The HCR Die has been Cast

(Implications for HIT Industry)

On Sunday night, March 21, 2010 the much debated and deeply polarizing Health Care Reform (HCR) bill has been passed by Congress, clearing the way for President Obama to turn it into law by a flourish of his pen.

Whether this makes you happy or distraught, whether you woke up in  a Socialist State this morning, or a Humanitarian one, whether you prefer Tea parties or Starbucks lattes, if you are a Healthcare Information Technology (HIT) professional, today brings with it a wealth of new challenges and opportunities to make a difference.

While ARRA and HITECH tasked the HIT community with the creation of an electronic medical record for every American by 2014, the new HCR bill will demand that HIT does its share to support improvements to the global quality of health care. Some of the quality goals outlined in the bill have been discussed for quite some time and others are being tried out in various clinical settings already.
Roughly speaking, there are four objectives in the HCR bill that will require massive HIT support: administrative streamlining, quality measurement, patient involvement and innovative care models. In these contexts, HIT will need to create real time, online communications between physicians and their patients, between community members, care givers, payers, pharmacists and government agencies. This could be the shining moment of the emerging Health 2.0 movement and a great opportunity for health insurers to redeem themselves by creating web accessible transparency in costs and quality for consumers.
So here is a hopefully comprehensive selection where HIT can have the largest beneficial impact.
All section numbers are from the original Senate Bill - H. R. 3590. My comments in blue.

Administrative
TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
Subtitle B—Immediate Actions to Preserve and Expand Coverage
Sec. 1104. Administrative simplification.
Financial and administrative electronic transactions between payers and providers are to be standardized, made more transparent, timely and uniform. This refers to the HIPAA transactions such as eligibility, electronic claims and electronic remittance advice. Hopefully this provision will eliminate, or at least reduce the variations in format and the multitude of the, so called, payer edits.
TITLE II—ROLE OF PUBLIC PROGRAMS
Subtitle H—Improved Coordination for Dual Eligible Beneficiaries
Sec. 2601. 5-year period for demonstration projects.
Sec. 2602. Providing Federal coverage and payment coordination for dual eligible beneficiaries.
Both demonstration projects and the ensuing coordination of benefits will require sophisticated additions to current billing software, both on the provider end and the payer end.
TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY
Subtitle F—Additional Medicaid Program Integrity Provisions
Sec. 6504. Requirement to report expanded set of data elements under MMIS to detect fraud and abuse.
Subtitle G—Additional Program Integrity Provisions
Sec. 6603. Development of model uniform report form.
More reporting.

Quality Measurement
TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle A—Transforming the Health Care Delivery System
PART I—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE PROGRAM
Sec. 3001. Hospital Value-Based purchasing program.
Sec. 3002. Improvements to the physician quality reporting system.
Sec. 3003. Improvements to the physician feedback program.
Sec. 3004. Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs.
Sec. 3005. Quality reporting for PPS-exempt cancer hospitals.Title III. Subtitle A. Part II.
PART II—NATIONAL STRATEGY TO IMPROVE HEALTH CARE QUALITY
Sec. 3014. Quality measurement.
Sec. 3015. Data collection; public reporting.
TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY
Subtitle D—Patient-Centered Outcomes Research
Sec. 6301. Patient-Centered Outcomes Research.
Sec. 6302. Federal coordinating council for comparative effectiveness research.


Patient Empowerment
TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
Subtitle D—Available Coverage Choices for All Americans
PART II—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH HEALTH BENEFIT EXCHANGES
Sec. 1312. Consumer choice.
The establishment of insurance exchanges will necessitate supporting software both for oversight of exchange activities and mainly to allow consumers to make informed purchasing decisions.
TITLE II—ROLE OF PUBLIC PROGRAMS
Subtitle L—Maternal and Child Health Services
Sec. 2952. Support, education, and research for postpartum depression.
Sec. 2953. Personal responsibility education.
Sec. 2954. Restoration of funding for abstinence education.
Sec. 2955. Inclusion of information about the importance of having a health care power of attorney in transition planning for children aging out of foster care and independent living programs.
TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle F—Health Care Quality Improvements
Sec. 3507. Presentation of prescription drug benefit and risk information.
Sec. 3510. Patient navigator program.
TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH
Subtitle A—Modernizing Disease Prevention and Public Health Systems
Sec. 4004. Education and outreach campaign regarding preventive benefits.
TITLE V—HEALTH CARE WORKFORCE
Subtitle F—Strengthening Primary Care and Other Workforce Improvements
Sec. 5507. Demonstration projects To address health professions workforce needs; extension of family-to-family health information centers.
Multiple patient education and patient involvement efforts that will need to be disseminated and accomplished, more than likely, by electronic means.

Innovative Care Models
TITLE II—ROLE OF PUBLIC PROGRAMS
Subtitle I—Improving the Quality of Medicaid for Patients and Providers
Sec. 2704. Demonstration project to evaluate integrated care around a hospitalization.
Sec. 2705. Medicaid Global Payment System Demonstration Project.
Sec. 2706. Pediatric Accountable Care Organization Demonstration Project.
Sec. 2707. Medicaid emergency psychiatric demonstration project.
TITLE III—IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle A—Transforming the Health Care Delivery System
PART III—ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
Sec. 3023. National pilot program on payment bundling.
Sec. 3024. Independence at home demonstration program.
Sec. 3025. Hospital readmissions reduction program.
Sec. 3026. Community-Based Care Transitions Program.
Sec. 3027. Extension of gainsharing demonstration.
Subtitle F—Health Care Quality Improvements
Sec. 3501. Health care delivery system research; Quality improvement technical assistance.
Sec. 3502. Establishing community health teams to support the patient-centered medical home.
Sec. 3503. Medication management services in treatment of chronic disease.
Sec. 3506. Program to facilitate shared decisionmaking.
Sec. 3508. Demonstration program to integrate quality improvement and patient safety training into clinical education of health professionals.
TITLE IV—PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH
Subtitle C—Creating Healthier Communities
Sec. 4206. Demonstration project concerning individualized wellness plan.
Subtitle D—Support for Prevention and Public Health Innovation
Sec. 4301. Research on optimizing the delivery of public health services.
Sec. 4302. Understanding health disparities: data collection and analysis.
Sec. 4303. CDC and employer-based wellness programs.
Sec. 4306. Funding for Childhood Obesity Demonstration Project.
TITLE VI—TRANSPARENCY AND PROGRAM INTEGRITY
Subtitle B—Nursing Home Transparency and Improvement
PART II—TARGETING ENFORCEMENT
Sec. 6114. National demonstration projects on culture change and use of information
technology in nurring homes.
A host of pilots and demonstration projects to explore cost reductions and quality improvements through a variety of innovative models such as Patient Centered Medical Homes, Accountable Care Organizations, wellness programs, payment bundling and global budgets. All these projects will require electronic coordination of care and payments and most will also require online patient and community participation.

Now that the dust has settled, or so we hope, I would say that we have our work cut out for us. So let us roll up our sleeves and do our part.