Value-based payment models drive physicians to use EHRs to improve care

Physicians who use EHRs and are in accountable care organizations or patient-centered medical homes are more likely to use care coordination, quality measurement, patient engagement and population health management strategies, according to a study published in the American Journal of Managed Care.

Researchers sought to determine whether physicians using health IT and working within these new reimbursement models were using improved care processes. Jennifer King, PhD, Vaishali Patel, PhD, Eric Jamoom, PhD, and Catherine DesRoches, DrPH, examined cross-sectional data on office-based physicians from the 2012 National Ambulatory Medical Care Survey Physician Workflow Survey.

"Early indicators suggest strong physician participation in initiatives to support health IT adoption and to reform healthcare payment and delivery," they wrote. "However, evidence on whether provider participation in these initiatives has translated to better care delivery is just beginning to emerge."

Studies conducted prior to HITECH and the Affordable Care Act found health IT and external reporting or payment incentives to be associated with a higher likelihood of performing these care processes, they wrote, but "they are performed at low rates even when these factors are in place."

King et al. examined how ACO and PCMH physicians used their EHRs for 14 specific processes in the four categories of population management, quality measurement, patient communication and care coordination.

"Physicians who were using EHRs in combination with participation in ACO or PCMH initiatives had the highest likelihood of routinely performing the care processes," wrote the authors, adding these physicians "were between 6 and 22 percentage points more likely to routinely perform the care processes than physicians with EHRs alone."

While fewer than half (44 percent) reported routinely doing quality measurement, substantial majorities of physicians said they routinely engage in care coordination (89 percent), patient communication (69 percent) and population management (67 percent).

"Given the cross-sectional nature of this study, these results do not establish a causal relationship between payment reform, EHR use and these care processes," the authors wrote. "Nonetheless, this finding is consistent with other research that shows that healthcare providers are most likely to perform these care processes when practicing in a payment environment that incentivizes and supports such care."