Patients in Utah and Arizona on Original Medicare and with Internet access can view and manage their own individual claims electronically starting this January.
The pilot program is part of a general operations upgrade announced by Health and Human Services Secretary Mike Leavitt during a trip to Salt Lake City this past spring to make the Centers for Medicare and Medicaid Services (CMS) more electronically accessible. It also will give those covered by the huge, government-insurance plans more power in managing their own health.
Ultimately, the pilot program is designed to evaluate how well CMS is meeting the needs of those covered by Medicare and will help determine for certain if, as is hoped, personal monitoring will improve overall health outcomes and lower costs the same goals of health-care system improvement strategies now being developed in Utah and several other states.
Giving people more help and thereby more responsibility for their own health-care decisions is central to the pilot plan. Beneficiaries in the two states will sign up for one of the selected commercial personal health record management tools, and CMS will transfer up to two years of a person's claims activity into the individual's personal data account. Private e-record management vendors were sent letters Friday notifying them of the pilot program and soliciting possible data-management options they could offer beneficiaries.
Leavitt said although a new administration will be in Washington come January, and his term as secretary will end before the program begins, such steps making the most use of technology and empowering individuals is a given and must get under way now, no matter the coming changes in personnel next year. Getting a handle on the rampant price increases and making health care more transparent to users is a major concern of states and the federal government. Utah has a special legislative task force considering a number of alterations and has begun drafting legislation initiating changes to enhance data access and management.
Both federal and state governments are betting that giving people more electronic access will ultimately make all facets of the health-care system more transparent to the public and easier for individuals to take more responsibility in their health-care decisions.
"This is a first, but exciting, step forward for Medicare," Leavitt said last week. "We believe that it will provide information and tools that will empower consumers to manage their health and more importantly tailor their plans to their individual needs."
A key reason why 40 million Americans don't have medical insurance and why employers have dropped offering medical benefit plans at work is they must buy coverage for health-care procedures they don't use.
"Anything that helps people tailor benefits and use to the individual is an improvement in the system," Leavitt said, noting that the era of people being buffered from the real cost and course of their own care is ending.
Almost every state economic forecast regarding health care by both private business and government agencies show that if the system isn't drastically altered and soon, the price of insurance premiums alone will equal the average household income in Utah by 2020.
The situation is simply unsustainable and broad-based adjustments have to be made, Leavitt said. But changes down to each and every individual have to be made if any systemic adjustments are going to have any significant and long-term effect.
That's why a personal health record under the control of the consumer or patient matters. They may be able to authorize links to other personal electronic information such as pharmacy data, which CMS hopes will be made easier and literally more legible under a change announced two weeks ago to allow doctors to prescribe medications electronically for Medicaid and Medicare patients.
Personal health records would offer links to tools that help consumers manage their health such as wellness programs for tracking diet and exercise, medical devices, health education information and applications to detect potential medication interactions.Personal health records vendors who want more information about the pilot program can visit www.NoridianMedicare.com/phr/, or they can send an e-mail to email@example.com.