- Value-based care at the Centers for Medicare & Medicaid Services (CMS) will be a driving force behind providers choosing health IT based on its interoperability and ability to support coordinated care.
This was the crux of the message delivered by CMS Acting Administrator Andy Slavitt on the role of health IT innovation at a Bipartisan Policy Center event on interoperability and information sharing last week.
Slavitt's counterpart at the Office of the National Coordinator for Health Information Technology Karen DeSalvo, MD, MPA, MSc, used the same event as an opportunity to lay out her agency's plans for enabling nationwide health information exchange in 2016.
According to the head of the federal agency, the shift from Medicare fee-for-service to value-base payment models will supply that impetus necessary for making interoperability a standard feature of health IT use.
"When you do that, physicians, nurses, and others actually want the technology for a different reasons — not for an incentive but because they need it in order to connect the care of the patient," Slavitt said.
Information sharing is "critical" to achieving the vision of value-based care at CMS, he added. And getting to this next stage of care delivery goes hand-in-hand with the federal agency's plans to move away from rewarding health IT use to rewarding providers for the quality of the care they deliver.
"But our hope is that we spend less time as a department talking about how to manage and manipulate technology and technology rules and more time talking to physicians about the things they actually care about, which are quality care and what we can do to help support that and get away from this stage of micromanaging every step of how someone uses technology," he revealed.
What's truly at stake
Slavitt's hint at an emerging strategy the federal agency is considering to promote patient-centered care, one that looks beyond technology to address the cultural ideas limiting information sharing.
"We have solved far more complex technology challenges than this," he maintained. "It's not technology that holds us back. It's business practices. We all need to look at ourselves — whether we're a health plan that's not sharing data, whether it's a technology company that is not building open-architecture technology, whether we're a hospital that's unwilling to share information with the hospital across the street."
The unwillingness to compete in ways other than by maintaining a proprietary control over the flow of information must give way in order for the value of care to become the focal point of the nation's healthcare industry.
"At the end of the day, people have to change the way they practice and the way they view information to match it to the way that we treat patients. Until that happens, we won't make progress. And once that happens, we'll make fast progress," Slavitt added.
Changing role of government
As Slavitt noted, the federal government still have an important job to play in leading the transition to value-based care. For one, it needs to ensure fairness as far as interoperability and information sharing are concerned.
"The government role is to create a level playing field," he explained. "So creating open APIs should mean that no one has a lock on the physician workflow. The people who build the best technology for the physician workflow should be able to create and produce in the physician workflow. That is the point of open APIs. That should get us away from this sort of dominance of the field by any one or two or three or four or five individual players."
Another is in the area of reinforcing best practices through incentives.
"Incentives would be the next thing," he continued. "I'm more interested in incentives that reward physicians for having coordinated care than I am in incentives that award people for using technology. I don't think we should be in the mode of rewarding people for the means but reward people for achieving the outcomes that they want to receive. When they realize we're speaking to the things they care about, it will help us immensely."
Lastly, agencies like CMS need to allow for market to find its own equilibrium rather than force it and any one direction or another — "to quite frankly let the market do its work."
In the end, the federal agency is planning to focus its energies and resources on creating "health equity" so that high-quality care is widely available, Slavitt emphasized.