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Reaching Out to NYC's Underserved

May 10, 2010
by Kate Gamble
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While some believe RECs lack the funding and staff needed to succeed, one NYC-based program is off to a promising start.

Over the past few months, ARRA-HITECH grants have been announced with an increasing regularity. In fact, it’s getting to the point where those who follow the health information technology industry — and perhaps even those who are part of it — might want to start carrying a score card to keep track of all the funds being allocated.

One area that has become a frequent recipient of funds is regional extension centers. RECs, as they are more commonly known, are designed to help small practices adopt and become meaningful users of health IT. In April, the Department of Health and Human Services (HHS) announced that $267 million in funds would go toward the development of 28 RECs. In total, about $640 million has been allocated for 60 centers across the country.

It’s a concept that has drawn quite a lot of skepticism. In April, Health Affairs published the results of a study indicating that RECs might be too understaffed and underfunded to provide the assistance physicians need.

If that’s the case, it could be a significant setback for health IT adoption efforts nationwide. But it’s still a bit early in the game to formulate any conclusions as to whether RECs are structured for success. Perhaps the study is meant as more of a warning that adequate funding is needed to enable the programs to flourish. But beyond the (hugely important) funding issue, there are concerns that RECs might lack the industry expertise needed to support providers — both in the short-term, and down the road. One possible solution is to create a center that is linked to an established program with experience in rolling out IT.

That was the thinking in New York, where NYC Regional Electronic Adoption Center for Health (NYC REACH) was selected to serve as the REC for New York City. NYC REACH is managed by — and is an extension of — the Primary Care Information Project (PCIP), a program designed to support the adoption and use of electronic records by primary care physicians in New York’s underserved communities.

PCIP is the largest community-based EHR program in the country, according to Jesse Singer, development director at PCIP (and a speaker at the recent Healthcare Stimulus Exchange conference in New York). The REC will target small physician offices, a group that Singer says is least likely to adopt health IT, despite the fact that it is responsible for the delivery of nearly 80 percent of outpatient care in the U.S. NYC REACH, which has received $21.7 million in funding, aims to combat that statistic by helping 5,000 physicians achieve meaningful use in two years. NYC REACH currently has enrolled 2,537 providers in the program; of those, 2,000 are live (the remaining providers are preparing to go live on an EHR).

According to Singer, the key to achieving this is to develop a payment model that rewards disease prevention and effective chronic care management (much like that offered by Kaiser Permanente) by offering higher payments to physicians who take on high-risk patients. One example is the NYC Department of Health’s Health eHearts, a pilot incentive program funded by the Robin Hood Foundation that recognizes EHR-enabled practices for achieving high rates of cardiovascular health. Unlike other pay-for-performance programs, eHearts utilizes EHR-generated clinical quality outcomes, he notes. “We want to bring the Kaiser model to small practices and give them resources they don’t have.”

NYC REACH will provide outreach and education to physicians to help obtain funding, aid in vendor selection, provide support at go-live and post-implementation, and offer meaningful use guidance. The REC will also focus on reducing health disparities, according to Singer, who says he hopes it will be able to leverage data to prioritize public health goals according to specific areas.

“Our mission is to improve care in underserved areas through health IT,” he adds. “Technology is just the vehicle; the end result we’re focused on is improving public health.”