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Plan Fine-Tunes Subsidy Program
March 1, 2008
A Hawaii insurer’s ambitious efforts to offer financial help to physicians and hospitals implementing information technology is off to a somewhat slower start than anticipated. So the payer is fine-tuning its strategy.
In late 2006, Hawaii Medical Service Association, the state’s Blue Cross and Blue Shield licensee, announced an ambitious $50 million program to help physicians and hospitals in the state adopt technologies and processes to improve the quality of care.
The insurer hopes to reduce its costs through fewer redundant tests and a healthier membership, among other benefits.
As of January, nearly 200 physicians have adopted ambulatory EHRs under the HI-IQ program of the 1,000 targeted for participation, says Georgiana Fujita, senior vice president, who’s in charge of the physician part of the program. And of the $20 million set aside for the program, about $4 million has been committed.
As of early December, five of the 17 qualifying hospitals had been granted funds.
“We expected to see a little higher level of participation,” Fujita says. “But there is a lot of attendance at information meetings.”
The insurer early this year had a round of meetings with vendors to get their views on how the program was proceeding and ways to stoke more interest.
Vendors told the Blues plan that some physician practices were shying away from HI-IQ because the practices would have to absorb all associated costs for their mid-level practitioners.
Consequently, HMSA added physician assistants and advanced practice registered nurses in some regions to the list of eligible clinicians, as well as recognized podiatrists.
HMSA also is trying to go beyond subsidies in helping physicians automate, Fujita says. A big factor in adopting electronic records, she notes, is converting paper charts to electronic media. So, the insurer is looking to work with document imaging and management vendors to offer discounts on their technology, or preferred flat rates for outsourcing the scanning of paper records.
How It Works
Under the HMSA Initiative for Innovation and Quality, called HI-IQ, the plan committed $20 million in grant funds over three years to contribute 50% of the cost of electronic health records software, implementation and training for physician practices, capped at $20,000 per physician.
On the HI-IQ hospital side, HMSA will offer $30 million in grants—$10 million annually for three years—to help finance projects to improve patient care and outcomes.
The state has about 5,500 physicians with 4,000 of them independent practitioners. The physician program targets about 1,000 independent primary care physicians. Physicians pay all costs for hardware, such as personal computers, servers and wireless networks, if desired. Six ambulatory EHR vendors are participating in the program, having met certain criteria set by HMSA, and another six vendors are in discussions with the Blues plan. Under the program, funds don’t go directly to physicians; vendors bill the insurer and are reimbursed by HMSA.
HI-IQ grants to Hawaii’s 17 acute care hospitals are based on their pro rata share of inpatient charges for HMSA members. Individual hospital awards could range from $30,000 to $7.89 million, says Paul Schnur, vice president and leader of the hospital initiative.
While the hospital portion of HI-IQ was announced in October 2006, it didn’t really get rolling until the second quarter of 2007, Schnur says.
“A major factor was that all hospital contracts were renegotiated in 2007, so that process needed to be completed first,” Schnur notes. “In addition, larger hospitals are wrestling with internal competing interests, which in the end should bring the best projects forward. Hospitals do not lose any funding if they take their time, but must be approved within the three-year window.”
Most of the hospital projects involve information technology to some degree. One hospital is using some of its grant to implement an emergency department information system, which originally was slated to be installed several years down the road, Schnur says.
Another hospital has requested combining HI-IQ funds with a government grant to implement an EHR. Voice-activated communication systems also are proving popular, he adds.
Other hospital initiatives being funded include safe patient lifting programs, expanding pharmacy services to 24 hours and hand hygiene programs. The insurer is encouraging hospitals to be creative in how they use the grants, whether or not they involve information technology, Schnur says.
“Because facilities already are undertaking many quality improvement initiatives, we hope they try some innovative things that might not be funded through normal hospital operations.”
A long-term goal of the physician and hospital HI-IQ programs is to facilitate the exchange of pertinent patient information among provider organizations. Consequently, electronic records software adopted under the program must be certified under criteria, including standards to foster interoperability, of the Certification Commission for Health Information Technology. And HMSA is ready to make more changes to the programs as necessary, Fujita says.
“Our objective is not just EHRs in doctors’ offices, but improved quality of care,” she adds. “We are going to keep going after this in different ways. This is the infrastructure we believe physicians will need to work in an integrated health care environment to improve care to their patients.” More information online For more information on HI-IQ and other initiatives of the Hawaii Medical Service Association, visit www.hmsa.com.
For more on payers’ I.T. strategies, visit the payer portal at www.healthdatamanagement.com. (c) 2008 Health Data Management and SourceMedia, Inc. All Rights Reserved. http://www.healthdatamanagement.com http://www.sourcemedia.com
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