Commercial Insurance Implementing Meaningful Use

The HITECH Law Blog had a post recently titled “Commercial Payors Implementing EHR Meaningful Use Criteria in P4P Programs.” Here’s a short excerpt:

On August 5, 2010, four major commercial health insurance payors participated in the Health Industry Forum in Washington, D.C., to discuss private industry collaboration with the United States Health & Human Services Department (HHS) to support providers in the adoption of certified electronic health records (EHRs). Leading the Forum’s panel discussion was David Blumenthal, M.D., Chief of the Office of National Coordinator of HIT. All four payors will include the Meaningful Use criteria in their pay for performance (P4P) programs.

The 4 insurance groups identified are Aetna, Inc and its subsidiary, ActiveHealth Managent, United Health Group (UHG), Wellpoint, Inc, and Highmark, Inc. (Blue Cross Blue Shield).

The author of the blog also asserts that now that the government has created the final meaningful use rule, it will clear the way for the commercial payors to implement it as well. The press releases from the 4 companies about this change are really vague and so it’s hard to say exactly how these companies will implement the meaningful use criteria.

In fact, this almost feels like it’s a little warning shot from the commercial payors. It seems like they’re testing the waters to see how doctors and practices will react to this type of announcement. Plus, I’ll be surprised if we see any major implementation of meaningful use by commercial payors until we see the first physicians showing meaningful use to the government. That way the commercial payors can sit back and watch the impact on physicians of having to show meaningful use to the government. If it goes poorly (like the bad PQRI incentives), then I can see commercial payors backing off the meaningful use bandwagon.

The theme I did read in all the press releases is that it’s valuable for commercial payors to have information from an EHR. Now I think the payors are just trying to figure out the best way to achieve that outcome. Will it be meaningful use? Will it be some other method? They don’t really care. They’re just concerned with their outcomes.

If commercial payors do require meaningful use, I think it’s going to be a really ugly outcome.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

4 Comments

  • Great post; my belief is its a matter of time that the insurance companies, just to make sure the costs are in line, will required structured data for analysis; this is probably the first time they will have access to meaningful data at point of care. Better late than never………… and I am sure 2011/12 could be a good entry point for Payers to implement P4P and have access to data for analytics.

  • In his BNET Health Care Commentary blog — Critical Condition Ken Terry yesterday covered the news as well.

    http://www.bnet.com/blog/healthcare-business/health-reform-and-insurance-companies-why-most-insurers-are-not-subsidizing-health-it/1591?tag=content;drawer-container

    In his piece entitled: Why Most Insurers Are Not Subsidizing Health IT he starts out:

    “A few major insurance companies are again taking steps to help healthcare providers acquire electronic health records (EHRs), which many experts say are essential to reforming the nation’s healthcare system. While commendable, these modest moves raise the question of why most health plans and employers — which would benefit from the cost savings if healthcare quality improved — have been so slow to help physicians computerize their practices”.

    He goes on to report …

    “Humana (HUM) has announced it’s teaming with athenahealth (ATHN), a vendor of Web-based practice management services and EHRs, to induce about 20,000 physicians in Humana’s networks to participate in a quid pro quo: If the physicians use athenahealth’s EHR to supply clinical data to Humana and receive performance feedback from the plan, and if they meet certain quality benchmarks, they can receive bonuses that might increase their payments by up to 20 percent. In addition, Humana is offering to subsidize the cost of the athenahealth system for about 100 practices totaling 1,000 physicians.

    “Highmark, UnitedHealth Group (UNH) and WellPoint are offering incentives for meaningful use of EHRs, but these rewards will be part of the plans’ pay for performance programs and might not increase the total amount available to physicians. Aetna may follow suit or may offer a separate incentive program for meaningful use.

    “At the same time, Aetna (AET), through its ActiveHealth subsidiary, joined with IBM to analyze hospital EHR and claims data and alert physicians about care gaps for individual patients. And WellPoint (WLP) announced that it would provide short-term financing to rural and critical-access hospitals to help them meet the “meaningful use” criteria so they can get federal incentives for EHR adoption. David Blumenthal, national coordinator health IT, praised both initiatives as the kind of public-minded ventures that will be needed to build a national electronic care system.”

    Later he notes…

    “…it would be great if physicians were rewarded for quality, rather than volume, and if complications and readmissions were reduced. But, with few exceptions, the payers have not wanted to invest in health IT, because they view the connection between the use of that technology and cost savings as too tenuous. And on the occasions when they have stepped up to the plate, the results have been underwhelming.”

    He provides examples of failed attempts by payers to contribute in the public space … please refer to his blog piece.

  • Health plans have in the past and will into the future adopt those CMS rules that they believe will save them money. They will utilize MU rules for their own benefit in this regard. I would love to believe that all of this MU activity is about “quality outcomes” but sadly I believe that it’s all about money and reimbursement.

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