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Making the Most of Health IT, Health Reform Overlaps

For years, health IT advocates and health care reformers have been saying the two efforts are intertwined and must be pursued in tandem.

Well, here they come, hand in hand.

Two massive pieces of federal legislation — the stimulus package last year and health care reform this year — aim two significant revenue streams at health care. How those two streams are directed in California — especially where they overlap and have the potential to expand their impact exponentially — will help determine how effective both pieces of legislation are in improving the state’s health care system.

David Lansky, co-chair of Cal eConnect, the new private organization formed to oversee California’s transformation to digital health care, said there are several areas of potential overlap, but one stands out as the most promising.

“The primary area will be in the area of bending the cost curve,” Lansky said. “I think there will definitely be other areas where the two will work together. I think IT will help increase coverage, and it will help marketplace efforts in that regard to a degree. IT also helps a little bit on the administrative side, but that could happen anyway and it’s a fairly modest gain.”

Lansky added, “The greatest impact health IT will have on health care reform — and vice-versa — is in changing the cost curve for medical care.”

Jonah Frohlich, deputy secretary for health IT at the California Health and Human Services Agency, identified four main areas where the two efforts will overlap:  enrollment in insurance programs, establishing primary care medical homes, administrative simplification and quality reporting. He said adhering to the timelines attached to health IT and health care reform programs will be an important factor in California’s ability to take advantage of federal funds.

“Both of these pushes come with fairly ambitious timetables and getting a good jump on things will be important,” Frohlich said.

Bending the Cost Curve

Lansky, CEO of Pacific Business Group on Health, believes health IT will help slow the increase of health care costs in several areas.

“It will reduce fragmentation of care delivery, allowing doctors and patients to have all the information at one time in one place. All that is not the case now, in most situations. By making it possible to provide the correct care — evidence-based care — you’ll see efficiency rise and errors reduced, both of which will help reduce costs,” Lansky said.

Health IT has great promise for improving safety and quality of medical work, Lansky said. “Improved safety and better decision making will be a key part of bending the cost curve. We need to gather and then deliver the best evidence of what works. We don’t do a very good job of that now. We mostly rely on what’s in the doctor’s head,” Lansky said.

Lansky said changing the way our health care system pays doctors and hospitals will play an important part in reducing costs, “but we can’t change things until we know what works. We need comparative effectiveness research and patient-centered outcomes research to begin to shift the way the system works,” Lansky said.

“We can bring all the world’s knowledge to the bedside,” Lansky said. “We’re not doing that very well now and the closer we get to that, the more we’re going to be able to bend the cost curve.”

Health IT Can Help Expand Coverage

One of the biggest goals of the national health reform legislation is to increase the number of people covered by health insurance. Health IT, designed and used appropriately in state health insurance exchanges, can play a vital role in that expansion, according to Frohlich.

“My reading of this is that these programs are really intended to facilitate electronic enrollment — an accelerated enrollment that will be one service that would allow anyone who does not have insurance and needs to under reform to enroll and then be directed to the right place,” Frohlich said.

“When you think about the individuals who will be getting insurance coverage under reform, they don’t know what they qualify for. They know they’re supposed to have insurance, but they’re not sure if it will be Medi-Cal or a private policy or what. It’s absolutely critical that we make that enrollment process as streamlined and efficient as possible. And health IT can be a big part of that,” Frohlich said.

Health IT’s Accelerated Pace

Health care reform and health IT both come with their own timelines and many individual deadlines. Piling one set of deadlines on top of another won’t present too much of a problem, Frohlich said, because the deadlines for health IT in the HITECH portion of the federal  stimulus package last year are already causing the campaign to move full speed ahead.

“None of HITECH is reasonable in terms of expected pace,” Frohlich said. “It’s all happening faster than it should. The first two years of meaningful use is when most of the (federal) money will be disbursed, so there’s a real need to get a set of basic services established in two years. That’s the key challenge right now.”

The long-term challenge for health IT in California “is all about sustainability,” Frohlich said. “We need to make sure we can keep these programs going after the start-up money is gone.”

Cal eConnect Ramping Up

Cal eConnect, starting with a $38.8 million grant from the state, will be responsible for developing a statewide system for hospitals, clinics, physicians and other health care providers to communicate with each other electronically.

One of Cal eConnect’s primary goals is to help California health care providers meet data exchange criteria to qualify for incentive payments from last year’s federal economic stimulus package. Over the next decade, Cal eConnect will oversee the disbursal of as much as $3 billion — the biggest state allotment of federal stimulus for health IT.

Now two months old, Cal eConnect is in the process of filling the chairs around the board of directors table, finding an office for those chairs and choosing a CEO to hire staff.

“We’ve got temporary staff in a temporary space but we hope to have a CEO and an office by the end of June,” Lansky said.

The passage of national health care reform — which occurred around the same time Cal eConnect formed — bodes well for both fledglings, Lansky said.

“I think it (the passage of health care reform) will help,” Lansky said. “The whole health care sector — doctors, hospitals, insurers — is now very tuned into the kinds of changes possible. Now they’re not looking at IT decisions just through a narrow lens, but now they’re looking at IT as ‘Gee, how can I be successful in the very different environment that’s now taking shape.'”

“I think we’re seeing an overall attitudinal change,” Lansky said.

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