Health centers are facing a new and exciting future. We are one full year into the February 2009 American Recovery and Reinvestment Act (ARRA), which contained $2 billion for health centers. This amount included $1.5 billion for capital needs such as construction, renovation, equipment and acquisition of health information technology; $500 million for strengthening health center operations; and an additional $500 million for investments in the primary care workforce. ARRA includes the Health Information Technology for Economic and Clinical Health Act, or the HITECH Act. Among other provisions, HITECH established Medicare and Medicaid incentive payments for adoption and meaningful use of electronic health record (EHR) technology.
One year later, on March 23, 2010, the monumental health care reform package (consisting of H.R. 3590, Patient Protection and Affordable Care Act; and H.R. 4872, Health Care and Education Reconciliation Act of 2010) was signed into law. Together, these two bills dramatically expand health insurance coverage, support primary care delivery, and provide the basis for a fundamental change in America’s health care system. Of direct and immediate relevance to community health centers are:
- The establishment of the new Health Centers Trust Fund and the allocation of $11 billion, through 2015, to facilitate the rapid expansion of community health centers by supporting both operational and capital needs; and
- The creation of a new National Health Services Trust Fund, with a total allocation of $1.5 billion through 2015, to improve the National Health Services Corps and support the placement of primary care providers in high need areas.
There are, of course, many additional crucial provisions that provide for payment improvements and protections for FQHCs, create health insurance exchanges, define a set of required benefits and important standards, and support primary care teaching training – all within the framework of improving access, quality and affordability.
But while the changes are overwhelmingly positive, we can expect things to be vastly different, very quickly, as health centers prepare to operate in a faster paced, more demand-intensive environment while supporting expanded clinical care and clinician training.
Critical Dimensions of the New Environment
From an operational perspective, two sets of separate but related requirements – those related to meeting the meaningful use criteria and those associated with medical home certification – will become a focus for health centers:
- Currently, the meaningful use of EHR technology, as stipulated by HITECH, is defined by 26 criteria in the initial qualification stage (stage 1) alone. A provider must meet each of these criteria in order to be eligible for enhanced Medicaid reimbursement1. These criteria have been covered in great detail in many other places, but the core requirements necessitate deep use of EHR, as well as ePrescribing, CPOE, consumer interaction, health information exchange (HIE), eReferral, biosurveillence and immunization reporting. In particular, making electronic records accessible to consumers and HIE may require additional technologies beyond EHR.
- The health reform package emphasizes the creation of patient-centered medical homes, which are essential for improving care and controlling costs. The law includes a number of initiatives – including the new Medicaid state plan option for the coordination of care to enrollees with two or more chronic conditions, Medicaid and Medicare demonstration programs, and a new Center for Medicare Innovation – all aimed at improving quality, facilitating care coordination, and supporting patient-centered care. The law also includes designation of providers who meet certain criteria as Accountable Care Providers, and makes those providers eligible for federal and state cost savings.
Speaking in March at the New England regional meeting of HIMSS, the Healthcare Information and Management Systems Society Senator Sheldon Whitehouse (D, RI) remarked that the medical home and community care (FQHC) models were the most effective that he had seen. Yet while community health centers are at the cutting edge of patient-focused, high quality care, considerable effort will be required to achieve medical home and ACO qualification. For example, the NCQA Medical Home standards measure, among other aspects of care, access and communication, care management, performance reporting and improvement, patient tracking and registry functions, and test and referral tracking. The medical home model requires improved coordination and communication across and among providers. Many of these elements are similar to meaningful use criteria; all are technology-enabled, if not technology-dependent.
Priorities for Health Centers
Every day counts in this new environment, so we need to get smarter about a number of things, and technology is one of the most important ones. Selection, adoption and effective use of
EHR are essential, but expanded operations, solidifying true primary care medical homes, and attaining meaningful use will also require the selection, adoption and use of other software applications and communication technologies. The electronic communication required for team-based care, consumer interaction and health information exchange means that health centers will require the adoption of Web and mobile device-based technologies that most EHRs do not provide.
The “meaningful use” of an EHR and these other technologies will require real changes in workflows and patient interactions. Such changes take planning and time for the organization to adopt and evolve. Organizational, administrative and process changes will be needed to support the new systems. Finally, both the meaningful use and medical home dimensions will require new administrative and reporting actions, especially in the areas of privacy, security and interactions with external bodies such as state and federal public health organizations. And while there are new resources available to facilitate these changes, qualifying for these funding streams will require considerable planning and operational commitment.
How We Can Help
Recognizing the increased importance of CHC-relevant technology content, the RCHN Community Health Foundation is kicking off a new format for the technology section of our website. We will continue to present columns and other writings, and will add links to timely external content and resource suggestions for making the use of technology more effective. We’ll offer “just in time’ information of both CHC-relevant technology and related policy, and serve as a resource for more specific information related to a number of issues, including but not limited to:
1. Technology adoption
2. Technology evolution, new infrastructure and service models
3. Solutions to support meaningful use
4. Federal programs and opportunities
5. Reports from meetings and conferences of interest to CHCs
Our goal is goal is to assist you – and all CHCs – in understanding technology and related issues so that they can operate most effectively in the new environment. We look forward to your feedback as we launch this new effort.
Please click here to visit the new HIT Updates page of RCHNFoundation.org
David Hartzband, D.Sc. is Director of Technology Research at the RCHN Community Health Foundation.