The chicken and the egg

So, it seems that health plans aren't as stoked about physician IT adoption as you might think (see article, below), ranking it low in importance when setting up pay-for-performance measurements. While I'm sure health plans agree that apps like EMRs, e-prescribing and clinical decision support are nice to have, they clearly don't see them as a life-and-death thing.

The question is, why not? One would think that given their access to aggregate data, they'd know full well how gaps in clinical data sharing muck up care, and how much such technologies can do to improve compliance with preventive care measures, just to name one major plus.

The answer, I think, is that they don't want to get too far ahead of the curve.
For example, when I spoke to a senior official at Blue Cross of California--which runs one of the most established P4P programs in the U.S.--he told me that IT was part of their evaluation, but that it was too soon in the adoption process to weight it heavily.

I guess I follow his logic. After all, what's the point of establishing detailed IT adoption metrics if most medical groups aren't even in the ballpark? Sure, such metrics would do a good job of distinguishing the enterprise IT efforts of huge, institutional practices like the Mayo Clinic from their rivals, but they may not even be relevant to the smaller practices which make up much of their roster.

But wait a minute. Isn't this a sort of chicken-and-egg problem? If health plans don't build IT adoption incentives into their P4P requirements, physicians have less reason to lay out the money. And if physicians don't lay out the money, health plans can always waffle on the subject.

Maybe, at this stage, health plans are smart to punt on the issue of IT in medical practices. As things stand, it does seem like it will be a long time before small practices, which make up the bulk of U.S. groups, will pick up enough next-gen health IT to create even a ripple.

Still, given their market power, health plans are in a unique position to catalyze physician IT use, which will certainly benefit them over the long run. No matter what surveys say, I don't think they'll wait much longer to flex those muscles. - Anne

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