The proposed private-sector successor to the federally controlled health information technology advisory panel, the American Health Information Community, could end up being the provider of governance and services for a national health information network, according to a key healthcare IT official at HHS.
The new group would raise revenue through per-transaction fees just as the Visa credit card network provides similar exchange services for financial transactions, Robert Kolodner said.
Kolodner, head of the Office of the National Coordinator for Health Information Technology at HHS, discussed that vision Wednesday during a forum for potential bidders on a federal contract to create the AHIC successor, dubbed by HHS Secretary Mike Leavitt as AHIC 2.0. The winning bidder on the $13 million, two-year contract offered by HHS would establish a planning board to set up the corporate structure of the new AHIC and work with HHS in choosing members for its initial board of directors.
Leavitt created the 18-member AHIC in 2005 to advise him on healthcare IT matters. He serves as its chairman. Half of its members are government officials and all of its funding comes from HHS.
Bidders should include in their presentations business plans so the successor organization would be self-sustaining financially. Revenue could be generated not only through membership fees, but also from the sale of products and services, he said.
"The (new) AHIC could be the member organization for the regional health information exchange," Kolodner said. "Right now, there isn't a specific way for the regional health information exchanges (to) organize on a national level, but that may come into being with the AHIC 2.0."
This is what the planning board members will be looking at, Kolodner said. "They might provide the governance for the NHIN (national health information network) once it is set up. We do think that NHIN will need a governance structure and the AHIC could provide that governance."
Kolodner said that Visa "is able to move transactions around the world for less than a penny." The new AHIC, he said, could raise funds to support itself and the national network by similarly charging a few cents per transaction on the Visa model. "It would be a break-even resource," Kolodner said.
Other issues to wrestle with are adequate representation of minority and consumer interests. "Membership fees should not create a barrier to participation," Kolodner said.
An official public comment period is open through Sept. 10 on a white paper outlining a first take by HHS on what the AHIC successor should look like.
In addition, a formal notice of the $13 million grant was published Aug. 13 with a bid deadline set for Oct. 5.
Finally, a 69-page PowerPoint presentation by Kolodner and others at the meeting Wednesday is also available.
Kolodner said the winning bidder will have discretion in choosing a structure for the successor AHIC, with one caveat where HHS has a strong preference. In his presentation, Kolodner offered up a board structure in which board members are chosen by members of the new AHIC voting by various healthcare industry sectors, including institutional providers such as hospitals and long-term-care facilities, clinicians, payers, employers and pharmaceutical and device manufacturers. The board members, however, should not view their roles as exclusively representing their sectors, but as having a higher duty to represent the overall organization.
"This is the one where we actually believe the duty to the AHIC success is the right answer," Kolodner said. Questioned on how consumers' interests would be protected if the board member consumers select owes a fiduciary duty to the AHIC and not them, Kolodner said they would have even broader protection under the HHS-proposed governance plan.
"The duty to the whole is where the insurers would be responsible not only to the insurers but also to the AHIC," Kolodner said. Representation of the consumers "would actually be better achieved by a duty to the whole," he said.
One sector notably underrepresented in the proposed new, private-sector AHIC structure, according to the HHS draft model, is the healthcare IT industry. Healthcare IT has neither its own sector, nor a board seat, an absence made more noticeable by the presence of Craig Barrett, the chairman of chip-maker Intel Corp., on the existing AHIC panel. At the time the current AHIC was impaneled, vendors complained that no healthcare IT company was represented on AHIC and were told by government officials that Barrett would be their representative, a somewhat less than satisfying response.
According to Kolodner, vendors might fit under several of the other sectors, such as employers, or as providers or payers, where they sell their software. The absence, if not a slight, was intentional.
"We actually chose not to include health IT vendors because they would be beneficiaries of what the AHIC might produce," Kolodner said. But Kelly Cronin, director of the office of programs and coordination at ONCHIT, said the model calls for two at-large board members, which could accommodate IT vendors.
HHS plans to award a contract by November to the winning bidder on the AHIC 2.0 conversion. The transition between the existing organization and the new AHIC will begin in April 2008. The question remains whether Congress will take the bat out of these planners' hands in light of a proposed bipartisan Senate bill, which would make AHIC a permanent part of the government.
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