Health IT Plays Vital Role in Health Care Reform

by Karen Ignagni


It may be too soon to predict the outcome of the health care reform legislation now being debated in Congress, but the potential for improved system efficiencies associated with moving from a paper to an electronic system is clear. Passing reform will accelerate the trend already under way to move our health care system away from its dependence on costly and error-prone paper-based transactions.

Reform will encourage the adoption of coordinated IT strategies that enhance interoperability while protecting the confidentiality of information transmitted among patients, physicians and other care providers and insurers.

America's Health Insurance Plans recently joined with other key health care stakeholders -- the Advanced Medical Technology Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, and the Service Employees International Union -- in a June letter to President Obama affirming our earlier pledge to help bend the health care cost curve in order to make broad reform sustainable in the long run. Accelerating the deployment of health IT strategies is an essential cornerstone of that commitment.

Our members are working on two fronts: First, we are moving from paying for volume to paying for value and providing incentives to improve safety and shrink health care variation. Second, we have proposed major administrative simplification initiatives comparable in concept and scope to the introduction of ATMs in the banking system.

Our goal is a comprehensive overhaul of common administrative transactions between health care providers and health plans, including claims submissions, eligibility determination, claims status, payment authorization and remittance.

Working through the Council for Affordable Quality Healthcare, health insurers are supporting new uniform rules that will enable physicians and hospitals to determine whether a health plan covers a patient, what that coverage is, the status of claims and other administrative information at the point of care.

In addition, we are supporting public and private initiatives to accelerate conversion of physicians' offices from paper-based to 100% electronic transactions, including e-prescribing, virtual office visits, monitoring of adherence to drug treatments and cooperative physician-patient management of chronic conditions.

Pilot Projects in Ohio, New Jersey

We're launching pilot projects in Ohio and New Jersey to provide physicians with one-stop service -- simplified access to multiple insurers through a single Web portal.

Physicians and office staff will be able to quickly access key eligibility and benefit information, receive prompt approval for services and referrals requiring prior authorization, and track the status of claims.

Feedback from participating doctors and physician organizations during these year-long pilot projects will inform the next round of regional and national collaborative initiatives and accelerate progress toward the day when one-stop service is available nationwide.

Responding to physician and hospital concerns about lack of uniformity in quality performance management, we are partnering with these stakeholders in a public-private initiative to measure quality of care on a consistent basis nationwide -- replacing the patchwork of inconsistent performance-measurement programs and criteria now in use.

One of these multistakeholder collaboratives is working to:

  • Implement performance measurements at the physician and other clinician or group level;
  • Collect and aggregate data in the most appropriate way; and    
  • Report meaningful information to consumers, physicians and other clinicians to inform decision-making and improve outcomes.

This effort will help identify quality gaps, control skyrocketing cost trends, reduce confusion over redundant performance measures and alleviate administrative burdens in the marketplace.

Working To Improve PHRs

In addition to working to improve quality performance measurement and to simplify administrative processes across the system, health plans have been working with other stakeholders on the development and deployment of model electronic personal health records that support improved information-sharing and coordination of care at the point of care and in every setting -- in the patient's home, in a 'medical home' guided by a primary care doctor, in referrals, in emergency departments, during hospitalizations and at the pharmacy.

Millions of Americans live with chronic conditions, which account for more than 75% of the nation's health care costs. Yet chronic care often is piecemeal and poorly coordinated, resulting in inefficient and inappropriate care, needless duplication of tests and procedures, preventable medical errors and chronically impaired health.

The widespread adoption of PHRs will stimulate related advances such as the use of personal computers by patients with diabetes to send real-time blood-sugar levels and other data to doctors and nurses monitoring their care. These steps allow interactivity between patients and care providers and employers, inform patients and lower hospitalizations.

Much Remains To Be Done

Much remains to be done to ensure that these and related health IT advances achieve their full potential. For example, accelerated transition to electronic health records spurred by the availability of stimulus funding should be done with the clear objective of interoperability. Losing sight of this goal could result in the adoption of technologies with limited ability to communicate across the health care system and the loss of a timely investment.

The nation is on the precipice of major change. If we proceed thoughtfully, with a clear plan to address systemic problems, we will be on the road to a more efficient and effective system. Our community is working hard to play a leadership role with other stakeholders in this transition.

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