Private Payers and Meaningful Use

Posted on June 25, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Is it time for Private Payers to join in on Meaningful Use? A number of people are starting to ask this question after CSC released a recent white paper called “Meaningful Use for Health Plans: Five Things to Consider.” I’ve always said that private payers adopting meaningful use would be a HUGE deal and would likely sway many doctors who are on the fence. The question is, will private payers adopt meaningful use?

An article in the American Medical News says they will:

Private insurers are latching onto the government’s meaningful use definition to bolster their own efforts to promote EMR use and possibly impose their own financial penalties for nonuse among contracted physicians, according to the author of a new study looking at the challenges physicians face with meeting meaningful use.

Neil Versel in his story on Fierce Health IT quotes the more reasoned opinion:

“At minimum, plans should use this as an opportunity to reformulate and realign existing pay-for-performance incentives with health IT implementation and meaningful use deadlines,” CSC says. “Minimizing differences between plan-sponsored incentive programs and Centers for Medicare & Medicaid-sponsored programs will also serve to simplify compliance and achievement, for provider organizations.”

Neil also ends with this little zinger, “Those statements are long overdue. Private payers, it’s time to ante up for the quality game.”

My personal feeling is that insurance plans won’t be adopting the meaningful use objectives. That’s not to say that they aren’t or won’t “ante up for the quality game” since healthcare quality could be great for insurers. However, I think it’s a stretch to call the meaningful use objectives a healthcare quality initiative. Maybe that’s the intent, but I think it misses those goals.

The bigger reason why I believe private payers won’t adopt meaningful use is there’s far too much kick back from doctors. Insurers do an interesting dance with doctors and I think that insurance plans won’t want to deal with all the angry doctors if they force meaningful use upon them. Plus, the case that meaningful use actually will provide benefits to private payers is a murky grey with little solid foundation.

Private payers do want doctors using EMR. They do want standards for communication. They do want EMR initiatives to work and quality of care to increase. However, I’ll be surprised if they choose to latch on to meaningful use to achieve these goals. If they do, then meaningful use as means of getting the EHR stimulus will be an afterthought.