David Blumenthal, MD, the national health IT coordinator, has asked his advisors to turn to one of the most vexing problems on the health reform horizon: streamlining federal and state systems for enrolling people applying for health insurance benefits under the law.
Blumenthal asked members of the Standards Committee at a meeting April 28 to start to develop standards for exchanging eligibility and enrollment data electronically between what is now a hodgepodge of federal and state health and social health programs and services organizations.
In doing so, he acknowledged both a major new direction - and workload - for ONC.
"Think of this in the same way that we are facilitating better healthcare through standards and interoperability, we have the opportunity to facilitate better coverage through standards and interoperability," he said.
Congress and the administration want to make it easy for people to learn if they are eligible for benefits under the law, which in addition to changes to Medicare and Medicaid calls for setting up 50 new state health insurance plan exchanges for people who lack coverage.
Potential beneficiaries would check their eligibility for such benefits online, where the data necessary to enroll an applicant might be scattered across separate social service and agency databases, like food stamps, a school lunch program, or the state tax department.
The challenge will be to standardize eligibility data that is common to all relevant programs. "The point is to make it as easy to buy health insurance as it is to buy from Amazon," Blumenthal said, referring to the online shopping site.
The standards will make possible electronic matching against federal and state data, vital records, employment history, benefit enrollment systems and tax records for eligibility, said John Halamka, MD, committee co-chairman, describing it as "a very heady body of work." Halamka is also CIO of Beth Israel Deaconess Medical Center.
The standards work would also encompass methods for patient identity matching, electronic documentation for verification of eligibility, re-use of eligibility and patient engagement in the eligibility process, Halamka added.
ONC has begun to discuss the coordination needed for enrollment standardization with other agencies in the Health and Human Services Department, meetings that will include the Internal Revenue Service and the Departments of Treasury, Agriculture and Housing and Urban Development, Blumenthal said.
"All of these organizations have regular electronic contacts with people who are uninsured and are potentially eligible for substantial federal subsidies for expanded federal programs starting in 2014," he said.
In the health reform law, Congress gave the Health and Human Services Department 180 days from enactment to come up with the standards, "a demanding deadline to do something that has been the holy grail of social services," Blumenthal said.
