Evaluation of the Personal Health Record Pilot for Medicare Fee-For Service Enrollees from South Carolina. CMS PHR Initiatives.

08/01/2009

In 2005, the Centers for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) soliciting public feedback on the CMS role with regard to PHRs. Findings from this RFI suggested that CMS should make Medicare data available to beneficiaries and should provide data to outside PHR vendors, use open standards, make available claims data as well as quality information in a timely basis and focus on ensuring high standards for privacy and security[17].  In 2006, the American Health Information Community (AHIC) Consumer Empowerment Workgroup (CEWG) made a recommendation to CMS to pilot programs that measure the value of a Registration Summary and Medication History PHR for patients with chronic conditions and their clinicians[18]. 

In July 2006, CMS awarded contracts to two organizations to test the feasibility of using Medicare claims data to populate personal health records.  One of the goals of the test was to determine if Medicare claims history information could be successfully imported into an Internet-based tool. The contracts were awarded to ViPS, using the WebMD tool, and Capstone Government Solutions, using the SharedHealth tool. The pilot was a success, proving that it was feasible to use Medicare claims data to populate PHRs. Those contracts formed the foundation for the pilots that were initiated in 2007 and 2008.

In 2007, CMS initiated two pilots; one targeting Medicare Fee-for-service (FFS) and one for Medicare Advantage and Part D Plans to assess the use of PHRs by beneficiaries. To expand on findings from both of the PHR pilots, CMS initiated a third pilot in 2009, Medicare PHR Choice Pilot, which will offer Medicare FFS beneficiaries from Arizona and Utah a choice to register for one of four PHRs, each of which consists of a variety of functions.[19] Findings from the FFS and the Managed Care pilots offer important insights related to usability and utility of PHR functions, preferences and challenges of beneficiaries and areas of future research that will inform various activities of the Medicare PHR Choice pilot.  Research methods for the evaluation of the Medicare PHR Choice pilot will include a survey of beneficiary satisfaction with the PHR and analysis of beneficiary claims and usage data.

CMS contracted with Quality Software Services Incorporated (QSSI) to administer the FFS pilot. QSSI worked with three key vendors and other partners to implement MyPHRSC.  Specifically, QSSI obtained its PHR product from HealthTrio[20], a PHR vendor.  As a CMS claims administrator, Palmetto GBA facilitated access to and importing of CMS claims data into the PHR, and IBM performed general consulting in an advisory capacity related to PHRs. MyPHRSC was designed with three central components: data (which include records of patients’ visits, surgeries, procedures, and medications); tools (which help patients plan for their health needs and capture important measurements); and security features (which include functions that protect personal health information as well as allow the user to assign permission to access the PHR).

The Assistant Secretary for Planning and Evaluation (ASPE) contracted with NORC to conduct an evaluation of the FFS PHR pilot.  The study helped CMS better understand Medicare beneficiaries’ experiences using PHRs, their opinions of PHRs in general, and the perceived effects of its usage on their management of their health information.  Analyzing the experiences of this pilot population expanded the understanding of how PHRs could be used to meet the needs of Medicare beneficiaries.    

The report begins with an overview of MyPHRSC followed by the methods section which describes the three phases of the project.  Next, we present results for each of the evaluation activities separately, followed by a discussion which provides a synthesis of the key findings across all evaluation activities. This discussion also highlights beneficiary user characteristics and the key components of PHR usability and utility.  We conclude with a set of recommendations and areas for future research.

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