Transcript Document 7263612

Michael S. Zamore, Policy Advisor
The Hon. Patrick J. Kennedy
Member of Congress
Co-Chairman, 21st Century Health Care Caucus
Show me the Money:
How Will We Fund Health
Improvement through Health IT?
eHealth Initiative 3d Annual HIT Summit
Washington, DC
September 26, 2006
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The current state-of-the-art?
“It was just common sense. A
local Blue Plan sent brown
paper bags to its members.
The idea was for them to put
all their prescription drugs,
over-the-counter medications
and herbal supplements in it.
People then took the bags to
their doctors….”
-- Ad in New York Times, 1/12/05
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Systemic problems require
systemic solutions

Need systemic solutions to
systemic problems, not just
band-aids.

Until we act, we’re doomed to
repeatedly face the same
symptomatic problems.
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How do we align incentives to
get the health care we want?

Focus on prevention and wellness
 Focus on chronic care, not acute care
 Focus on outcomes not process
 Continually improve quality
 Continually improve the patient experience
 Coordinate care
And what is the role of health I.T.?
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We need I.T. to redesign
health financing to create
incentives for using I.T….
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Long term: create a market for
high quality, efficient health care

In a functioning marketplace, I.T. is a sound
investment (though safety-net providers,
rural providers will still need help).
 Physicians who deliver highest quality care
most efficiently should do better.
 Investing in quality improvement should
give market advantage.
 Ability to differentiate on quality and
efficiency critical to a functioning market.
Need I.T.
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Short term: Regional collaborations
could substitute for market forces




Grants to RHIOs to develop regional networks
and plans to support adoption by providers.
Strong interoperability requirements and other
minimum requirements (esp. privacy, quality
reporting)
Medicare, Medicaid match private sector
support for providers participating in networks
Stark and anti-kickback safe harbors for
participants in regional networks
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A community-based approach
to IT can fix structural flaws.

Investments in physicians’ IT can be financed
proportionally to expected returns.

A community-wide strategy minimizes free rider
problems – everyone jumps at once.

Creating information-sharing capability
maximizes value to participants.

Developing networks requires consensus among
stakeholders.
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Short term (2): Use PHRs to
grab low-hanging fruit

Improving patient behavior is low-hanging
fruit – disease management, Rx compliance
 PHRs with data feeds from plans, PBMs,
labs, and/or docs can be big value-adders
 PHRs can be personalized communications
channel to influence consumer behavior– if
consumers use them. Take-up rates are very
low to date.
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Use the doc-patient
relationship to give PHRs
value for consumers

Eliminate the need for that *!#&! clipboard
 Give patients easier way to stay in touch
with their physician
 Target chronic patients who already cart
around their records
 Once consumers use it, can send patientspecific messages (e.g. “refill your Rx”;
“you’re due for a mammogram”)
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Targeted incentives to get
docs to urge use of PHRs

Offer physicians $1-$2 for each patient they
see making use of a qualifying PHR
– Use for intake, rather than clipboard
– Update meds, diagnoses lists
– Could add e-consultations, scheduling, etc.

Streamline incentives, so docs only deal
with one program, not one from each plan
 Doc/consumer choice of any PHR that
meets criteria
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Create public-private PHR
Incentive Fund

Pharma and plans stand to gain much by
better patient adherence
 Working together through PHR Incentive
Fund amplifies incentive for physicians
 Contributing to PHR Incentive Fund would
enable a partner’s messages to be sent to
appropriate consumers, if objective and
accurate. NO MARKETING!
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Wider use of PHRs can have
ripple effects

PHRs can serve as de-facto health
information networks if have reliable data
feeds.
 Docs can gain some benefits of technology
w/ minimal investment; build up to EHRs,
telemedicine, proactive disease mgmt.
 Engage consumers, both in technology and
in own health care.
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The goal: scaleable innovation

Recognize systemic barriers, and
begin moving the systemic levers

Encourage different models but
within broad parameters to ensure
interoperability

Leverage private sector
investments

Target federal investments
strategically, learn and prove the
concept, build towards long-term
solutions
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The Hon. Patrick J. Kennedy
Member of Congress
Co-Chairman, 21st Century Health Care Caucus
For more information, contact:
Michael Zamore
Policy Advisor
(202) 225.4911
[email protected]
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