Former ONC heads: Payment reform beneficial, but business model still broken

National Coordinators for Health IT past and present gathered at ONC's annual meeting Tuesday in the District of Columbia to talk about where the agency has been and where it is going, with the role of payment reform in interoperabilty garnering the most passionate discussion.

Current National Coordinator Karen DeSalvo was joined by David Brailer, the first national coordinator who served from 2004-2007; Robert Kolodner, who served from 2007-2009; and Farzad Mostashari, who served from 2011-2013. David Blumenthal, who served from 2009-2011, joined the conversation via Skype due to inclement weather in Boston.

Brailer, who now serves as CEO of Health Evolution Partners, pointed to the recent announcement on payment reform by the U.S. Department of Health and Human Services as a huge exclamation point for interoperability. The industry can't accomplish policy-level or provider-level risk management, population management or payment reform management without interoperability, he said.

However, Mostashari, who now serves as CEO of Aledade, which helps physicians begin their own accountable care organizations, said that while "it's fantastic to create a value-based payment environment where providers are incentivized," the vendors don't have the same incentives as the providers do. He said that shows a market failure in terms of the vendors reflecting the desires of their customers.

Blumenthal, president of The Commonwealth Fund, agreed with Mostashari, adding that information exchange is a team sport.

"You can be the Tom Brady of information exchange, but if you don't have any available receivers you might as well not show up," he said. "If there was a strong will to exchange information, we would find a way to do it with the current infrastructure. But there is no business case for the vendors and there's no business case, or hasn't been, for the providers."

It's easier to solve problems with technology, than confront the fundamental characteristics of the healthcare marketplace, Blumenthal added.

"We can have the most beautiful technological solutions, but humans will find a way not to implement them if it's not in their self-interest," he said. 

In addition to advancing interoperability, the national coordinators agreed that in general, it is time for health IT to take some big steps forward. Health IT was something that hit at the right time in 2004, Brailer said, and the movement still has the passion and intensity now as it did then.

But today it's going to have a different flavor, he said. "It's going to be: How do we keep it going? How do we take it to the next level?" he said.

Blumenthal said the industry is now going to have to keep up with demand from consumers. 

"With the spread of the technology, with people understanding the potential, we have demand for performance that didn't exist and which will move the IT capabilities in ways we could never have done [before]," he said.

Mostashari added that it is time to iterate, to improve and to take another look at the little implementations.

"People have the systems in place, they're are not happy with them, they're not working as well as they'd like to," he said. "It's that time to optimize ... certainly time to optimize implementation."

DeSalvo said another important thing that has shifted and will allow health IT to move forward is the culture surrounding healthcare.

"The world realizes that health is more than healthcare," she said.