Commercial Payors Implementing EHR Meaningful Use Criteria in P4P Programs

Update: On August 9, 2010, Humana, Inc. and athenahealth, Inc. announced their collaboration to provide physicians access to a practice management/EHR software system combined with a rewards program related to quality measures.  For more information, click here.

On August 5, 2010, four major commercial health insurance payors participated in the Health Industry Forum in Washington, D.C., to discuss private industry collaboration with the United States Health & Human Services Department (HHS) to support providers in the adoption of certified electronic health records (EHRs). Leading the Forum’s panel discussion was David Blumenthal, M.D., Chief of the Office of National Coordinator of HIT.  All four payors will include the Meaningful Use criteria in their pay for performance (P4P) programs.

The payors represented on the Forum’s panel, along with a brief overview of their EHR initiatives, were:

  • Aetna, Inc., and its subsidiary, ActiveHealth Management:  Aetna will offer P4P incentives to physicians who achieve specific quality goals and who make investments in EHR technology.  ActiveHealth Management has partnered with IBM to jointly design an EHR product called Collaborative Care Solution.  See Aetna’s New Release for more information.
  • United HealthGroup (UHG):  UHG is supporting EHR implementation in several ways: a) Ingenix, a UHG company, is collaborating with the American Medical Association (AMA) to provide Ingenix Care Tracker (TM) (a cloud-based EHR system) to physicians through AMA’s new online health information solutions platform; b) Ingenix also created an Ingenix Care Tracker for Federal Qualified Health Centers; c) UHG’s on-line, physician directory will identify physicians who have met MU criteria; and d) UHG’s P4P contracting program will make financial incentives available for physicians who meet MU criteria. For more information, see UMG’s News Release.
  • WellPoint, Inc.:  Wellpoint will align its P4P incentives with the MU standards and will provide financing of health information technology to hospitals in rural, critical access or medically underserved areas. See Wellpoint’s News Release, for more information.
  • Highmark, Inc. (Blue Cross Blue Shield):  Highmark also will include the MU criteria in its P4P program, QualityBLUE.  It already has been promoting EHR adoption through its $29M Health Information Technology Grant program, which has reportedly provided 3,140 physicians with over $19.6M to assist with health information technology, including e-prescribing.   For more information, see Highmark’s News Release.

Now that the federal government has done its part to make clear the Stage One criteria for achieving Meaningful Use of EHRs (see Final Rule), we can reasonably expect that more and more commercial payors will align their payment systems with such criteria.

Post Note: The August 5, 2010 Forum was co-hosted by Health Affairs and the Health Industry Forum at Brandeis University.  Marilyn Tavenner, Principal Deputy Administrator, Centers for Medicare and Medicaid Services (CMS), also spoke on the panel.  Links to posts from Forum participants or their representatives are available on the Health Affairs Blog here.  In addition, Dr. Blumenthal and Donald Berwick, the new CMS administrator, coauthored an article about Meaningful Use of EHRs on August 5, 2010, which also is available on the Health Affairs Blog here.

2 thoughts on “Commercial Payors Implementing EHR Meaningful Use Criteria in P4P Programs

  1. I share some peoples concern regarding the ability of current users of EHRs that have not been re-certified. I hope that if the practice is “missing” a particular component (ie, e-prescribing) that they will be able to purchase this separately and thus qualify for the ARRA incentives. However, we are recommending to all MGMA members that have an EHR to review their contracts and amend them if possible to ensure that the vendor’s software will qualify for the incentives. If this is not possible, practices will need to weigh the advantages (ie, upgraded functionality, access to the incentive funds) of moving to a new systems with the disadvantages (cost, staff training, moving patient data over to the new system, practice disruption, etc). It would be interesting to hear from members who have initiated these actions–contract discussions with their vendors and/or weighing the value to moving to an all new EHR.


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