Transcript Document

Financing and Incentives For Community
Health Information Exchange:
Rewarding and Supporting
Population Health
Jonathan P. Weiner, Dr.P.H.
Professor
Johns Hopkins Bloomberg School of Public Health
[email protected]
Presented at The Connecting Communities for Better Health
Forum, Washington DC, 5/26/05
Who I am and the perspective I bring
My Goals
• To offer a few comments on:
– The financial sustainability of health
information exchange (and HIT more
generally).
– How “population health” must become
central if a national health information
infrastructure is to become viable.
Population and Public Health:
Quick Definitions
• Population Health: A comprehensive
framework for understanding and
improving the health and well being of a
defined population.
• Public Health: Societal (i.e., government)
actions to improve health. Core functions
relate to assessment, assurance and
policy setting.
Source: National
Committee
on Vital &
Health Statistics.
Pay for Performance
• Current Pay for Performance (P4P) approaches,
though the right thing to do, are imperfect:
– We should not confuse giving “bonus” for
having an EHR as true P4P.
– P4P should attempt to support movement
towards e-enabled “population health”
management systems.
P4P and Population Health
• For example, bonus should be based on “e-indicators”
that measure cross-cutting information flow: E.g.:
– Coordination of care across providers
– Needs assessment / screening across settings
• Ultimately, payment of providers should be based
primarily on e-indicators of the health and well-being
of target population. This will be feasible only with:
– wide-scale medical information exchange.
– Incorporation of vital record / public health data.
But if HIT and community interchange
are to become viable over long term,
significant financial, structural and
legislative changes will be necessary
within our healthcare system at-large.
Organizational Structure that will help
support EHR / Interchange viability
• Providers that are organizationally, or at
least “virtually”, integrated.
• Global, fixed budgets with financial
accountability.
• Active management of resources based on
population- based information, scientific
evidence, and outcomes.
Partnership and Collaboration are Fine,
But ….
• If we are really serious about universal and
sustainable information infrastructure:
– All payers must contribute fair share on a
mandatory basis.
– We need government sanctioned
“Community Health Information Authorities”
(RHIOs
CHIAs? )
• Possibly modeled in part after Strategic Health Authorities and
Primary Care Trusts in UK.
If we are serious …..(cont.)
• Provider HIT investments must be
subsidized, as they are in all other nations.
– But in return, HIT and interchange
involvement should become a mandatory
condition of health plan reimbursement.
Potential Roles of “Community Health
Information Authority”
Graphic Adapted from Public Health Agency of Canada