In part 1 of FierceEMR's two-part interview with Colorado Regional Health Information Organization Executive Director Morgan Honea, the former practice administrator discussed the various hurdles to health information exchange--such as associated costs--particularly for small and rural providers.
"I know firsthand the challenge of paying for new technology that is necessary to maintain competition in the market today," Honea told FierceEMR. "It's certainly not a small undertaking and it's a cost that wasn't necessarily there 10 years ago."
In part 2 of our exclusive interview, Honea (pictured) addresses the correlation between technology effectiveness and new payment models, and also shares his thoughts on the federal government's role in pushing the use of health information technology.
FierceEMR: In testimony at a mid-August meeting of the Health IT Policy Committee's subgroup on governance, you said that "until payment reform can catch up with CORHIO's network," HIE will be a "pure cost." Is that the case across the board?
Honea: We have to be able to develop these type of health information technology and exchange solutions that inform those providers who are getting ready to take risks for the patients that they're empaneled for so that they can have visibility into the what parts of the system they're using and making sure that we're using the system adequately.The core concept behind payment reform is rather than paying for quantity, paying for quality. Really, where we're seeing things go, like in the Medicare programs, some of things that are happening with the accountable care collaboratives in Colorado, there's this real desire to move to payment for quality, payment for outcomes. In order to do that on a population or macro basis, you really have to have visibility into everything that's happening with that patient's healthcare.
If you think about it, it's really HMO version 2.0 on its head. It used to be in the 1990s, the gatekeepers--the providers--were responsible for providing access to the different components of the system. We saw how that worked out. Now, it's the provider's responsibility to do the contracting mechanisms with the health insurance companies to manage that patient, and they can go wherever they want in the system.
Until we flip the switch from that fee for service into a more pay for performance and outcomes basis, yes, it's a sunken cost that we don't have a reimbursement mechanism for right now.
FEMR: How is your state progressing on these efforts?
Honea: I think Colorado is one of the states that's moving there very quickly, and we're making good progress in that regard, but still, I can tell you that as a practice administrator, I was constantly being pushed toward this conversation about taking risks for my patient population, when in reality, I didn't have the type of global information on those patients that I felt comfortable that I would even be able to take that risk without knowing how they were interacting or utilizing the system.
There's a lot of work being done with claims-based systems, but the timing of those systems is a constraint because by the time that we know through claims-based analytics that something is happening within a population, it's very possible that my risk has gone through the roof.
FEMR: What do you think the role of the federal government should be in all of this?
Honea: I come from a community and a program that was sponsored through the Bureau of Primary Care at the Health Resources and Services Administration, so I've worked with the federal government for the majority of my career.
That said, I think that the role of the federal government--and particularly ONC in this case--is to provide a clear enough direction and the type of funding to either states or communities to be able to implement the types of solutions that work for them. I spent all of last week visiting different communities in Colorado and no one community is doing healthcare the same. There are an infinite number of local programs that are underway that use technology in varying ways, and there's a fine line for the federal government being too prescriptive and not prescriptive enough. I think that the thing that probably resonates with me the most is this isn't about competing business models.
If you were to Google "industry," you'd get pictures of coal-burning power plants and machinery. People don't want to think of healthcare as an industry in that regard. When you take on the role of working in healthcare, you really accept this mission of doing the best good for public interest as possible. In many aspects of healthcare, you're taking care of people at their most vulnerable time. They're sick, they're scared, they may not have appropriate support mechanisms; these headlines that something is one person's fault or another person's fault, to me that feels like it's missing the point. If you get into healthcare, it doesn't matter if you're in technology, or if you're a provider or a nurse, you get into it to take care of people and to make the system better.
What can ONC do? One of the things that needs to be done is that an expectation needs to be set that we're all in this together. That we're trying to improve a system that, at some point in every single person's life in the United States, they will access. When you have to access it, it needs to be the most efficient system possible. At the end of the day, it's not about who's responsible for not improving the system, it's that shared burden of improving the system as a whole.
Editor's Note: This interview has been condensed for clarity and content.