HHS pursues transparency in health IT

The Health and Human Services Department plans to harness the participation of physicians, hospitals, insurance plans, employers and consumers to make health care quality and prices more transparent, and to drive down overall costs.

The transparency initiative follows on an executive order President Bush issued in August that will change how the government procures health care.

'Health care costs have the capacity to erode the economy. We can no longer remain prosperous if we allow this to continue,' said HHS secretary Mike Leavitt at the third annual Health IT Summit in Washington, sponsored by the eHealth Initiative, a collaborative health care industry group. Health care costs currently account for 16 percent of the economy.

Leavitt's goal is for the $2 trillion health care sector to organize itself into a system that measures price and quality, moving to value-based components of care. The foundation of that is to:
  • Implement standards of interoperability in connectivity
  • Determine and measure standards of quality among providers and procedures
  • Identify procedures and publish their prices for comparison
  • Establish incentives for providers to promote efficiencies in health care.

Members of the medical profession, for reasons that are financially and professionally important to them, are working to develop quality measures. And the economic community is joining with them, Leavitt said.

'I believe that within two years we will begin to see pockets of quality being measured against price, and we will begin to see value-based competition emerge in several markets around several procedures around the country,' he said.

HHS has started quality pilots in Boston, Minneapolis, Indianapolis, Phoenix, San Francisco and Madison, Wis. Some of these began under an earlier initiative. But in the last year, HHS has designated these six local organizations as pilots and asked them to form a network, harmonize standards, share best practices and encourage other local quality pilots. The Hospital Quality Alliance and Physician Quality Alliance also are participating.

'We intend to go from six to 60 pilots as rapidly as we can, with no time frame, so you end up with local organizations collecting quality data and working with their physician and employer community to begin creating this combination of value and price,' Leavitt said.

These local organizations will electronically collect and share quality and price data. Currently, local organizations don't have the ability to collect that data electronically, he said.

'In very small pieces, you can see this value-based competition beginning to develop,' he said. For example, in Wisconsin some health care companies are assembling cost and quality based on the data that the Madison pilot has developed. In Indianapolis, the pilot is putting out report cards on physicians who are measuring quality. In California, some health systems are paying physicians in part on their capacity to meet quality standards.

Milestones that will advance quality and price transparency also are part of HHS' overall health IT efforts to promote electronic health records that can exchange data. The Health IT Standards Collaborative, through a contract with HHS, has developed interoperability standards on three early versions of electronic health records, bio-surveillance and personal health record systems. It expects to deliver additional standards every eight to 10 months over the next two years, Leavitt said.

The public/private American Health Information Community will make recommendations on those standards. Then another contracted group, the Certification Commission for Health IT, will incorporate those standards into its product certification process. CCHIT has certified 22 electronic health records systems as capable of meeting interoperability standards when they are decided, and other standard security and network functions.

AHIC is also forming a Quality Workgroup in addition to those on bio-surveillance, chronic care, consumer empowerment, electronic health records and privacy. It will make recommendations that specify how certified health IT should capture, aggregate and report data for a core set of quality measures.

The Physicians Quality Alliance has developed a starter set of frequently used procedures to be compared on quality and price. Specialty providers will come forward with more procedures over the next several months, Leavitt said.

About the Author

Mary Mosquera is a reporter for Federal Computer Week.

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