Chronic Care Improvement with Effective Health IT

Health care in the United States today is marked by growing concern about the gap between the care that Americans actually receive and the quality and efficiency of care that is possible. One of the most significant examples of this gap is the potential for health IT (HIT), effectively used in support of a range of delivery system reforms, to improve results for patients with chronic disease. Such tools may provide important opportunities for achieving better health, while addressing the problem of rising costs at the same time. Consequently, addressing the challenge of effective chronic disease care must be a core focus of meaningful health-care reform. In response to this challenge, a number of multi-payer community- and regionally based initiatives and employer and health plan initiatives are being developed to combine the use of HIT with payment reforms to improve the coordination of care for chronic disease. Preliminary results from several such initiatives suggest that more reliable, accurate, and secure availability of electronic health information can reduce gaps in quality and efficiency.

The Engelberg Center is leading a project designed to build an infrastructure for the development of much better evidence on how payment reforms and HIT can be used to improve care for people with chronic disease. This project will describe, analyze, and synthesize new evidence from community, payer and purchaser initiatives, including Medicare demonstration projects and Medicaid waivers, to guide further policy reforms and close gaps in care coordination nationwide. As part of this project, we will establish informal relationships with each of the sites with the aim of building a “community of communities” to facilitate knowledge-sharing and coordination with respect to the longer-term goals of the project.

In the early stages of the project, the Center will identify opportunities, key strategies, and preliminary evidence on the use of HIT in conjunction with payment reforms as part of a strategy to improve the coordination, effectiveness, and efficiency of chronic disease care. We will develop criteria for evaluating ongoing and future initiatives in this area and apply the criteria to a limited number of pilot sites. This work will in turn help develop a roadmap for larger-scale implementation of the strategies deemed most successful.

The result will be a reliable foundation for the widespread, effective use of HIT supported by financing reforms that are feasible to implement and that have earned maximum confidence based on sound analysis. We will not develop theoretical “use cases,” but rather a clear foundation for practical, achievable rapid applications and “value cases” for adoption that would have the support of a broad range of key stakeholders. While the primary focus of this project will be on closing the significant gaps in quality and efficiency with respect to care coordination, this model of collaborative health-care reform properly implemented could have a broad impact on improving the overall value of the health-care system.

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