EHR Meaningful Use Not Being Embraced by Commercial Carriers

This time last year—amidst all the hoopla surrounding the finalization of the Stage 1 meaningful use requirements—it appeared that the commercial insurance companies were ready to jump on the meaningful use bandwagon and follow the government’s lead. What has happened to their interest? I have not read about the development of such programs since the initial announcement of the carriers’ intentions.

Aetna promised to reward the achievement of specific quality goals, and United HealthGroup, WellPoint, and Highmark (a Blue Cross Blue Shield program) said they were going to make meeting meaningful use criteria the basis for rewards in their programs. The general consensus was that we could expect many more carriers to align their payment systems with the EHR incentive program—but this has not happened.

What caused the private sector to abandon the rush to meaningful use? I believe that the following are the factors preventing private payers from embracing meaningful use and incorporating it into their reimbursement schemes:

  • CMS essentially acknowledges that the clinical quality measure data being collected through meaningful use will be of no real value. We have heard over and over, in response to criticisms levied, that for Stage 1 this is strictly a reporting exercise. Unlike PQRS, there are no thresholds to meet, physicians are being asked to report on measures not relevant to their practice, and no one’s medical practice is being judged on the numbers submitted.
  • Private carriers cannot afford failure. They would like nothing more than to be able to use proven quality measures to drive quality and efficiency so that they can keep their premiums competitive and gain market share. But the evidence is not there yet.
  • There has been a great deal of conversation about whether physicians are being pushed too hard and too fast. Providers are challenged by an overwhelming number of looming IT requirements. Registration for the EHR incentives is moving forward, but attestation numbers and incentive payments are lagging behind expectations.
  • Insurance carriers also have a lot on their plates—health care reform, insurance exchanges, maintaining the required loss ratio, ICD-10, etc. Meaningful use is taking a back seat to other priorities.