DIVURGENT

If you haven’t kept up with what the NCQA has been up to in supporting patient centered care initiatives, it’s interesting to look at the program in light of ARRA and the most recent meaningful use definition.

NCQA’s Physician Practice Connections –  The Patient Centered Medical Home (PPC-PCMH) initiative is aimed at recognizing medical practices who are meeting NCQA standards related to providing a patient centric medical home model (for definition, see). This model emphasizes patient centric, holistic care coordinated by a physician.

I have become increasingly concerned lately about the multitude of programs (see my previous post), aimed at improving various components of the healthcare system, due to the amount of confusion it is occurring at the provider level of care. Although all have admirable goals, the lack of coordination may actually freeze the market as providers work to reconcile the various programs and what they must do to receive incentives, achieve meaningful use, obtain NCQA accreditation and so on. What is needed at the Federal and State level is a coordinated effort which aligns these programs and provides clear direction to providers so they can act on implementing strategic and tactical initiatives.

However, it is most interesting how many of these programs/initiatives are aligned in their mission and goals. For example, NCQA’s PCMH “must pass” elements include:

1. Written standards for patient access and patient communication
2. Use of data to show meeting standards
3. Use of paper or electronic based charting tools to organize clinical information
4. Use of data to identify important diagnosis and conditions in practice
5. Adoption and implementation of evidence based guidelines for three conditions
6. Active support of patient self management
7. Tracking system to test and identify abnormal results
8. Tracking referrals with paper based or electronic system
9. Measurement of clinical and/or service performance
10. Performance reporting by physician or across the practice

It is clear that the above elements are largely included in the current definition of meaningful use. In fact, it is virtually impossible to achieve NCQA level 3 recognition without an electronic health record of some sort.

My hope is that providers are able to devote the appropriate resources and develop an overall organizational strategy that will allow them to achieve the greatest success in obtaining incentives, obtaining recognition and of course improving the overall. And most importantly, accomplishing this with the most efficient utilization of resources.

This blog was created to provide a forum for talking about innovative and interesting topics related to the direction our healthcare system is taking. Before the first post, President Barack Obama signed into law the American Recovery and Reinvestment Act of 2009 (ARRA), on February 17th, 2009.

The ARRA includes appropriations for a wide variety of health initiatives and will inevitably change the landscape of our healthcare system. Appropriations include those for: biomedical research, public health, and other health-related programs within the Department of Health and Human Services, as well as authorizing language to promote health information technology and establish a federal advisory panel to coordinate comparative effectiveness research.

The ARRA contains over $20 billion for the development of an IT infrastructure and to help providers adopt health information technologies. This is the largest single investment in our healthcare system of all time. It is for this reason that I’d like to devote some time to this topic. This has the potential to be a true “game changer”. The Congressional Budget Office (CBO) estimates that as many as 90% of doctors and 70% of hospitals will be using comprehensive health records as a result of the ARRA, which is a significant improvement over estimates in absence of this funding.

HIMSS provides a good summary of Health IT appropriations in the ARRA:

- $2 billion for the Office of the National Coordinator (ONC)
- $17.2 billion in incentives through the Medicare and Medicaid reimbursement systems to assist providers in adopting EHRs
- $4.7 billion for the National Telecommunications and Information Administration’s Broadband Technology Opportunities Program
- $2.5 billion for the U.S. Department of Agriculture’s Distance Learning, Telemedicine, and Broadband Program
- $1.5 billion for construction, renovation, and equipment for health centers through the Health Resources and Services Administration
- $1.1 billion for comparative effectiveness research within the Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH), and the Department of Health and Human Services (HHS).
- $85 million for health IT, including telehealth services, within the Indian Health Service
- $500 million for the Social Security Administration
- $50 million for information technology within the Veterans Benefits Administration

In future posts, I’d like to explore the potential short and long term impacts on healthcare providers.

ck
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