is well under way. She added that numerous health care providers already are participating in the meaningful use program and that should continue.
However, if the Supreme Court rules against the health reform law, Marchibroda said, "I think our biggest issue is going to be confusion." Some health care providers might not fully understand that a ruling against the health reform law would not dismantle the meaningful use program, she noted. "So it requires education and communication about the program," she said.
Covich Bordenick said there is a lot of nervousness and anxiety in the health care industry, noting that people are waiting to see whether the Supreme Court will strike down the health reform law. However, she added, "I think that what we're going to find is that even if it is struck down, these people are still going to make decisions and still buy EHRs."
Implications for Health IT Bipartisanship
Regardless of how the Supreme Court rules on the health reform law, experts predict that health IT will continue to be a bipartisan issue.
According to Covich Bordenick, health IT has a long history of support from both sides of the aisle. She said, "President [George W.] Bush was pivotal in the national drive for health IT with the establishment of the Office of the National Coordinator for Health IT, and President Obama has continued to build on this potential and development with the HITECH legislation."
She added that there is bipartisan support for a transition to a health care payment system that rewards efficiency and quality. She said, "Health IT is fundamental to this mission, and both Republicans and Democrats recognize that."
Even with all of the heated debate over the Affordable Care Act, Smith says that she doesn't think the long-standing bipartisanship of health IT is in jeopardy. "The support for health IT on both sides of the aisle continues to be strong," she said, adding that such support "has been unaffected by the discussions and the debates around the health reform law."
Smith said, "Members of both parties get it. They absolutely understand that health care needs to be transformed in this nation. They may have very different ideas about how to achieve that transformation, but everybody agrees that the system as it currently works needs to change."