Health IT–Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians

We appreciate the comments by Dr. Nagykaldi about the importance of financial incentives to help facilitate increased interoperability among EHR and other health IT systems. Support is needed first to set up these systems of interoperability and then second to encourage its use by all types of medical providers (i.e. physicians, hospitals, labs). Only then will the true benefits of care coordination be achieved.

We recommend other broader incentive programs than that of a transaction-based system of payment for individual pieces of information. The new CMS chronic care management payment allows for a monthly reimbursement to cover the costs of coordinating care with specialists and facilities and developing comprehensive care plans for patients with two or more chronic conditions.(1) CMS has also instituted a value-based payment modifier. This provides a differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) program based quality measures used in the Physician Quality Reporting System (PQRS) and compared to the cost of care.(2)

Another possible solution is to realign the economic incentives of all parties involved with health information exchanges (HIEs). Dr. Yaraghi presents an interesting business model which suggests generating revenues from HIEs by providing data services to organizations such as accountable care organizations, public health authorities, payers, and pharmaceutical companies.(3) These revenues could then be used to fund a shared savings program in which clinicians and medical data providers receive payments for providing their patients' data to the HIE. This model is similar to that used by the three major credit bureaus in the financial services industry.

We recommend exploring multiple ways of providing both technical and financial support to practices and possibly other health care entities to learn the best approaches for improving health IT support for care coordination.

1. Edwards ST, Landon BE. Medicare's chronic care management payment -- payment reform for primary care. N Engl J Med. 2014; 371:2049-2051.

2. Value-Based Payment Modifier. Centers for Medicare and Medicaid Services Website. http://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/PhysicianFeedbackProgram/ValueBasedPaymentModifier.html. Updated March 26, 2015. Accessed March 27, 2015.

3. Yaraghi, N. A Sustainable Business Model for Health Information Exchange Platforms: The Solution to Interoperability in Healthcare IT. Washington, DC: The Brookings Institution, 2015. http://www.brookings.edu/~/media/research/files/papers/2015/01/30- sustainable-business-model-health-information-exchange-yaraghi/hie.pdf Published January 2015. Accessed June 1, 2015.

Competing interests: I work for NCQA, which recognizes patient-centered medical homes.