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Health IT in Obama’s Second Term

January 14, 2013
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Time to better align infrastructure with health reform programs

In the weeks immediately after the election, I got the chance to interview an assortment of experts for a Government Technology magazine article about what they expect from the second Obama administration in terms of government IT initiatives. If I had to sum up their responses in one word, it would be continuity.

Initiatives launched during the first term should only gain momentum during Obama’s second term, including those in the Department of Health & Human Services. That continuity extends itself to personnel.

CQ HealthBeat has reported that the Obama health policy team will remain largely intact, including HSS Secretary Kathleen and CMS Acting Administrator Marilyn Tavenner. (Interestingly, it has also been reported that former CMS Administrator Don Berwick, M.D., is considering a run for governor in Massachusetts in 2014.) Farzad Mostashari, M.D., the national health IT coordinator, is also staying. The day after the election, he addressed a meeting of the Health IT Policy Committee and said the president’s re-election “gives us the chance to continue to make strides, continue the essential thrust of the policies and the approaches. But it also affirms our responsibility to do the peoples’ work, to come together — Republicans and Democrats — to do the peoples’ work.”

At the Jan. 8 Health IT Policy Committee meeting, Mostashari and Paul Tang, M.D., vice chair of the committee, outlined some priorities for the year ahead, including a glimpse of what Stage 4 of meaningful use might address. They talked about creating a “learning health system” and about meaningful interoperability and exchange of data as well as consumerism in health care.

For the Government Technology story, I asked some sources what the president’s re-election means for ONC. Jonah Frohlich, managing director of consulting firm Manatt Health Solutions, mentioned two things: First, the office has more time to work on meaningful use incentives; second, it may consider waivers to extend the state health information exchange program to give states more time to implement it. 

“I think they also need to consider how to better align infrastructure for the health reform programs. They are done in piecemeal fashion now,” said Frohlich, who previously served as deputy secretary of health IT at the California Health and Human Services Agency. For instance, a demonstration project in 12 states is examining how best to treat patients eligible for both Medicaid and Medicare. “They need to think how those should be supported from a technology standpoint, including EHRs, telehealth and remote monitoring,” Frohlich said. “They should look at which policy levers they need to pull to make those coordinate better.”

Frohlich also expects a stronger federal focus on identity management in 2013. “You have to have hand-offs between local, state and federal agencies and private insurers, where appropriate. That requires identity management so people don’t fall through the cracks,” he said.

States will continue to work on eligibility portals not just for health insurance exchanges, but also tying them to other programs people might be eligible for — including the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families — so that when people come to the portal, they are steered to programs they’re eligible for. 

For the Government Technology article, I interviewed Andrea Danes, director of health care and human services for CSG Government Solutions. She told me some states such as Mississippi already have such eligibility portals in place and are now updating them to make them compliant with ACA. For other states, this is more difficult because they are tying in legacy systems and trying to interface with federal systems on tax information and citizenship.

Perhaps not surprisingly, the comments section of the Government Technology web site story drew a few bitter comments from conservative readers upset with the election's outcome. One noted that "there isn't enough money in the world to pay for free health care for 95% of the population. So, it'll be taken from responsible people who work, save and invest, until they get fed up and leave. Then all you'll have left is Greece."

Do Healthcare Informatics readers have any predictions they would like to share about the direction health IT will travel in the second term?

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