Managed Care

Kaiser finishes major phase of costly EMR project

Mon, 12 May 2008 06:59:58 -0400

Kaiser has put the finishing touches on a major phase of its costly, high-profile EMR project, giving all of its 8.7 million enrollees and 13,000 physicians access to its outpatient system. To date, Kaiser has spent $4 billion on the EMR installation, which has been in progress for years. In recent times the project has been dogged by allegations that it had been botched, so much so that last year the California Department of Managed Health Care formally requested information on its progress.

Despite reaching an important milestone, the Kaiser EMR project still has a ways to go, given that it's got miles to travel on its inpatient rollout. To date, only 13 of the system's 36 hospitals have put Kaiser's Epic EMR system in place. It expects to see 14 hospitals to bring up the system this year, with the remaining nine hospitals slated for implementations in 2009 and early 2010. No word yet as to how much that $4 billion number will increase over the next year or two, but I doubt the remaining inpatient installs are going to be cheap.

To learn more about the Kaiser EMR project:
- read this Healthcare IT News article
- read this Pacific Business News article

Related Articles:
Kaiser's EMR facing state investigation
New Kaiser IT head charts change of course
Controversy topples top Kaiser IT executive
The whistleblower speaks: the Kaiser EMR drama

New Kaiser IT head charts change of course

Sun, 01 Jul 2007 20:01:38 -0400

After months of being in a holding pattern, Kaiser Permanente has hired a new, permanent top technology leader to stabilize its troubled IT organization.

Philip Fasano, former CEO of Capital Sourcing Group, is now vice president and chief information officer. He takes over from Bruce Turkstra, who served as interim IT chief after Cliff Dodd resigned in November. Dodd left practically overnight after a junior employee, Justen Deal, sent an email to Kaiser employees detailing serious uptime problems with its EMR. Since Deal's letter, the California Department of Managed Health Care began investigating problems with Kaiser's $4 billion Epic installation.

Fasano, who comes from the financial services industry, has vowed to bring Kaiser's HealthConnect EMR the "five nines" uptime enjoyed by users of financial information networks. To do so, he's planning to decentralize, giving a group of regional "business information managers" the ability to exercise more control over local IT problems. He's also planning to shift thousands of IT employees over to helping internal customers like physicians. In the past, most IT staffers were focused on maintaining standard IT services. In addition, he hopes to spend $100 million to $200 million on infrastructure investment, on top of his $1.6 billion overall IT budget.

To find out more about Fasano:
- read this East Bay Business Times article

Related articles:
Read Justen Deal's opinion on K-P's new hire. Blog
Controversy topples top IT exec. Article

Providers not moving fast enough on NPIs

Sun, 17 Jun 2007 20:01:35 -0400

When CMS agreed to give providers a bit of a breather on transitioning to the new National Provider Identifier, it might have given them a false sense of security, according to a consultant who coaches execs on this topic. True, CMS agreed to suspend penalties for providers who aren't NPI compliant yet, but are making reasonable and diligent efforts to get there. The problem is that grace period will expire on May 23, 2008--and the deadline is barreling down on providers, said Martin Jensen, COO and chief analyst of Healthcare IT Transition Group of Tulsa, OK. Now is the time for medical groups and healthcare executives to begin forming realistic plans for transitioning to full-time NPI use, particularly given that CMS isn't going to be much help, he says. Otherwise, not only will providers face CMS penalties, they may soon find that they'll have trouble tracking revenue and getting claims paid.

To find out more about NPI preparations:
- read this Healthcare IT News article

The chicken and the egg

Sun, 06 May 2007 20:01:39 -0400

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

Health IT not playing key role in P4P

Sun, 06 May 2007 20:01:38 -0400

In theory, payers include smart use of technology in their standards for handing out pay-for-performance bonuses. In reality, however, they aren't paying that much attention to IT adoption, according to a new study by analyst firm Health Industry Insights. The study, which surveyed 57 U.S. health plans with P4P programs planned or underway, found that when provided with a list of seven factors needed for P4P success, payers ranked physician IT adoption near the bottom, at fifth.

The researchers argue that for P4P programs to succeed, payers will have to get with the IT program, establishing incentives for doctors to adopt more sophisticated IT infrastructure. In particular, they contend, payers should encourage doctors to use certified technology using interoperable standards. Ultimately, they say, IT use will have to be a meaningful part of how physician practices are evaluated for P4P payouts.

To find out more about the study:
- read this Healthcare IT News piece
- read the Health Industry Insights release

Related Articles:
Bill would pay for physician health IT costs. Report
Health IT legislation likely in '07. Report
MD group asks for federal help with EMRs. Report
Smaller practices still behind in IT adoption. Report

BCBS plans offer data for 11 million insureds

Sun, 29 Apr 2007 20:01:38 -0400

A group of Blue Cross and Blue Shield plans spanning four states have come together to funnel data on 11 million people into a broadly-accessible EMR. The EMR, which uses MeDecision's Patient Clinical Summary Software, pulls together patient data from various sources, including eligibility, medication, lab visit, hospitalization and physician office visit databases into a single integrated system. The system then uses data analytics to offer physician reminders, including preventive care alerts or potential drug conflicts. The project is being managed by Health Care Services, which runs BCBS plans in Illinois, New Mexico, Oklahoma and Texas. The system is already in operation in New Mexico, Oklahoma and Illinois, and will launch in Texas later this year.

To find out more about the project:
- read this ComputerWorld piece

Related Articles:
Florida health plans lead e-prescribing effort. Report
Blue Cross of California launches PHR. Report
Hawaii Blue plan offers $20 million EMR boost for doctors. Report
BCBS association touts world's biggest healthcare info database. Report

FL health plans lead e-prescribing effort

Sun, 15 Apr 2007 20:01:36 -0400

Florida has become another front in the battle to foster e-prescribing adoption, with a group of health plans banding together to get the job done. The group, ePrescribe Florida, is led by Blue Cross and Blue Shield of Florida, UnitedHealthcare, Humana and AvMed. Other participants include CIGNA, Aetna, the Florida Academy of Family Physicians, Florida Pharmacy Association, Florida Medical Association, Florida Hospital Association and vendors RxHub and SureScripts. The group's goal is to bring pharmacy chains, state and regional health plans and relevant technology vendors into the e-prescribing game. In addition, group members are reaching out to members of Congress to educate them on the benefits of e-prescribing. Given the publicity that existing state e-prescribing efforts are receiving, it's likely they won't have to work that hard.

To get more background on this initiative:
- read this Jacksonville Business Journal article
- read the group's launch press release

PLUS: Florida lawmakers are considering a handful of bills that would create a statewide health information network and EMR. Article

WellPoint loses patient care data

Sun, 18 Mar 2007 20:01:36 -0400

It was a near miss this past week for a unit of WellPoint, one of the largest insurers in the United States. Early last week, WellPoint's Empire Blue Cross and Blue Shield announced that it had lost medical and personal data on 75,000 members. The data had been lost when an unencrypted CD was sent to mental health benefits manager Magellan Behavioral Services by Health Data Management Solutions, and lost in transit somehow. As part of its public mea culpa, Empire had announced that it would offer the standard 12 months of credit monitoring to the 75,000 members. Luckily for Empire and WellPoint, however, Magellan located the CD within 48 hours. Nonetheless, Empire will now require Magellan to transmit personal health information only over a secure network.

To learn more about the data loss:
- read this New York Times piece
- see the Empire BCBS press release announcing that the disk had been found

Related Articles:
Johns Hopkins loses patient, employee data. Report
Massive data loss at HCA. Report
Allina suffers patient data theft. Report
VA pledges better data security. Report
TX healthcare system loses data. Report

Blue Cross of California launches PHR

Mon, 19 Feb 2007 19:01:35 -0500

One of the nation's largest health insurers, Blue Cross of California, has joined the PHR craze. The Blue has launched an integrated wellness, care management and physician communication program--360 Degree Health--with its personal health record model as a central component. The program is intended to better reach the 20 percent of the health plan's members at greatest risk. Like other new PHRs, it's also an exercise in seeing how much useful information patients can actually be tempted to provide. It seems likely that any PHR, no matter how catchy the interface, would have a "shopping cart abandonment" problem.

The new PHR will include both member-provided data and claims data, both of which will be accessible by telephone and the Web. Wrapped around the PHR is a more comprehensive wellness initiative, offering members lifestyle programs, alternative medicine information and live health education. The website also offers interactive online tools helping patients make well-informed health choices.

To get more background:
- read BCC's press release

Related Articles:
GA insurers unveil easy-access PHRs. Report
Groups sink $5.3 million into PHR apps. Report

Blue plans, health industry group plan PHR

Sun, 17 Dec 2006 19:01:38 -0500

It's dueling data stores, everyone. This week, the Blue Cross and Blue Shield Association and health industry trade group America's Health Insurance Plans have announced that they're creating their own personal health record (PHR) model. This new PHR would be transferable from one insurance company to another. The effort, which should go live in 2008, will presumably compete with the giant personal health record effort being launched by a handful of mega-employers like Wal-Mart Stores and Intel.

The main difference between the two efforts, not surprisingly, is that in this model, the insurers control the data, while in the other initiative, employers will build a data warehouse of their own. Initial announcements of the plan were light on technical detail, although AHIP did note that their proposed PHR will be Web-based, and integrate administrative and claims data as well as personal health information. Core data elements will include patient histories, medication lists, immunizations, allergies, risks and plans of care.

The two health industry groups also announced that they'd be pilot-testing the program with the National Health Council, on a project focused on the needs of people with chronic conditions and disabilities.

ALSO: While it might not have any co-sponsors this time around, it's still a sign of the times. Rep. Patrick Kennedy (D-RI) filed a bill this year offering a financial reward to doctors who build PHRs. Link

For more information on the project:
- see this press release from AHIP
- read this Workforce Management article