The Centers for Medicare and Medicaid Services launched a pilot project in June 2007 to explore whether personal health record technology could work for Medicare recipients. CMS partnered with seven Medicare Advantage and Part D health plans, using their existing PHRs to help boost consumer use.
In enlisting the help of health plans — including Humana, the University of Pittsburgh Medical Center (UPMC) health plan and HIP USA — CMS sought real-world test beds for PHR technology, which gives patients a measure of control over their medical records.
“The private PHRs that are out there right now work very well, and we definitely have no intention of building new ones,” said Lorraine Doo, a senior policy adviser at CMS’ Office of E-Health Standards and Services who is helping oversee the project. “What we do want is to be able to leverage them so they are better able to serve our purposes.”
The project is just one component of a broader CMS strategy to test PHRs. Officials have just launched a second pilot project in South Carolina that will offer PHRs to participants in the agency’s fee-for-service plan.
“We’re starting small, looking at levels of use and consumer satisfaction,” Doo said. “By implementing the pilot projects in different ways, we’ll be able to compare a fee-for-service approach to one that uses health plans to determine if one or the other is more successful.”
Doo said working with payers would help CMS determine whether the Medicare population might need a particular kind of PHR and what features would be best.
“There are a host of advantages to working with health plans: They have existing PHRs, they have patient data, and they already have relationships with patients,” Doo said.
The Pittsburgh project
CMS had several requirements for the pilot project. PHRs needed to contain basic demographic information about members, they had to include a medication history component and information about the procedures performed, and PHR owners had to be able to grant other people access to their profiles.
UPMC delayed its implementation until January 2008 — long after the project’s official launch — to ensure that its PHR would run smoothly, said Cathy Batteer, UPMC’s vice president of Medicare. Officials monitor who accesses the PHRs and which elements they use, and they report that information periodically to CMS.
UPMC increased the size of the type on the existing PHRs and tailored other features to make them more senior-friendly, Batteer said. Officials also plan to conduct focus groups to improve usability and identify potential barriers to adoption. Still, the level of use among Medicare patients is likely to be low, at least at first, Batteer said.
“We did distribute a booklet about the PHR in our new-member packet, and we have talked about a potential member incentive that might be tied to preventive screenings, but that’s in its infancy,” she said. “Unless there is some kind of incentive, uptake is not enormous, and the Medicare population is even harder. For that reason, this process will evolve over time, but with the pilot, we can learn what parts of the PHR were used most often, and we can make adjustments.”
The fee-for-service approach
For its initiative to offer PHRs to fee-for-service Medicare beneficiaries in South Carolina, CMS enlisted QSSI, an information technology solutions provider based in Gaithersburg, Md., as the lead project manager. HealthTrio, of Centennial, Colo., provided the PHR.
QSSI is populating PHRs with two years of administrative claims data for the beneficiaries participating in the project, Doo said. Users have online access to records covering their medical conditions, office visits, procedures and medications.
The project presents some challenges when it comes to creating awareness, Doo said. Health plans have a relationship with their members, but CMS has had to find creative ways to encourage beneficiaries to sign up for PHRs. CMS is hosting community events, partnering with AARP to attract users, and holding health fairs at which officials work one-on-one with people to demonstrate features of the system and help them create PHRs.
“We can’t really be sure how many people will participate, especially because we haven’t started any evaluations yet,” Doo said. “There can be a whole series of reasons why one approach works or doesn’t, and it’s hard to quantify success. If there are only 100 users, but they love the PHR and use it all the time, is that a failure compared to 1,000 users? We’ll just have to wait and see.”
PHRs and the federal government
Although PHRs are a product of the private-sector health care market, the federal government has an important role to play in the development of the technology, Doo said. One duty will be similar to its current efforts to encourage the spread of health information exchanges and electronic health records.
Public-sector involvement can bolster PHR initiatives, said Dr. Stasia Kahn, vice president of Northern Illinois Physicians for Connectivity, an HIE in the western suburbs of Chicago.
Developing a PHR program is high on the group’s agenda. The organization includes three hospitals, several physician groups and Northern Illinois University. During the planning stage, the members met with the Illinois Department of Public Health and brought in a regional CMS director to give a presentation and answer questions.
“We wanted to get state and local government involved as much as possible,” Kahn said. “Unfortunately, the EHR task force bill that was put before the state of Illinois was vetoed, and a portion of the bill dealt with PHRs. Now we’re just waiting to see what happens.”
Kahn said she is hopeful that even if the state government’s efforts to increase adoption falter, county initiatives will develop quickly enough to pick up the slack. For example, she said, counties communicate with federally qualified health clinics and might be able to increase pressure on them to adopt electronic solutions.
“The public sector doesn’t have to re-create something that is already being built well, but it does have to act to increase adoption and take it to the next level,” Doo said. “What we need now are standards and security. Patients need to be able to move information from WebMD to HealthTrio if they want to, and that’s not possible now.”