Document the proven value of e-care technologies



Recommendation #100

Status: In progress

Congress and the Secretary of Health and Human Services (HHS) should consider developeing a strategy that documents the proven value of e-care technologies, proposes reimbursement reforms that incent their meaningful use and charts a path for their widespread adoption.

A clearly articulated e-care strategy will accomplish two main purposes:

  • Marshal support from Congress, states and the health care community to drive e-care use
  • Provide the health IT industry with a clear understanding of the federal government's policies toward e-care

HHS should :

  • consider developing new payment platforms to drive adoption of applications proven to be effective,
  • support evaluation of nascent e-care technologies through pilots and demonstration projects, and
  • look for opportunities to broaden reimbursement of e-care under the current fee-for-service model.

After a reasonable timeframe, Congress should consider convening a panel to review HHS's recommendations and taking action to ensure these technologies' wider adoption.

The National Broadband Plan recommends including the following steps as part of this initiative:

1. HHS should identify e-care applications whose use could be immediately incented through outcomes-based reimbursement.
In its recommendations to Congress, HHS should prioritize e-care applications that it believes are proven to warrant reimbursement incentives. Using the same rigor applied to meaningful use of EHRs, HHS should define these applications' use cases, data requirements and associated outcomes (expenditure reductions and health improvements).

2. When testing new payment models, HHS should explicitly include e-care applications and evaluate their impact on the models. Where proven and scalable, these alternative payment models would provide an additional solution for incenting e-care.

3. For nascent e-care applications, HHS should support further pilots and testing that review their suitability for reimbursement.
HHS should:

  • champion e-care technology pilots where additional data are needed to evaluate their value,
  • use a number of testing mechanisms to prove the system-wide potential of e-care,
  • design major pilots of e-care to adhere to HHS standards for program design, data capture and other requirements for reimbursement decisions and payment model reform, and
  • collaborate in design stages with parties conducting pilots and provide additional funding when its criteria create extra administrative cost.

There are a number of opportunities for HHS to pursue further pilots:

  • HHS should make e-care pilots and demonstration projects a top priority across the agency, including the Health Services Resources Administration, the Substance Abuse and Mental Health Services Administration, IHS, NIH and the Agency for Healthcare Research and Quality. HHS-funded projects should be designed with the objectives of understanding use cases, measuring outcomes and determining optimal payment methodologies to produce efficient, highquality care.
  • HHS should collaborate with federally administered providers of care (e.g., VHA, IHS and the Bureau of Prisons) that can act as role models and testbeds for health IT use. For future programs similar to VHA's e-care program , HHS should become involved early on to ensure that programs are designed appropriately to inform reimbursement decisions and payment model reform.
  • Large-scale private pilots of e-care such as the Connected Care Telehealth Program in Colorado and the Community Partnerships and Mobile Telehealth to Transform Research in Elder Care should similarly consult with HHS and share valuable lessons learned. For pilots that meet HHS's data collection standards, Congress should consider tax breaks or other incentives.

The FCC should use data from e-care pilots to update its understanding of health care institutions' broadband requirements.

Updated use requirements should be coupled with periodically updated reviews of the country's state of connectivity (both wired and wireless) to give the public and other government agencies a better understanding of potential health care broadband gaps.

4. As outcomes-based payment reform is developed, the Centers for Medicare and Medicaid Services (CMS) should seek to proactively reimburse for e-care technologies under current payment models.

CMS should proactively seek means for reimbursing e-care under the current fee-for-service model.

CMS's review board should ensure it fully analyzes the system-wide benefits of e-care when making reimbursement decisions.