INNFOCUS—HEALTH
In-depth coverage of issues affecting specific lines of business
enced sluggish growth for years. The
stimulus’s Health Information Technology for Economic and Clinical
Health Act, or HITECH Act, offers
$18 billion in incentive payments
through Medicare and Medicaid reimbursement systems to prod hospitals and physicians to implement
digital health record systems.
The ARRA legislation says providers will be reimbursed for the “
meaningful use” of certified EHRs. Though
still being fleshed out, such “
meaningful use” includes not only ensuring that the EHR system records
medical information, but also that it
is able to share such data with other
systems. Payer-based PHRs also can
qualify for some of these funds to the
extent that they satisfy the meaningful use criteria. To help build indus-trywide consensus and standards, the
ARRA created the Health Information
Technology Policy Committee, an advisory body that provides recommendations on issues such as how to
use technology to create a single understanding of the patient shared
across all providers.
Growth and the arra
Typically, an EMR is clinician-fo-
cused, offering a single place where
all medical information related to a
patient resides. This can include pa-
tient readings, lab results, EKGs and
X-rays. In contrast, a PHR generally
is sponsored by a carrier health plan,
and it gives patients an Internet-
based repository for their personal
health information so they can keep
track of allergies and medications in
a fashion they can understand it.
The HITECH Act boosted recog-
nition that patients’ information
needs to be electronically archived.
Still more vital, it underscored the
need for health IT vendors to build
“shared clinical intelligence” on top
of the raw data. To get value from an
electronic health solution, behavior
needs to be altered; simply provid-
ing reams of data to physicians and
patients is not helpful. “You have to
analyze the data so that it is person-
al,” says Kennedy, who is a member
of the Health Information Technol-
ogy Policy Committee. “You have to
get to personal, timely, specific and,
most importantly, actionable infor-
mation in order to get the value
from the solutions. And you see the
foundation for that kind of thinking
reflected in the HITECH Act.”
Recent trends for EMR and PHR
growth are encouraging, according
to some observers. “We are just see-
ing a dramatic uptake in both PHRs
and EMRs,” says Larry Leisure, a
managing director in the payer and
employers markets practice of Inge-
nix Consulting, an Eden Prairie,
Minn.-based health IT subsidiary of
UnitedHealth Group. “Health plans
left and right are in the process of
not just rolling out PHR capabilities,
but enhancing the capabilities of
those PHRs.”
Sophisticated EMRs and PHRs
now provide for rich and convenient
conversations between physicians
and patients. For instance, surging in
popularity are e-visits, in which a
patient and physician exchange e-
mails around a specific set of data,
says Leisure. He expects such visits
to continue since the patient need
not get in his car and the doctor can
schedule more efficiently.
With 34 million members, Well-
Point implemented digital health re-
cord initiatives that use claim data
and apply algorithms to identify cost-
reduction opportunities, while send-
ing both paper and electronic mes-
sages to patients and physicians to
increase the quality of care. It also
launched EHR pilots that it developed
with the Kettering Health Network.
During a one-year period for a
WellPoint pilot in Ohio called the
DaytonHealthKonnect Individual
Health Record, members using the
system lowered overall health care
trend costs for medical benefits by
7.4% more than non-users, while
they also had up to a 40% greater
likelihood of receiving key disease
screening tests than non-users. The
pilot also yielded cost reductions,
including a 10.3% decline in cost
per employee for inpatient services
year to year.
More so than EMRs, PHRs have
struggled to find a foothold. Ac-
cording to a study on PHRs late last
year by Forrester Research, two-
thirds of consumers do not have a
PHR, nor do really know what one
is. Nonetheless, carriers such as
Hartford, Conn.-based Aetna are
leading the way in revolutionizing
the use of PHRs. In order to interface
with its rules-based technology,
called Care Engine, Aetna developed
PHR technology that went into full
production in January 2008. Its tools
scan patients’ records and identify
gaps in care as well as opportunities
to improve care. They also shoot out
targeted, personalized alerts to peo-
ple based on their condition. For in-
stance, if an Aetna member has dia-
betes and has not had a hemoglobin
A1c test in six months (which the
rules engine recognizes as being too
long), he will get an automated alert
recommending that he get such a
test. His physician also will receive
such an alert.
At Aetna, the PHRs have seen
steady adoption, and greater use has
meant better health for members,
says Dan Greden, head of E-health
product management for the com-
pany. Across Aetna’s entire book of
business, more than 9 million en-
rolled members have a PHR, and ap-
proximately 15% have used their
Charles Kennedy
Wellpoint Inc.
Getting our members to interact with tools like this adds
value to improving their health, and the economics of a
healthier population are pretty clear.
— Dan Greden, Aetna
