Anyone looking for evidence of the job-creating effects of the 2009 stimulus act need look no further than the burgeoning health information technology marketplace.
Four years ago, the Obama administration earmarked more than $20 billion for incentive payments to hospitals and physician practices that installed electronic health records. Today, most of that money is spent. Over the next few years, the stimulus will fade away.
Yet there remains a vibrant, self-sustaining sector. The U.S. health information technology market will grow to $9.3 billion in 2015, a 7.1% increase over this year, according to one estimate last week from the Healthcare Information and Management Systems Society meeting in Orlando, Fla. The installed EHR base has set the stage for a major advance in U.S. healthcare—comprehensive health records available at every point of care in a patient's journey through the health system.
In economic development circles, government support for infrastructure like HIT is considered pump priming. It jump-starts a market that without government spending either would not get off the ground or, as in this case, would evolve at a much slower pace.
Another major pump primer seen at HIMSS this year was evidenced in the creation of dozens of private-sector health information exchanges. These private HIEs facilitate the data warehousing and analytics needed to provide comprehensive histories at the point of care, gleaning claims and clinical records from hospitals, physicians and other providers that care for patients within a system or network.
HIEs also provide managers at payer and provider organizations with data that enable them to manage population health. For instance, to identify the most costly patients for health interventions, or to zero in on practice patterns of physicians whose patients have suboptimal outcomes, managers at systems participating in private HIEs can now comb through comprehensive patient records to find actionable information.
There was no shortage of software developers and vendors touting their population health management “solutions” and “dashboards” at HIMSS, and just as many health system chief information officers willing to vouch for their effectiveness.
As with EHRs, the private HIE marketplace would not have evolved so rapidly without government pump priming. The stimulus act contained about $2 billion for grants to government-designated health information exchanges and regional extension centers—modeled after the agricultural extension service—to “train” providers to actively collaborate by exchanging patient data.
Most of the government grants will expire at the end of this fiscal year and it's uncertain how many of the not-for-profit HIEs and RECs will survive without government funding.
Many may survive because they are developing pay-to-play financing models with their payer and provider clientele. Some plan to build an independent financial base by serving the data needs of government providers such as the Veterans Affairs Department.
Should we care if some of these government-sponsored HIEs fall by the wayside? Certainly, vendors and consultants touting enterprise-based HIEs won't mind. Nor will many early adopter providers of these population health management tools.
In their fight for market share, many integrated delivery systems may view their enterprise-based HIEs as a competitive advantage over less nimble or smaller systems. As payers turn to risk-based reimbursement models that reward value over volume, systems with the greatest capacity to effectively manage the care of their most costly patients will be able to deliver the lowest rates. They're also likely to have the highest quality rankings. Effective population health management will also be an integral part of making narrow networks work.
But there's a downside to a world with only enterprise-based HIEs. In our fragmented insurance system, many people do not have a stable provider network. They shift plans and providers either because their employers change plans, they move, or they change jobs. And those in high-deductible plans may choose a cheaper out-of-network provider, such as a retail clinic. If that provider is not connected via an enterprise HIE, that visit's record is lost to the provider who keeps the person's medical records.
Providers can meet the government's meaningful-use standard for EHRs by participating in an enterprise HIE. But that won't necessarily serve the needs of patients whose records need to follow them wherever they seek care. That's why there is still a role for government-funded HIEs.
Follow Merrill Goozner on Twitter: @MHgoozner
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