Governor s Task Force on Health Care Access and Reimbursement MHCC s efforts to Expand Health Information Technolog

1.   Governor’s Task Force on Health Care Access and Reimbursement & MHCC’s efforts to Expand Health Information Technology Adoption Rural Health Roundtable October 2, 2008 Ben Steffen Center Director Maryland Health Care Commission

3. HCAR Mission Develop Recommendations on … Options to increase physician reimbursements given limitations in Federal law. Options available to increase the ability of physicians to negotiate reimbursement rates with health insurance carriers The sufficiency of present statutory formulas for the reimbursement of noncontracting providers. Do state agencies have sufficient authority to regulate rate-setting and market–related practices of insurance carriers ( that unreasonably reducing reimbursements)?

4. HCAR Mission Develop Recommendations on… Need to establish a rate–setting system for physicians and other health care providers. Advisability of the use of payment method linked to quality of care or outcomes, Need to prohibit a health insurance carrier from requiring health care providers to participate in another carrier’s network. Should carriers provide incentives for physicians to provide care on evenings and on weekends. The ability of primary care physicians to be reimbursed for mental health services performed within their scope of practice.

5. What are the some of the problems? Geographic and income-driven access problems, concerns that problems are worsening. Federal law limits state policymakers ability to act. Highly concentrated health insurance market – little prospect for new entrants. High costs per user has fueled purchaser and consumer resistance to fee increases. Reimbursement systems poorly linked to desired outputs. Uneven quality and cost efficiency – systems to measure quality and effectiveness are in their infancy.

6. Process October 2007 – August 2008 – gathered information on… Insurance market concentration Physician workforce and future needs Challenges of rural areas and existing programs to address shortages Variations in reimbursement rates across specialties Alternatives for spawning growth in primary care Factors affecting practice formation October – December 2008 Task Force develops recommendations Public Comment Submission of the recommendations to Governor and General Assembly

7. Options that affect rural communities Establish a practice development loan program Many communities struggle to attract providers Practices are economic resource Modify incentives for reimbursing non-participating providers (§19-710.1) Raise reimbursement levels for non-participating providers that treat HMO patients Set payment floors for PPO payment to non-participating providers in hospital-setting (where patient can’t choose provider). Require the carrier or provider to absorb cost of non-participation Limit carriers ability to designate a hospital as a participating provider ,if physicians are non-participating. Allow further experimentation with reimbursement alternatives Develop a demonstration to test the feasibility of a hospital-based physician payment system. Require pay-for-performance systems to be linked to factors in addition to cost efficiency Promote greater transparency in design

8. Options that affect rural communities (continued) Further primary care practice development. Leverage Maryland’s leadership in patient-centered medical home development by participating in demonstrations . Encourage rural hospital residency program development . Establish a loan program to finance residency program development. Require commercial carriers and Medicaid to pay 10 percent bonus in rural geographic HPSAs as required under Medicare. Expand incentives to provide cost effective care. Require commercial payers to incentivize providers for after hours care, phone and eVisit communications delivered at any time of the day or night. Establish parity in payments for primary care physicians that provide mental health services within scope of practice. Improve ability to plan for future needs by improving data collection on physician practices through the Maryland Board of Physicians and MHCC.

9. The promises of Health IT Fewer adverse drug events, medical errors, and redundant tests and procedures because EHRs can ensure physicians have access to an accurate and complete health history. Faster diagnoses and treatment of serious illnesses with comprehensive information available at the touch of a screen. Timely provision of preventative care and services, such as health screenings, which can help reduce health care costs. Better communication between patients and physicians, giving patients enhanced access to timely information. Shorter wait times for patients and lower operating costs for physicians through improved office efficiency.

10. Why the Slow Pace? Health IT adoption in integrated systems VA, DOD, Kaiser Permanente, Geisinger, Mayo Clinic. Significant internal savings and quality improvements accrue to organization bearing the expense. Non-integrated providers have a more difficult time capturing the benefits of IT. External savings accrue to the system , not the investor . Current financial incentives may penalize providers for use. Providers and payers feel competitive pressures -- sharing information may allow competitors to pursue patients. Inability to internalize investment is a major factor in slow adoption.

11. Maryland’s Health Information Technology Strategy Determine roadblocks and identify possible solutions. Plan a Consumer-Centered Information Exchange. Collaborate with other states and federal gov’t in joint initiatives and demonstrations. Use the planning process and shared knowledge gained through collaboration to launch health information exchange. Need for experimentation is great and other parallel innovations in care delivery and reimbursement must also occur.

12. Consumer-Centered Health Information Exchange – Planning Phase(Building the Backbone) Two multi-stakeholder groups were chosen: the Chesapeake Regional Information System for our Patients and the Montgomery County Health Information Exchange Collaborative. Both groups received approximately $250,000 to take part in the planning phase funded through the all-payer rate system A final report is due in early 2009 that will address governance, privacy and security, access policies, strategies to ensure appropriate patient engagement, general architecture, proposed technology, estimated costs, and a possible sustainable business model. Development phase to follow for an exchange based on principles proven in the planning period. Development phase will be funded at significantly higher level through all-payer system.

13. Collaborate with other states and the federal gov’t Centers for Medicare & Medicaid Services – Electronic Health Record Demonstration Project A five-year project designed to show that widespread adoption and use of EHRs will reduce medical errors and improve quality of care. 200 Family Practices, General Practices, Geriatrics and Internal Medicine practices with 20 or less physicians are eligible to participate. 100 practices will be assigned to the demonstration and 100 to the control group. Practices can receive an incentive payment ranging from $58,000 (per physician) to $290,000 (per physician practice) over five-year period. To participate, practices must have a minimum of 50 “fee for service” Medicare beneficiaries for which they provide the greatest number of primary care visits. (Primary source of Care). MHCC estimates that approximately 1,200 practices eligible to participate.

14. Time Frame September 2, 2008 Recruitment begins November 26, 2008 Last day for applications March 2009 Notification to practices of their participation May 2009 Local kick off meetings June 1, 2009 Demonstration begins May 31, 2014 Demonstration ends

15. Where we need to go Better information Access to information when it is needed Comparative effectiveness research Greater transparency Improved financial incentives Better care, not more care Coverage patients vs. differentiated payments for each treatment Focus on Health behavior Evidence-based behavior and social norms among medical professionals Manage chronic disease Emphasize prevention Make it easy for people to lead healthy lives

16. For More Information Task Force on Health Care Access and Reimbursement http://www.dhmh.state.md.us/hcar/index.html Ben Steffen bsteffen@mhcc.state.md.us Electronic Health Record Demonstration Project http://mhcc.maryland.gov/electronichealth/cmsdemo/index.html CMSEHRDEMO@mhcc.state.md.us or by phone to Kathy Francis at (410)764-5590.