Value-based payments and EHRs expected to continue trajectory during reform

Despite the uncertainty surrounding health care reform under the upcoming Trump administration, health law experts project that the transition to value-based payments and further development of electronic health record (EHR) systems will be a constant in the coming years. Four of Avalere Health’s senior vice presidents offered their opinions during the 2017 Healthcare Industry Outlook webinar, making educated guesses about what upcoming changes the industry may see.

What will change?

The webinar started with the topic on everyone’s mind: what will happen to the Patient Protection and Affordable Care Act (ACA)? Broadly, the presenters expect that federal spending on health care will be capped and states will be granted more flexibility in designing their Medicaid programs. Reduction of regulations to encourage the private sector to provide a range of products in a competitive market is also to be expected.

The likelihood of repeal was discussed for several different ACA sections. The most likely to be repealed were the individual and employer mandates, subsidies, industry taxes, Medicare tax for high earners, and cuts to disproportionate share hospitals. Certain reforms, like protection for pre-existing coverage, drug related provisions, and changes to Medicare Advantage and Medicaid payment provisions are considered likely to remain. Subjects likely to be up for serious debate are Medicaid expansion, the Center for Medicare & Medicaid Innovation (CMMI), essential health benefits, and the preventive services coverage requirement.

Other areas

The focus on quality and value in health care is not expected to waver during the new administration. In light of significant regulatory and policy barriers, providers are unable to establish outcome-based contracts and create more innovative payment arrangements. More flexibility in the ability to establish and agree on value between parties is expected to be a policy pressure point.

The value discussion typically focuses on provider performance, but the presenters noted that drugs are an important value consideration, especially in light of rising costs. The traditional approach to determining drug value is expected to evolve, as frameworks had previously been established based on clinical benefit, toxicity, and product cost, which ignored patient considerations and relied too much on data from limited populations. In addition to incorporating more real world data, drug value frameworks have begun to focus on not only on health outcomes, but patient experiences and financial considerations during treatment.

Although “virtually every hospital” is using some sort of EHR system, interoperability continues to be a sticking point. In the near future, the ability to more effectively use, share, and interact with data is expected to improve. Continued advancements in studying data is also expected to change the way providers practice, including big advances in population health.

Annual report shows Health IT dramatically improving quality of care

Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the health information technology (health IT) landscape has dramatically evolved, with hospitals and health care providers using health IT more than ever. In 2015, 96 percent of hospitals and 78 percent of physician offices used certified EHR technology. The Office of the National Coordinator for Health Information Technology (ONC) details the advancements made in the health IT landscape in its 2016 Report to Congress on Health IT Progress.

Reporting requirements

Section 13113(a) of the American Recovery and Reinvestment Act of 2009 (ARRA) (P.L. 111-5), under the HITECH Act, requires HHS to submit to the appropriate committees of the House of Representatives and the Senate a report (1) describing the specific actions that have been taken by the federal government and private entities to facilitate the adoption of a nationwide system for the electronic use and exchange of health information; (2) describing barriers to the adoption of such a nationwide system; and (3) containing recommendations to achieve full implementation of such a nationwide system. This is the annual update to the previous submissions, which were released on January 17, 2012, June 21, 2013, October 9, 2014, and February 29, 2016.

HHS priorities

The progress of health IT allowed for a transition in focus for HHS to the seamless and secure flow of health information, or interoperability. The advancements set the foundation for delivery system reform, the Cancer Moonshot, combating the opioid epidemic, the Precision Medicine Initiative, clinical innovation, and protecting and advancing public health. HHS has focused on three priority areas:

  • promoting common standards to facilitate the seamless and secure exchange of data, including through the use of standardized, open application programming interfaces (APIs);
  • building the business case for interoperability, particularly through delivery system reform efforts that change the way CMS pays for care to reward quality over quantity of services; and
  • changing the culture around access to information through combating information blocking; ensuring that individuals know they have a right to access and transmit their health information and that health care providers know they must provide access to the individuals; and reminding health care providers that they are legally allowed to exchange information in the course of treatment or coordinating care.

Health IT changing the provision of care

The rapid adoption of health IT has facilitated increased use of functionalities that have real-world clinical impacts. These include clinical decision support, which can point health care providers to evidence-based clinical guidelines at the point of care, facilitate an enhanced diagnosis or treatment path, and alert providers to potentially harmful drug interactions. Hospitals and physicians have also gained the ability to exchange more electronic health information than ever, with 82 percent of non-federal acute care hospitals electronically exchanging laboratory reports, radiology reports, clinical summaries, or medication lists. Approximately 90 percent of hospitals reported that they routinely had clinical information needed from outside sources or health care providers available at the point of care. Notably, EHR systems have transformed the prescribing and dispensing of medications, with e-prescribing systems lowering costs, improving care, and saving lives by reducing medication errors and checking for drug interactions.

Increased access to health information

Digitizing the U.S. health system has empowered individuals to be more in control of their own health decisions. Those with electronic access to their health information can monitor chronic conditions, better adhere to treatment plans, find and fix errors in their records, and directly contribute their information to research. Today, 95 percent of hospitals have the capability to allow patients this type of access.

Transparency websites give health IT purchasers clear view of products

Purchasers of certified health information technology (IT) have access to information about health IT products’ costs and limitations via two new websites maintained by the HHS Office of the National Coordinator for Health Information Technology (ONC). The 2015 Edition Health IT Final rule required developers to disclose information about known material limitations and types of costs associated with their products and to make an attestation as to whether they will voluntarily take additional actions to increase transparency regarding their products and business practices. The information is available on the ONC’s Certified Health IT Developer Transparency website, as well as on the upgraded health IT product list.

Mandatory disclosures

The Final rule (80 FR 62602, October 16, 2015) mandated developer disclosures so that purchasers could better understand obstacles and costs that they might face, allowing them to compare and knowledgeably select products. Statements must be written in detailed, plain language. Because customers can make more informed choices based on the disclosed information, developers have more incentives to improve upon their products and to refrain from engaging in information blocking, which is deliberate or unreasonable interference with the exchange of electronic health information.

Voluntary attestation

Earlier in 2016, companies that provide 90 percent of electronic health records (EHRs) used by hospitals nationwide made an interoperability pledge, agreeing to improve consumer access, refrain from blocking and ensure transparency, and implement federally recognized interoperability standards. “Nearly all developers” who made the earlier pledge have voluntarily attested, pursuant to the requirement set forth in the Final rule, that they will take additional actions to promote transparency, including making information about their business practices available to potential customers and requestors. The Final rule also allowed developers to attest that they will not take additional voluntary actions.

ONC-Authorized Certification Bodies (ONC-ACB) will monitor developers to ensure that they are “reporting accurate and compliant disclosures.” Developers who fail to do so will be subject to corrective action, including potential termination of certification.

EHR adoption up, ONC discussing further plans at national convention

Almost all hospitals have implemented certified electronic health record (EHR) systems, a notable increase from 2008 survey data. In order to further the efforts to ensure transmission of health information between providers, the Office of the National Coordinator for Health Information Technology (ONC) will convene with public and private sector parties at its 2016 annual meeting, where sessions will educate those attending on current advancements and future plans.

Increased adoption

According to the ONC’s May data brief, 96 percent of reporting non-federal acute care hospitals had certified EHR systems in 2015. Eight of 10 small, rural, and critical access hospitals possessed at least basic EHR technology, although only about half of children’s hospitals and 15 percent of psychiatric hospitals had done so. Across all states, at least 6 out of 10 non-federal acute care hospitals had adopted basic EHR, a significant increase since 2008 when most either reported none or less than 20 percent.

Future of health IT

The annual meeting’s agenda includes presentations on the federal government’s commitment to better health, advances in interoperability, research, and health innovation. The government is particularly interested in precision medicine, which ensures that treatments are individualized to each patient’s needs. The presentations also cover the health IT response to the Zika virus, advancing health IT for Medicaid programs, and cybersecurity.