Federal Health IT Strategic Plan: Where are the incentives?

He always resides in the details, and you know who “he” is

Last month, HHS released its Federal Health IT Strategic Plan 2015-2020 . Until this week, I had only read some stories about it. This week, I read it. It points out in several places that we have made tremendous progress through the federal push via financial incentives and disincentives to force providers to install and use electronic patient record systems. While acknowledging those systems aren’t fully living up to their potential (see interoperability), HHS pats itself on its back for moving the needle a lot through its sort-of bully approach.

“Implementation of the prior Plan created a strong foundation for achieving this Plan’s goals and objectives. Over 450,000 eligible professionals and 4800 eligible hospitals received an incentive payment for participating in the Medicare and Medicaid electronic health record (EHR) Incentive Programs. This achievement was not easy. . .this has created a strong demand for sharing of information across systems, information platforms, location, provider or other boundaries.

“This Plan aims to remain flexible to evolving definitions of health, health care, and the technology developments that support them.” (p.4)

General Direction, Not a Direct Path

Having led the parade in the past, HHS makes it clear in this document that it recognizes the future direction of health technology lies more in the hands of consumer demand, provider need-to-know and the pace of technological advancement.

The Federal Strategic Health IT Plan is 50 pages of guidance and direction. The detail of the IT part of execution lies in a separate roughly 250-page document, also released last month, the Roadmap.

In 2011, the last time the government delivered a strategic health plan, it wasn’t gifted with the vision to see around corners. In fact, the whole Office of the National Coordinator for Health Information Technology came out of a “we better do something” mindset back in 1986. Now, with hindsight and lots of input from thousands of providers, policy experts, tech gurus and numbers crunchers, this document is one that gives the future a general direction but doesn’t provide a direct path. Hindsight has given the strategists the insight to know that the future will take shape in unforeseen ways.

In particular, it moves the locus of responsibility from the federal government out closer to the place where health happens in individual lives and communities. The detail supports a move toward personal responsibility and community actions. It is clear that this document moves the country toward population health by frequent references to community context.

“This plan seeks to illuminate issues where federal action will have less reach, and where state, territorial, regional, private and individual actions will be more impactful. . .through a resilient health IT infrastructure.” (p. 6)

Supporting the Health of Individuals through Collective Efforts

The federal government doesn’t plan to be completely hands-off, though.

“Many health and social determinants outside of care delivery influence individuals’ health and well-being, and the federal government can play an important role to guide inclusion of these determinants into the electronic information stream for decision-making by individuals, providers, and communities, as well as the organizations and technology developers that support them.” (p. 11)

“…Communities have a responsibility to help individuals live healthy and productive lives, and protect them from harm. Home- and community-based organizations, as well as social and human service organizations can play an integral role in assisting individuals to achieve their health potential.” (p. 11)

The Plan acknowledges this will require some change in the way we think about healthcare.

“This person-centered infrastructure will require cultural shifts and technological adaptations that strengthen and make clear the connections between health care providers and community supports and services.” (p. 14)

Where are the Incentives?

It was the government’s financial largesse in the form of about $20 billion of incentives that put the current electronic patient record system in place. Where are the incentives to continue to nudge the country in the direction outlined by HHS in this document?

Ah, here we go, page 18.

After referencing the fact that the government, through Medicare, Medicaid, CHIP and its various DoD/VA programs already is the largest provider and payer of healthcare in the nation, the document explains that Medicare providers will be moved to a value-based payment system in the next few years.

“HHS Secretary Burwell announced measureable goals and a timeline to move the Medicare program, and the health care system at large [emphasis mine], toward paying providers based on quality, rather than quantity, of care they give patients. A key goal of the initiative is to have 85% of all Medicare fee-for-service payments tied to value or quality by 2016 [editor’s note: checking my calendar…that’s two months away], and 90% by 2018.

“Another key target is to have 30% of Medicare payments tied to alternative payment models [editor’s note: read ACOs eg like Pioneer ACOs – check to see how that is working out by the end of 2016 [editor’s note: back to my calendar…you’ve got a year] and 50% of payments by the end of 2018.”

Basically, in order to get paid, providers will have to be able to prove that they have met certain quality and performance targets set by government and professional standard-setting organizations. That kind of proof will only reside in the data collected by the electronic patient record system across entire health networks and within health plans.

There’s your incentive. Yes, pay for performance and value, outcomes-based payment are here. Show us your data and we’ll cut you a check.