As the president-elect and his administration-in-waiting gear up to take the reins of government and as Washington looks forward to the new 111th Congress, many of us look forward to the next phase in digitizing our health care system.
By any measure, the Obama campaign and the presidential transition team understand and have made brilliant use of technology to communicate President-elect Barack Obama's ideas and network his supporters. The president-elect has announced that, for the first time, there will be a Chief Technology Officer for the United States. Indeed, the transition's agenda for technology is impressive and exciting.
Goal: Lower Health Costs
With regard to health IT, the transition's technology agenda calls for reducing health care costs, in part by investing $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.
Of course, investing in health IT alone will not lower costs. That point has been made by Obama's nominee to direct the Office of Management and Budget, Peter Orszag. Orszag has made important contributions during his tenure as director of the Congressional Budget Office. In particular, his work on the costs and benefits of health IT has helped set the stage for the next phase.
As I read the CBO work, Orszag's view seems to be that the justification for a major health IT investment by the federal government and the opportunity for a major return on that investment lies in the use of health IT to accomplish fundamental reforms and improvements in the broader health care system.
In particular, the ROI would come from significant improvements in administrative efficiencies -- both fiscal and clinical (avoiding duplicative tests, for instance) -- and in the improvement of clinical and operational quality (further empowering the development and utilization of evidence-based medicine and comparative effectiveness research).
Now Comes the Hard Part
Reforming our stressed and, in many respects, failing health care system will require an integrated health IT system that does not exist today. And, there is little reason to believe that an integrated health IT system will be achieved absent comprehensive and systemic reforms to our health care system. So … what comes first?
That leads me to a healthy dose of optimism. While I've toiled in the vineyards of health reform for many years, the stars look to be in alignment for real … what shall I say … change?
President-elect Obama made health care reform a cornerstone of his campaign. The transition's health care policy team -- lead by former Sen. Tom Daschle (D-S.D.), the president-elect's choice to be HHS secretary -- is an impressive group of some of the best minds in the business.
The accelerating failure of the current health care system, amplified by the economic crisis confronting the country, seems to have galvanized business leaders and poverty advocates; insurers, providers and patients; Republicans and Democrats; and those sitting at board tables and those sitting at family tables. The political stars seem to have aligned for reform.
Consensus Building on Reform Elements
There appears to be movement toward a consensus on the elements of reform. Those elements are reflected in Obama's health care agenda, the "Call to Action" proposal offered by Sen. Max Baucus (D-Mont.), the work of CBO, and others.
It includes providing affordable access to care for all, having payment methodologies that reward quality and efficiency, covering what works, managing the care of those who are chronically ill, increasing the focus on health promotion and disease prevention and, from my view, changing the incentives in our payment system to encourage care coordination and move away from the care delivery stove pipes fee-for-service medicine.
What we're talking about is a data-driven system with the ability to capture and analyze data and provide clinicians, patients, payers and policymakers with the information they need to make the system work.
Baucus has offered his thoughts on all of this. Sen. Edward Kennedy (D-Mass.) and his staff are hard at work developing his proposal for comprehensive reform. And the transition team is no doubt adding detail and nuance to the president-elect's campaign plan. Things are moving quickly. We should expect to see congressional hearings on health reform shortly after the 111th Congress convenes.
Health IT May Play Key Role in Stimulus Package
In the meantime, don't be surprised to see health IT assume a key role in the economic stimulus package being prepared for consideration by the House of Representatives.
There are some indications that House leaders are considering including Rep. Pete Stark's (D-Calif.) bill, "The Health-e Information Technology Act of 2008" (HR 6898), in the stimulus package. Among other things, Stark's bill would offer incentives for clinicians and hospitals to implement and use HIT systems. Action on the stimulus package could come as soon as Jan.21, 2009.
So, my genetic predisposition to optimism may explain why I'm not feeling the cynicism that comes with living and working inside the beltway for more than 25 years. Or, just maybe, there is real reason for optimism that a data-driven health care system is what lies on the other side of productive legislative and presidential action.
I'm betting on the latter.