At least four private payers are following the lead of the federal government by offering health care providers financial incentives for the "meaningful use" of electronic health records.

The programs also piggyback on the meaningful use standards that are set by CMS, so expectations on what providers need to do to demonstrate meaningful use in order to qualify for incentives is consistent between the public and private payer systems.

During an Aug. 5 meeting sponsored by Health Affairs and the Health Industry Forum, representatives from WellPoint, Highmark Blue Cross Blue Shield, Aetna and UnitedHealth Group offered insights on what they are doing to encourage the adoption of electronic health records.

WellPoint VP of Health Information Technology Charles Kennedy introduced two initiatives - an alignment of the company's pay-for-performance measures related to the meaningful use of EHRs to that of the federal government's measures and a financing assistance program to help providers get their EHR systems set up.

CMS on July 13 issued the final rule on the first stage of criteria that physicians and hospitals will have to meet in order to demonstrate meaningful use and qualify for federal incentive payments (Also see "CMS Reduces Criteria To Qualify For Electronic Health Record Financial Incentives In Final Rule" - Pink Sheet, 13 July, 2010.). Two more stages of meaningful use, with more stringent criteria, are scheduled to come out during the coming years.

Kennedy said the alignment "will allow the physicians to have one set of measures to work through and will allow them to focus on processes that perfectly align with those quality measures."

On the financing side, Kennedy noted that the program that WellPoint is offering specifically to hospitals in California and Georgia are aimed at helping those that may otherwise have difficulty accessing capital markets to make the necessary investments in health IT or help hospitals make investments before federal incentives are available.

"We do not want health IT to create a world of the haves and the have-nots," Kennedy said. He noted that funds were coming from WellPoint reserves and reach into the hundreds of millions of dollars.

Donald Fischer, senior VP and chief medical officer at Highmark Blue Cross Blue Shield, also said that the company was aligning its pay-for-performance incentives with the recently-release meaningful use rule.

Likewise, Rhonda Medows, executive VP and chief medical officer for UnitedHealth's public and senior market group, said alignment with the meaningful use rule and incentives for meeting the rule's targets are going to be a part of the payer's nationwide performance-based contracting program.

UnitedHealth also announced four other programs aimed at boosting the adoption of electronic health records: a "premium designation" performance assessment that will now include the meaningful use of health IT; the development of a cloud computing-based EHR system through its Ingenix business; the availability of zero-interest loans to implement the cloud-based system; and an expansion of its Physician Advocate Program to help providers qualify and apply for meaningful use incentives from the government.

Aetna Senior VP and Chief Medical Officer Lonny Reisman said his company also was incorporating incentives for health IT use. He also announced a cloud computing approach being developed by Aetna subsidiary ActiveHealth Management and IBM called Collaborative Care Solution.

One way all these companies differ from the federal incentive program is that they have no penalties on the back end for not becoming a meaningful user, but none of the panelists during the session thought that would be any kind of hindrance to adoption.

"Physicians already see not getting a bonus as a penalty," Reisman said, suggesting that with the incentives in place, doctors will do what they can to capture them.

-Gregory Twachtman (g.twachtman@elsevier.com)

Private Payers Follow Government Lead In Offering Electronic Health Records Meaningful Use Incentives

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