Communication with patients is at the heart of new primary care tools and models that improve outcomes and lower costs, such as patient-centered medical homes (PCMH) and interactive preventive health records (IPHR). Often, communication means electronic communication, and is part of efforts by Medicare, Medicaid, and private health plans to create incentives for use of health information technology (HIT) by physicians, hospitals, and other health care providers.
Health IT, despite its promise, comes with complications that discourage providers from using tools for electronic patient communications. Providers or patients might not have the technical capabilities to use electronic tools, and providers often have to make large investments to retrain their staffs and upgrade their systems. In addition, federal laws – the Health Insurance Portability and Accountability Act (HIPAA), and the Patient Safety and Quality Improvement Act (PSQIA) – closely regulate privacy and security for electronic health records (EHR).
Recommendations to Improve Electronic Patient Communications:
The smart people at the Bipartisan Policy Center (BPC) make several recommendations to help organizations overcome those obstacles and to start communicating with patients electronically. Most of the recommendations deal with raising awareness about health information technology among consumers and providers.
Their ideas about consumer education are in the same spirit as my own suggestion to give Medicare and Medicaid enrollees an annual benefits report that lays out the care they received, what providers charged, how much the health plan paid, and how much the consumer paid. For more suggestions, read the blog post, Seven Ideas to Reduce Costs and Improve Outcomes in Medicare and Medicaid.
The BPC’s recommendations included:
- Building awareness among hospitals, physicians, and other providers about the benefits of electronic and tools for patient engagement
- Building awareness among consumers about electronic tools
- Developing and disseminating best practices and strategies for providers using electronic tools to communicate with patients.
- Increasing federal, state and private-sector incentives for health information technology geared to patient engagement
A Look at Health IT Initiatives:
The federal government, as well as private health plans and employers, are already doing a lot to promote health information technology, electronic health records, electronic prescribing, and patient-centered health care and communications.
Here is a snapshot of a few important HIT-related developments and initiatives:
1. Interactive Preventive Health Records (IPHR)
An IPHR is a web portal for patients to review their health records, to get personalized recommendations for preventive care, and customized resources to help them manage their own health. The Association for Healthcare Research and Quality (AHRQ) recently published a handbook for primary care physicians interested in launching IPHR systems, and the American Academy of Family Physicians (AAFP) published a study showing IPHRs improved the proportion of patients who adhered to recommended preventive services.
2. CMS EHR Incentive Program
Thanks to the Health Information Technology for Economic and Clinical Health Act (HITCH) of 2009, physicians, hospitals and certain other providers can receive payment incentives through Medicare and Medicaid if they demonstrate meaningful use of federally certified EHR systems. From Medicare, physicians can receive as much as $44,000 in bonus payments, and hospitals get $2 million plus an amount based on the number of patient discharges during the year. In 2015, the bonuses turn into penalties for providers not using EHRs. The Medicaid EHR incentive program gives states a 100% federal match for EHR incentive payments to providers who demonstrate meaningful use, worth up to $63,750.
Since 2008, the number of physicians using electronic prescriptions has quadrupled, according to Surescripts. E-prescribing is an important development in the move toward better health outcomes, since electronic prescriptions are less susceptible to errors than are paper subscriptions. CMS took note and launched an eRx incentive program and published eRx standards.
4. Health Insurance Exchanges
Online tools will be vital to enrolling people in Medicaid and qualified health plans (QHP) through health insurance exchanges (HIX), once they come online in 2014. Web portals, email, and online chats could be the way many people become newly insured under the Affordable Care Act (ACA) health reform law’s provisions.
The Robert Wood Johnson Foundation (RWJF) published a brief that made a good case for why online technologies are a more effective and less expensive way for states and the federal government to reach people who enroll through health insurance exchanges. By law, online tools cannot replace other forms of enrollment – by phone, in person, or on paper – but it will be interesting to see how different states take advantage of online tools to handle the influx of newly insured people.