Asked to find policy solutions for promoting interoperability, the ONC Health IT Policy Committee’s Information Exchange Workgroup recommended the agency focus on payment policies, non-meaningful use eligible providers and state HIE policy and program variations.
Micky Tripathi, Massachusetts eHealth Collaborative president and the workgroup chair, told the committee Wednesday that although HIE “is advancing rapidly” in much of the country, “it is being held back by demand -- and supply-side friction created by variation in federal and state programs and policies that give unequal and sometimes conflicting emphasis on interoperability.”
[See also: Physician approaches to HIE vary widely.]
A CMS and ONC review of those areas of friction, and policy levers for reducing or eliminating it, “would do much to advance HIE adoption across the country,” Tripathi said.
Advanced payment models spurned by health reform, such as the shared savings contracts used in accountable care organizations, are increasing demand for information exchange, Tripathi said.
But there’s a “complexity of requirements, and there’s a relatively slow adoption,” with fee-for-service riding out on a “long tail” and slowing down HIE. “For providers on the ground, there’s a lot of focus on the complex requirements that can sometimes obscure or eclipse the focus on the outcomes,” he said.
Although the federal government is limited in requirements it can place on private payers, simplifying and harmonizing advanced payment models in Medicaid and Medicare, while encouraging alignment in commercial insurance, could go a long way to improving and expanding HIE and care coordination, Tripathi said — helping providers focus more on outcomes rather than the “complex mechanics” of the payment programs.
As another possible remedy to payment model complexity, the 19 member workgroup also suggested voluntary certification for HIE functions geared specifically towards value-based payment models.
Beyond advanced payment models, another HIE gap the workgroup wants to address is providers ineligible for meaningful use — such as long-term and post-acute care providers, pharmacists, commercial labs and behavioral health providers — which could “result in structural impediments to progress in interoperability across the care continuum,” Tripathi said.
The workgroup, which includes representatives from Aetna, Epic, the Mayo Clinic and the Minnesota and Rhode Island health departments, suggested HHS harmonize documentation requirements, extend incentives to Medicare Part D providers and promote administrative simplification in clinical standardization, such as in prior authorization documentation requirements.
[See also: Tiger Team aims to remove HIE barriers.]
The workgroup recommended providing laboratories safe harbor from certain federal clinical lab requirements, if the providers are meaningful use compliant, and requiring or encouraging certification of technology used by providers not eligible for meaningful use, to help ensure interoperable exchange along the care continuum.
Another barrier to interoperability the workgroup found in its research, Tripathi said, is state-level variation in HIE-related programs and policies, which make it more difficult “for multi-state care organizations and technology vendors to create scaleable processes, services and products.”
Some of the variation stems from state-by-state differences in components of federal-state programs, like Medicaid reimbursement and waivers, and some of the variation stems from state control over issues like privacy, liability and immunization reporting, Tripathi said.
The workgroup is suggested CMS include HIE requirements in all of its programs, including state Medicaid waivers and advanced payment demonstrations. The Department of Health and Human Services could also create model language for inclusion in state-level programs, such as Medicaid managed care contracts and state employee health plans, and could encourage any opportunities for standardizing state privacy and liability policies for HIE, Tripathi said.
