RHIO launches next-generation quality effort

The Indiana Health Information Exchange, a prototype for many RHIO efforts across the country, is leading the pack again with its Quality Health First program. IHIE, which delivers online clinical information to doctors from hospitals, pharmacies, and labs, is combining its data with claims data from payers in the Indianapolis area and CMS to provide doctors with what may be the most complete reports on their performance available anywhere in the U.S.

The private and public payers involved in this quality improvement effort—including Wellpoint/Anthem, Medicare, Medicaid, and several local plans—represent about 70 percent of the market. They've all agreed to use standardized measures, and, even more remarkable, they're using the combined data to determine rewards for individual improvement, rather than for meeting specific goals, as most other P4P programs do. These innovations grew out of discussions among employers, plans, and physicians under IHIE's aegis.

The reports that are starting to be provided to primary-care physicians show how they compare with their peers on 26 measures. They also give doctors information about individual patients that they can act on. "We don't want to tell them how to practice medicine," says internist J. Marc Overhage, president and CEO of IHIE. "We just want to give them tools that they can build on." Later on, he adds, specialists and hospitals will also be measured.

Overhage acknowledges there are problems with publishing report cards on individual physicians. Although the Quality Health First data includes far more than typical claims data, and thus should be more accurate, it's still difficult to decide which physician is responsible for providing particular services, he says. If a patient gets a primary-care service from a specialist, for example, it's not fair to penalize that patient's PCP. There are also systemic problems that need to be addressed, admits Overhage.

Nevertheless, when an IHIE committee made up mostly of physicians decides that the results of IHIE's measurement are "meaningful," the organization will make those results public, he says.

Meanwhile, IHIE has received a $1.7 million grant from the Regenstrief Foundation to help small practices join the Quality Health First program. The grant will allow IHIE to explore the resources that small groups need to participate and to develop a sustainable approach to providing those resources.