Guest Column: Data will drive the future of health care delivery
The federal health care reform package passed by Congress in 2010 has pushed this medical-information revolution forward in a number of ways. At Primaris, a health care business consultant and Medicare contractor based here in Columbia, we are seeing some of these exciting developments firsthand.
Better use of information, particularly electronic information, is essential to the government’s strategy to create a more fair and effective health care system in the United States. Data can make the difference between a hunch and knowing something for a fact, and increased use of medical data, for example, can indicate whether practices are treating Medicare patients effectively or being reimbursed fairly.
Payers in the health care system — health insurance companies and, in the case of Medicare beneficiaries, the federal government — currently cover the costs of individual treatments in a pay-per-service system. The overall trend included in health care reform is to move toward a pay-for-value system, which rewards effective treatment and shares costs more effectively.
“In the Affordable Care Act, there is much that is not yet established or implemented,” said Cora Butler, director of commercial operations for Primaris. “But what is established is the overall goal.”
This model of payment has been used in various pilot projects during the past three or four years.
“So all the data is not in, but this is where CMS (The Centers for Medicare and Medicaid Services) wants to continue to drive,” Butler said. “They want the providers to share both the benefit and the loss.”
Another part of health care reform, the Health Information Technology for Economic and Clinical Health Act promotes the use of electronic health records while ensuring patient confidentiality. Soon after the act’s passage, federal officials awarded contracts to more than 50 organizations across the country to act as consultants for physicians trying to use electronic health records meaningfully.
In Missouri, one such contract for $6.8 million was awarded to the Curators of the University of Missouri; Primaris is a subcontractor for this effort.
Although there are penalties for not implementing EHR systems for primary-care providers after a few years, there are also incentives for doing so. Specifically, physicians who successfully demonstrate “meaningful use” of an EHR system can collect up to $44,000 in Medicare-related grant money; some may collect even more in Medicaid-related grant money.
All of these changes require a good deal of communication to avoid confusion.
For example, more people on Medicare have questions about how reform affects them; supplemental insurance plans under Medicare Advantage have changed. Counselors with Missouri CLAIM, an organization administered by Primaris offering free expert advice to Missouri’s Medicare beneficiaries, have fielded a great deal of questions about these changes.
Finally, medical data is helping to keep patients safer. An affiliate of Primaris, the Missouri Center for Patient Safety is working together with hospitals in our state to collect and ultimately analyze information related to medical errors. We hope the center’s work will help doctors and nurses do their jobs more effectively.
We look forward to meeting these challenges and more. And generally, in the health care sector of our economy, we expect to see much more information and information-gathering in 2011. v
Richard Royer is the CEO of Primaris, a nonprofit organization that works with providers and Medicare to improve the quality of health care delivery.