Speaking at the State Healthcare IT Connect Summit in Baltimore on April 1, Kelly Cronin, health reform coordinator for the Office of the National Coordinator for Health IT, described how ONC and the Department of Health & Human Services plan to pull all available levers in working with state partners to promote health data interoperability and reach providers who were not eligible for meaningful use incentives.
Expanded health insurance coverage is just one aspect of the Affordable Care Act, Cronin noted. The ACA is also about improving care and lowering cost — and for that to happen, data needs to flow. ONC is thinking about how to support data exchange across a variety of settings. “We have seen tremendous adoption of EHRs and some movement of data, particularly with e-prescribing, but we are not where we need to be,” Cronin said. “One of our key priorities is to advance connectivity. We are looking at what we need to do to get to system-wide interoperability.” She mentioned HIE governance as an issue that ONC would revisit in 2014.
“We have to work on how to further integrate data across the system and develop a much more rational system of claims and clinical data, she said, because today the architectures are very disparate, with data in many silos, including HIE repositories, data warehouses and registries. “We have to build that architecture together,” she told state health IT leaders.
The meaningful use Stage 1 quality measures were not perfect, Cronin said. “We have to evolve a set of longitudinal measures that support accountable care. The more we get standards into measure development, the better you will be able to implement the infrastructure to support it.”
She noted that CMS has several projects underway that stress health data interoperability, including a chronic care management fee structure, Medicare Shared Savings plans, and home health value-based purchasing models.
In terms of reaching providers who weren’t included in the meaningful use program, Cronin said there is a clear commitment from the Centers for Disease Control, the Health Research Services Administration, and the Substance Abuse and Mental Health Services Administration to support providers with policies and clinical standards. She cited the role of states such as Delaware, which requires Medicaid managed care providers to participate in the state HIE. She said more would be done on the policy level to ease the sharing of structured lab data and medical images so that eventually they are shared as a routine part of practice.
Jessica Kahn, director of the Division of State Systems in the Center for Medicaid and CHIP Services, Data Systems Group, talked about connecting the health insurance marketplaces and health IT. She urged state health IT leaders to “make a link between the newly enrolled and HIE. People who have been uninsured are likely the ones you would like to track longitudinally to improve health," she said. She also stressed connecting state Medicaid IT enterprises with state HIE. “It is an important connection to make,” she said. “This is not just getting people coverage. It is about getting people healthier. Are they getting healthier? Why are they healthier? What is happening to the cost curve? We won’t know these things until we have the data. But understanding those trends also requires intellectual curiosity.”
Kahn added that rather than funding every state request, CMS is starting to think of itself like a venture capitalist. “If a state says it wants to do something, we have to ask ourselves if it is something we want to invest in,” she said. “Nothing says we have to approve everything. Funding needs to be performance-based. We can be strategic about it.”