Jonathan Weiner, Dr.P.H. is a professor of Health Policy & Management and of Health Informatics at the Johns Hopkins Bloomberg School of Public Health, and is director of the Johns Hopkins Center for Population Health Information Technology (CPHIT), which was founded in 2012. The Johns Hopkins CPHIT, under his direction, has been very involved not only in academic research and study around the intersection of population health initiatives and health information technology; it has also been deeply involved in a new initiative designed to boost the all-payer hospital rate regulation system unique to the state of Maryland (the Johns Hopkins organization is based in Baltimore).
Jonathan Weiner, Dr.P.H.
As Kaiser Health News reported on January 10,“Maryland officials have reached what analysts say is an unprecedented deal to limit medical spending and abandon decades of expensively paying hospitals for each extra procedure they perform. If the plan works, Maryland hospitals will be financially rewarded for keeping people out of the hospital—a once unimaginable arrangement.”The KHN report went on to note that, “After months of negotiations with state and federal officials, the hospitals also agreed that their revenue from all sources—private insurance, government and employers—will rise no faster than growth in the overall state economy.” And the report quoted Uwe Reinhardt, Ph.D., the renowned Princeton University healthcare economist, as saying, “This is without any question the boldest proposal in the United States in the last half century to grab the problem of cost growth by the horns.”
As a Jan. 31 article in USA Today noted, “A key ingredient of the state's regulatory scheme is a 36-year-old waiver from the federal government that allows Maryland to set its own reimbursement rates for Medicare, instead of following the rates for the country as a whole. This new plan replaces that waiver and requires the state to cut total Medicare costs by $330 million over the next five years. The waiver also requires Maryland to reduce its hospital readmission rate and cut hospital-acquired infections and other preventable conditions by 30 percent.”
Given both the opportunities and challenges inherent in the Maryland payment initiative, there is no question that data and IT will be key elements in the potential success of the program. The state has an all-payer database, and a level of collaboration among providers and between providers and private and public payers, that is rare in the U.S. And that’s where some of the functions of the Johns Hopkins CPHIT come in, notes Dr. Weiner.
Specifically with regard to the statewide payment initiative, Weiner says, “We’re trying to link data from EHRs, vital records, and claims data; we do have an all-payer database here. And the data are everywhere, but they’re just not linked. And to be more specific, at Hopkins, we’re blessed with a lot of doctors, nurses, public health people, engineers, and computer scientists; and our goal is to bring them all together to improve health. “
Dr. Weiner spoke recently with HCI Editor-in-Chief Mark Hagland regarding the Center’s activities broadly and also in relation to the Maryland initiative. Below are excerpts from that interview.
Tell me about the work of the Center for Population Health Information Technology in general.
There are very few people trying to create connections between EHRs [electronic health records] and population health, and public health. Our organization is trying to create those connections, and it’s based in a population health school. The soft start for our center was in late 2012. And our goal is not just to focus on the person with diabetes who’s in front of a doctor, but on all persons with diabetes. From time to time, clinicians and hospitals focus on the broader populations; but that is at the core of our activity.
And how are you accomplishing that work?
Our goal is to tap into the data coming out in the medical environment, through EHRs. Some 85 percent of doctors are already using EHRs. And we’re thinking about how to leverage that data; and we’re focused on public health. But we didn’t call it the center for public health IT, for a number of reasons; we think the trick is to focus on the entire healthcare system. We do studies, we do syntheses of knowledge, we develop tools. In addition, I and my late colleague Barbara Starfield developed something called Johns Hopkins ACGs—adjusted clinical groups (originally ambulatory care groups). In the early 1980s, we were working with diagnostic data and pharmacy data in our own health plans, and we developed tools for predictive modeling, for risk stratification purposes. ACGs work mainly with claims data.
But we’re now using data from EHRs, from mhealth, from vital records, and we’re linking data sources. For example, here in Maryland, on January 1, we started with a new model that includes an all-payer hospital system. Until recently, the payment was based on case type. Now, Medicare, Medicaid, and commercial payers all the pay the same rates in our all-payer system. But as of January 1, it’s moving towards a globally capitated budget based in part on health data.
So part of what you’re doing will help support the new plan in Maryland?