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CMS program offers PHRs to Medicare population

Senior citizens and computers are not usually thought of as allies, but a new CMS pilot project is testing personal health records (PHR) in the Medicare population.

The pilot project, which will run through September with the possibility for an extension, will offer PHRs to 100,000 beneficiaries in Medicare’s fee-for-service program in South Carolina. 

Medicare will populate the PHRs by importing two years of claims data, including diagnoses, procedures, tests, and hospitalizations. The project will not initially include pharmacy claims, although individuals will be able to add their prescriptions into the tool.

The PHRs are being offered by HealthTrio in Centennial, CO, which already provides these tools to more than 100,000 individuals through their employers. The contract is being managed by QSSI, which has partnered with Palmetto GBA and IBM.

“This is a tremendous opportunity for CMS to show that they are very interested and very aware of how to help [Medicare beneficiaries] gain information and knowledge [about their healthcare],” says Dave Syposs, vice president of product marketing and sales support at HealthTrio.

Lorraine Tunis Doo, senior policy advisor for the Office of eHealth Standards and Services at CMS, says the project is part of a larger initiative in which the federal agency is developing the framework for an infrastructure to support PHRs, and is currently evaluating the many important issues that affect adoption, including privacy, security, and data standards. Doo says CMS plans to work with vendors on PHRs, rather than create its own version.

“We are evaluating how Medicare can provide access to its (claims) data to beneficiaries who want to have their own PHR,” says Doo.

HealthTrio spent several months working with QSSI to develop a PHR that seniors would want to use on a regular basis. “Things that were required were to make it easier to navigate and for visual effect. The product we developed is specific to that population,” says Syposs.

The PHR pilot will use a number of different outreach initiatives to educate seniors about PHRs, including community events and working with caregivers, advocates, and associations. The next edition of Medicare handbooks will provide information about PHRs, and CMS’ Web site has FAQs and general information about PHRs.

“We will continue to work with the Office of External Affairs [at CMS] to identify appropriate and creative ways to educate beneficiaries about PHRs, including collaboration with those community resources who have access to, and are trusted by, seniors,” says Doo.

Doo says CMS will gauge regular utilization and perceived value as guideposts to whether the South Carolina PHR project is successful. The project is the second CMS PHR initiative for Medicare beneficiaries. The other project kicked off in June 2007 and included four insurers offering Medicare Advantage/Part D plans that had existing PHRs.

There are now seven plans participating in that project, and CMS expects to evaluate that pilot within the next few months.

CMS will report the findings to the American Health Information Community and U.S. Department of Health and Human Services Secretary Mike Leavitt by the end of the year, according to Doo.

Joseph C. Kvedar, MD, founder and director of the Center for Connected Health in Boston, a division of Partners HealthCare that is applying communication technology and online resources to improve access to and delivery of quality patient care, says a successful PHR with engaged consumers requires users who have the time, technology expertise, and interest in their health to closely monitor the PHR. Seniors may have the time and interest in their health, but many don’t have computer access or the computer skills necessary to maintain a PHR.

Kvedar suggests that as younger generations with computer experience grow older, PHRs will gain in popularity.

“There’s a much larger group of seniors that are afraid of computers ... It’s going to require a few more years of maturing and graying of the computer-friendly generations to get a significant uptick,” he says.