Health Project Transforming Health Care: The Role of Health IT Bipartisan Policy Center Task Force on Delivery System Reform and Health IT January 2012 Transforming Health Care: The Role of Health IT 1 BPC Task Force on Delivery System Reform and Health Information Technology MEMBERS Senator Tom Daschle (D-SD) Michael Critelli Margaret O’Kane Co-Chair President and Chief Executive Officer, President, National Committee for Dossia Quality Assurance Senator Bill Frist (R-TN) Co-Chair Governor John Engler Stephen Palmer President, Business Roundtable State Health IT Coordinator Janet Marchibroda and Director, Office of e-Health Chair, Health IT Initiative, Alissa Fox Coordination, Texas Health and Human Bipartisan Policy Center Senior Vice President, Office of Policy Services Commission and Representation, Blue Cross Blue Scott Armstrong Shield Association Herb Pardes, MD President and Chief Executive Officer, Executive Vice Chairman Group Health Cooperative John Glaser, PhD of the Board of Trustees, Chief Executive Officer, Health Peter Basch, MD, FACP NewYork-Presbyterian Hospital Services, Siemens Healthcare Medical Director, Ambulatory EHR and Robert Pearl, MD Health Information Technology Policy, Douglas E. Henley, MD Executive Director and Chief Executive MedStar Health Executive Vice President and Chief Officer, The Permanente Medical Executive Officer, American Academy Christine Bechtel Group, Kaiser Permanente of Family Physicians Vice President, National Partnership John Rother for Women and Families Karen Ignagni President and Chief Executive Officer, President and Chief Executive Officer, David Blumenthal, MD, MPP National Coalition on Health Care America’s Health Insurance Plans Professor of Medicine and Health Care Governor Mike Rounds (R-SD) Policy, Massachusetts General Hospital Brent James, MD, M.Stat. and Harvard Medical School Chief Quality Officer and Executive Mark Segal, PhD Director, Institute for Health Care Vice President, Government and Russell Branzell Delivery Research, Intermountain Industry Affairs, GE Healthcare IT Vice President and Chief Information Health Care Officer, Poudre Valley Health System Michael Simpson David Lansky, PhD Vice President and General Christine Cassel, MD Chief Executive Officer, Pacific Manager, Healthcare Knowledge and President, American Business Group on Health Connectivity Solutions, GE Healthcare Board of Internal Medicine (through December 2011) Jack Lewin, MD Reginald Coopwood, MD Chief Executive Officer, American Governor Ted Strickland (D-OH) President and Chief Executive Officer, College of Cardiology Regional Medical Center at Memphis Tony Tersigni, EdD, FACHE Deven McGraw President and Chief Executive Officer, Janet Corrigan, PhD Director, Health Privacy Project, Center Ascension Health System President and Chief Executive Officer, for Democracy and Technology National Quality Forum Betsy Weiner, PhD, RN-BC, FACMI, FAAN Senior Associate Dean for Informatics Vanderbilt University School of Nursing Health Project HEALTH PROJECT LEADERSHIP Senator Tom Daschle Sheila Burke Co-Chair Co-Director Senator Bill Frist Chris Jennings Co-Chair Co-Director Governor Mike Rounds Julie Barnes State Co-Chair Director of Health Policy Governor Ted Strickland Katie Golden State Co-Chair Project Assistant ACKNOWLEDGMENTS The Bipartisan Policy Center would like to acknowledge Janet Marchibroda, Health IT Initiative Chair, for her leadership and support of the Task Force on Delivery System Reform and Health Information Technology and Ann Gordon for her writing and editorial guidance for the Report. The Bipartisan Policy Center would also like to acknowledge and thank those who provided their insights and expertise during the report process: Mark D. Barner, Ascension Health David Liss, NewYork-Presbyterian Hospital Justin T. Barnes, Greenway Medical Technologies Michael Lovett, NextGen Healthcare Abdul R. Bengali, Mayo Clinic Randy McCleese, St. Claire Regional Medical Center Sharon F. Canner, CHIME J. Marc Overhage, MD, PhD, Siemens Healthcare Charles E. Christian, Good Samaritan Hospital Mary Ella Payne, Ascension Health Jay Cohen, MD, Monarch HealthCare Marc Probst, Intermountain Healthcare Kirstin Dawson, America’s Health Insurance Plans Donna R. Scott, McKesson/RelayHealth Michael DeCarlo, Blue Cross Blue Shield Association Susan Pisano, America’s Health Insurance Plans Scott Decker, NextGen Healthcare Patricia Skarulis, Memorial Sloan-Kettering Cancer Center Jan De Witte, GE Healthcare Joel Slackman, Blue Cross Blue Shield Association Douglas Gentile, Allscripts William A. Spooner, Sharp HealthCare Maria Ghazal, Business Roundtable Jeanette Thornton, America’s Health Insurance Plans Tee Green, Greenway Medical Technologies Glen Tullman, Allscripts Jim Hansen, Executive Director, Dossia Consortium Charlene Underwood, Siemens Medical Solutions Aparna Higgins, America’s Health Insurance Plans Steven Waldren, MD, American Academy of Family Physicians Charles Jarvis, NextGen Healthcare David Whitlinger, New York eHealth Collaborative John M. Kravitz, Geisinger Health System Michael Wood, McKesson Health Solutions Transforming Health Care: The Role of Health IT 3 Table of Contents About This Report .....................4 Chapter 3: Achieving The Health IT Capabilities Necessary To Improve Health And Health Executive Summary ....................5 Care: Findings And Recommendations ......17 Alignment Of Financial Incentives ................17 Chapter 1: Introduction .................9 Recommendations For Aligning Incentives .............17 Chapter 2: High Performing Health Care Privacy And Security .........................18 Organizations And New Models Of Care Recommendations To Address Concerns About Privacy And Security .................19 Demonstrate Common Attributes That Require Advanced Health IT .........11 Adoption Of Electronic Health Records ............19 Recommendations To Address Limited EHR Adoption .....22 Organization-Wide Focus On The Needs Of The Patient ...................11 Engaging Consumers With Electronic And Online Tools ....................23 Strong Organizational Recommendations To Increase Engagement And Clinical Leadership .......................11 Of Consumers Using Electronic Tools: .................26 Access To Information To Interoperability And Health Information Exchange ....27 Support Efficient, Coordinated Care ...............11 Recommendations To Accelerate Timely Access To Care ........................13 Health Information Exchange .......................31 Emphasis On Prevention, Aligning Federal Programs .....................35 Wellness And Healthy Behaviors .................14 Recommendations To Promote Accountability, Alignment Of Alignment Across Federal Programs ..................36 Incentives And Payment Reform .................15 Appendix ...........................39 End Notes ..........................41 Health Project ABOUT THIS REPOrt Led by Bipartisan Policy Center (BPC) Health Project co-leaders and former Senate majority leaders Tom Daschle and Bill Frist, and including a broad range of nationally respected experts and leaders from many sectors of health care, the Task Force on Delivery System Reform and Health Information Technology was created to focus on two primary goals: • Identify real-world examples and best practices that facilitate coordinated, accountable, patient-centered care; and • Make recommendations for ensuring that current health information technology (IT) efforts support delivery system and payment models shown to improve quality and reduce costs in health care, in ways that best utilize scarce public and private resources. The task force spent six months working collaboratively to forge consensus around a set of recommendations for the most effective use of health IT dollars to support new models of care that improve quality and health, and reduce costs. These recommendations are grounded in a review of the literature and interviews with leaders of nearly 40 high-performing organizations (see Appendix). This report presents the task force’s findings and recommendations. Transforming Health Care: The Role of Health IT 5 Executive Summary Health information technology (IT) plays a critical role capabilities required for their success, will not become in supporting new models of care and payment that are the norm without transforming the nation’s primarily designed to achieve health care’s triple aim: improve health, volume-based payment model to one that promotes improve the experience of care for patients and families, higher quality, more cost-effective care. and reduce the cost of care. Despite the introduction of IT to nearly every other aspect of modern life, the U.S. health 2. Lack of Health Information Exchange care system remains largely paper-based. Greater use of While the exchange of information across the multiple health IT enjoys bipartisan support. settings where care and services are delivered is a central and necessary component of coordinated, accountable The authorization of up to $30 billion to support health IT and patient-centered models of care, the level of health under the Health Information Technology for Economic information exchange in the U.S. is extremely low. and Clinical Health (HITECH) Act of 2009 has spurred significant private sector investment to further increase the 3. Limited Level of Consumer Engagement use of health IT. Most of these funds are for the Medicare Using Electronic Tools and Medicaid Electronic Health Record (EHR) Incentive Health IT plays a critical role