Honolulu-based HSMA also thinks the program will foster the longer-term goal of establishing regional health information organizations. "We're making this investment to move the community along to wider adoption of I.T. so we can be ready for RHIO activity," says Cliff Cisco, senior vice president. "There's a lot of RHIO talk, but we're a ways off from implementing a network. We want to prepare for that and give motivation."
Under the three-year HMSA Initiative for Innovation and Quality, the plan has committed $20 million to the purchase of EMRs for physician practices. It will contribute up to half the cost of an EMR, capped at $20,000 per physician, for about 1,000 physicians.
The remaining $30 million of the funding, to be given out over three years, is available to state hospitals in Hawaii to finance proposed projects-that could include use of information technologies-to improve patient care and outcomes. Cisco believes a "significant" amount of funds under the hospital program will go toward I.T., but the overall goal is to reduce practice variances and improve safety. Details of the program remain under development. "We've made the commitment and now are talking to hospitals," he adds.
Getting the docs
Hawaii has about 2,200 practicing physicians. About half are closely affiliated with urban hospitals, and many of their practices are using some clinical software.
The program to help pay for EMRs is open to any physician who doesn't have EMR software. But the focus will be on small and rural practices where adoption rates are low. HMSA hopes it will get most of these practices to take up its offer, Cisco says. "This is an effort to bring on slower adopters of the technology."
The Blues plan this fall was developing criteria for EMRs purchased with its financial assistance. "They'd have to be known systems with wide adoption rates," Cisco says. "We're not going to pay $20,000 for a system someone's nephew built in his garage."
The EMRs also will have to be certified by the Certification Commission for Healthcare Information Technology. HMSA expected to have a list of acceptable EMRs available by the end of 2006.
Heavy penetration of EMRs in Hawaii could support more comprehensive pay-for-performance programs. HMSA for five years has had a pay-for-performance program that gives physicians and hospitals "modest" payments for meeting certain quality standards, Cisco says. The new initiative is much larger than existing P4P programs, he notes. "Our board thought we'd ramp this up a bit, put out this $50 million commitment and see what it achieved."
Joining the fray
Several other Blues plans-particularly Highmark Inc. in Pennsylvania, CareFirst in Maryland, and Blue Cross and Blue Shield of Massachusetts-have launched significant initiatives to help defray physician costs for EMRs.
HMSA has an advantage, however, because the Blues plan controls 80% of the private insurance market in Hawaii, says Kennedy, the consultant. That's about three times the market share of most Blues plans.
Consequently, other Blues can't expect to get the same type of return on investment that HMSA should get, he adds.
Nor can other commercial insurers expect the same ROI, even large ones like Aetna Inc., Cigna Corp. and UnitedHealth Group. Despite their size, these national payers don't have a dominant market share in most of their regions, Kennedy says.
But many commercial insurers are talking with Blues plans about cooperating in regional I.T. incentive strategies, he notes.
Payers, however, are not yet convinced that state laws-and the recently changed federal rules governing the Stark Act and anti-kickback laws-are clear enough to allow the insurers to work together, Kennedy adds. "They're not sure they can do this without getting their hands slapped."
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