<DOC>
[109th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:33251.wais]
H.R. 4859, PART II, HEALTHIER FEDS AND FAMILIES: INTRODUCING
INFORMATION TECHNOLOGY INTO THE FEDERAL EMPLOYEES HEALTH BENEFITS
PROGRAM
=======================================================================
HEARING
before the
SUBCOMMITTEE ON THE FEDERAL WORKFORCE
AND AGENCY ORGANIZATION
of the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
ON
H.R. 4859
TO AMEND CHAPTER 89 OF TITLE 5, UNITED STATES CODE, TO PROVIDE FOR THE
IMPLEMENTATION OF A SYSTEM OF ELECTRONIC HEALTH RECORDS UNDER THE
FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
__________
JUNE 13, 2006
__________
Serial No. 109-215
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
http://www.house.gov/reform
______
U.S. GOVERNMENT PRINTING OFFICE
33-251 WASHINGTON : 2007
_____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512ÿ091800
Fax: (202) 512ÿ092250 Mail: Stop SSOP, Washington, DC 20402ÿ090001
COMMITTEE ON GOVERNMENT REFORM
TOM DAVIS, Virginia, Chairman
CHRISTOPHER SHAYS, Connecticut HENRY A. WAXMAN, California
DAN BURTON, Indiana TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania
GIL GUTKNECHT, Minnesota CAROLYN B. MALONEY, New York
MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
STEVEN C. LaTOURETTE, Ohio DENNIS J. KUCINICH, Ohio
TODD RUSSELL PLATTS, Pennsylvania DANNY K. DAVIS, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
JOHN J. DUNCAN, Jr., Tennessee DIANE E. WATSON, California
CANDICE S. MILLER, Michigan STEPHEN F. LYNCH, Massachusetts
MICHAEL R. TURNER, Ohio CHRIS VAN HOLLEN, Maryland
DARRELL E. ISSA, California LINDA T. SANCHEZ, California
JON C. PORTER, Nevada C.A. DUTCH RUPPERSBERGER, Maryland
KENNY MARCHANT, Texas BRIAN HIGGINS, New York
LYNN A. WESTMORELAND, Georgia ELEANOR HOLMES NORTON, District of
PATRICK T. McHENRY, North Carolina Columbia
CHARLES W. DENT, Pennsylvania ------
VIRGINIA FOXX, North Carolina BERNARD SANDERS, Vermont
JEAN SCHMIDT, Ohio (Independent)
------ ------
David Marin, Staff Director
Lawrence Halloran, Deputy Staff Director
Teresa Austin, Chief Clerk
Phil Barnett, Minority Chief of Staff/Chief Counsel
Subcommittee on the Federal Workforce and Agency Organization
JON C. PORTER, Nevada, Chairman
JOHN L. MICA, Florida DANNY K. DAVIS, Illinois
TOM DAVIS, Virginia MAJOR R. OWENS, New York
DARRELL E. ISSA, California ELEANOR HOLMES NORTON, District of
KENNY MARCHANT, Texas Columbia
PATRICK T. McHENRY, North Carolina ELIJAH E. CUMMINGS, Maryland
JEAN SCHMIDT, Ohio CHRIS VAN HOLLEN, Maryland
Ex Officio
HENRY A. WAXMAN, California
Ron Martinson, Staff Director
Shannon Meade, Professional Staff Member
Alex Cooper, Clerk
Adam Bordes, Minority Professional Staff Member
C O N T E N T S
----------
Page
Hearing held on June 13, 2006.................................... 1
Text of H.R. 4859................................................ 6
Statement of:
Fallis, Charles, president, National Active and Retired
Federal Employees Association; Colleen Kelley, national
president, National Treasury Employees Union; Jacqueline
Simon, director of public policy, American Federation of
Government Employees; Archelle Georgiou, M.D., executive
vice president, strategic relations, specialized care
services, UnitedHealth Group; Stephen W. Gammarino, senior
vice president, national programs, Blue Cross and Blue
Shield Association; and Joe Witkowski, vice president,
Government Employees Hospital Association, Inc............. 38
Fallis, Charles.......................................... 38
Gammarino, Stephen W..................................... 80
Georgiou, Archelle....................................... 69
Kelley, Colleen.......................................... 47
Simon, Jacqueline........................................ 57
Witkowski, Joe........................................... 91
Green, Dan, Deputy Associate Director, Center for Employee
and Family Support Policy, Office of Personnel Management.. 21
Letters, statements, etc., submitted for the record by:
Fallis, Charles, president, National Active and Retired
Federal Employees Association, prepared statement of....... 41
Gammarino, Stephen W., senior vice president, national
programs, Blue Cross and Blue Shield Association, prepared
statement of............................................... 82
Georgiou, Archelle, M.D., executive vice president, strategic
relations, specialized care services, UnitedHealth Group,
prepared statement of...................................... 72
Green, Dan, Deputy Associate Director, Center for Employee
and Family Support Policy, Office of Personnel Management.. 24
Kelley, Colleen, national president, National Treasury
Employees Union, prepared statement of..................... 50
Simon, Jacqueline, director of public policy, American
Federation of Government Employees, prepared statement of.. 60
Witkowski, Joe, vice president, Government Employees Hospital
Association, Inc., prepared statement of................... 94
H.R. 4859, PART II, HEALTHIER FEDS AND FAMILIES: INTRODUCING
INFORMATION TECHNOLOGY INTO THE FEDERAL EMPLOYEES HEALTH BENEFITS
PROGRAM
----------
TUESDAY, JUNE 13, 2006
House of Representatives,
Subcommittee on Federal Workforce and Agency
Organization,
Committee on Government Reform,
Washington, DC.
The subcommittee met, pursuant to notice, at 2 p.m., in
room 2154, Rayburn House Office Building, Hon. Jon C. Porter
(chairman of the subcommittee) presiding.
Present: Representatives Porter, Marchant, Schmidt, Davis
of Illinois, Norton, and Clay.
Staff present: Ronald Martinson, staff director; Chad
Bungard, deputy staff director/chief counsel; Shannon Meade,
professional staff member; Patrick Jennings, OPM detailee/
senior counsel; Chad Christofferson and Alex Cooper,
legislative assistants; Adam Bordes, Tania Shand, and Mark
Stephenson, minority professional staff members; and Neil
Shader, minority staff assistant.
Mr. Porter. I'd like to bring the meeting to order. I
appreciate you all being here today.
This is a hearing on Healthier Feds and Families:
Introducing Information Technology into the Federal Employees
Health Benefits Program, a Legislative Hearing on H.R. 4859,
Part II.
We will probably be called for votes here momentarily, but
I do know we have a special guest with us, so I'd like to do my
opening and then have Mr. Clay give his opening, and then, by
that time, we should be taking a recess for probably 15, 20
minutes.
So, again, thank you all for being here. This is the third
hearing that I've chaired that will examine the need to improve
the quality and delivery of healthcare within the Federal
Employee's Health Benefits Program and the second hearing that
focuses on the bill that I and Representative Lacy Clay from
Missouri have introduced; that's H.R. 4859, the Federal Family
Health Information Technology Act.
As a primary sponsor of H.R. 4859, I often get asked by
Federal employees and others the following question: How will
electronic health records [EHR], proposed in my bill help the
employees? Well, it's quite simple and clear. What the last two
hearings have taught us is that the EHR, as proposed under H.R.
4859, will reduce medical errors, lower the cost of healthcare
and improve quality of care while at the same time empowering
consumers by giving them and their providers access to critical
information about their health status and medical needs.
At the last hearing on H.R. 4859, former Speaker of the
House Newt Gingrich stated from his testimony, which was
extremely powerful, that paper kills. He continued: Instead of
saving lives, our current paper-based health system is taking
them, with as many as 98,000 Americans still being killed by
medical errors every year. Ridding the system of paper-based
records and quickly adopting health information technology will
save lives and at the same time save money.
H.R. 4859 will also improve the quality of care. At that
same hearing, IBM testified that the implementation of personal
electronic health records for its employees has played a major
part in making IBMers healthier and others in the industry, and
lowering healthcare premiums. Substantially reducing medical
errors and improving the quality and delivery of care within
the FEHBP will be a welcomed improvement in and of itself, but
like the old commercials for the ginseng knives used to say,
but, wait, there's more, the implementation of H.R. 4859 should
lower the cost of healthcare for all the participants in FEHBP
over time.
In my home State of Nevada, Health Plan of Nevada's
transition from paper records to electronic records have saved
them nearly $1.7 million to date, resulting from a more than 50
percent reduction in medical records, staffing and paperwork.
In drafting H.R. 4859, my staff and I have met with over
three dozen different stakeholders, including trade
organizations, nonprofit organizations, hospitals, various
companies, employee groups and Federal agencies. I have very
much appreciated their advice and input from all of them and
have learned a great deal.
Staff and I have also examined many demonstration projects
using electronic health records, including regional health
information organizations, and have gone to physician offices
and hospitals to see the effectiveness of health information
technology firsthand.
The reason that we have invested so much time on this
legislation is because we want to do it right. I'm pleased to
announce that, in addition to some of the organizations with us
today, the Federal Family Health Insurance Health Information
Technology Act has received a significant amount of public
support, including Mr. Newt Gingrich, the Health Information
Management Systems Society, which has almost 300 corporate
members, IBM corporation, the ERISA Industry Committee and U.S.
Chamber of Commerce, among many others.
Additionally, in its program carrier letter for fiscal year
2007, issued a month after the introduction of H.R. 4859, the
Office of Personnel Management for the first time expressed its
expectations that carriers will work toward creating carrier-
based and personal electronic health records.
The Federal Family Health Information Technology Act is
designed to provide the voluntary electronic health records to
the FEHBP participants cost free while at the same time
maintaining strict adherence to HIPAA. This means that, during
implementation, carriers will be unable to pass costs on to
FEHBP participants because all carriers must contract with OPM
annually. I believe this explicit requirement will be a
reality, especially with continued aggressive congressional
oversight. Moreover, if history is any indication, the
implementation of H.R. 4859 could also lead to lower premiums.
The Federal Family Health Information Technology Act
requires carriers participating in the Federal Employees Health
Benefits Program to provide their members with two types of
electronic records, a carrier-based electronic health record
and a personal electronic health record. The carrier-based
electronic health record will provide valuable information by
leveraging the claims data, technology and capabilities of
health plans to improve healthcare decisions by patients and
providers. This claims information already exists and is
maintained by the carrier. In fact, most carriers use this
claims-based information for disease and care management. The
bill simply requires a carrier to make it available for a
member. It is a shame that many carriers do not make this
information available to their members today.
The trend, however, is looking up as many carriers are
moving in this direction, such as United Health Care and Blue
Cross Blue Shield of Texas, Delaware and Illinois, just to list
a few. The bill will require that carriers that want to do
business with and participate in FEHBP make this information
available upon request to its members.
Contracts between OPM and insurance carriers also will
require carriers, upon the request of a member, to provide for
the establishment and maintenance of a personal electronic
health record for their members. This record will be controlled
by the individual, and it will contain personal health
information the individual chooses to include, such as personal
and family health histories, symptoms, over-the-counter
medication use, diet, exercise or other relevant health
information activities. The creation of a personal electronic-
based health record will simply provide program participants
with greater control over their health information.
The bill also requires the carriers to make electronic
health records available in some portable fashion to all
requesting FEHBP members.
With the 109th Congress heading toward a close, I intend to
move forward in short order--I like to say we're moving toward
a close; we're being very optimistic--I intend to move forward
in the short order on subcommittee consideration of H.R. 4859.
However, let me reemphasize the commitment to getting this bill
right. That is what these hearings are about and the countless
meetings and discussions on this bill that I've had to date.
Based on some of these discussions, I've already agreed to
work on some changes. Both the National Association of Active
and Retired Federal Employees and the National Treasury
Employees Union have expressed uneasiness about our inclusion
of a provision that would allow the unused portion of FEHBP's 1
percent administrative fee to be made available to help fund
the implementation of electronic health records. I've agreed to
eliminate that provision at this time prior to mark-up. In
addition, all employee groups with us today, NARFE, NTEU and
the American Federation of Government Employees have expressed
concern about certain older annuitants or employees who are not
computer savvy or lack access to a Web-based portal but who
should have the same ability to access and input information
into the electronic health records as those who are computer
savvy. This is an important concern and a matter that must be
dealt with accordingly, and I look forward to working with
these groups on appropriate language prior to the mark-up.
It's also important to clarify that H.R. 4859 does not
intend in any way to get ahead of standards being developed and
is intended to provide both flexibility for appropriate market
determinations and for OPM to administer the program. The
Office of National Coordinator for Health Information
Technology within the Department of Health and Human Services
is fostering certification and harmonizing standards by
creating a cooperative environment within and outside the
Federal Government to ensure that consensus industry standards
are developed and adapted in both the private and the public
sectors. The certification process will determine whether the
particular products, like electronic health records, meet
minimum requirements as identified by the industry-led
cooperative effort.
Another process already underway will identify harmonized
standards to ensure that a full array of nonconflicting
standards is available to the industry. I'll continue to work
with HHS prior to the mark-up to get technical assistance to
ensure that H.R. 4859 does not get ahead of the game with
regard to standards and does not inadvertently lead to
conflicting standards which could be a barrier to
interoperability and patient portability of health information.
Privacy remains a major concern for a number of
individuals, and rightly so, especially in light of the recent
theft of data from the Veterans' Affairs employees. There is
nothing more personal and private than a person's medical
information. The Federal Family Health Information Technology
Act intends to ensure that a participant's medical information
is kept private and secure by requiring compliance with the
Health Insurance Portability and Accountability Act.
HHS has committed to provide technical assistance to ensure
that the language in H.R. 4859, which is intended to be wholly
consistent with and not modify HIPAA, does not inadvertently
alter it in any way.
In addition, there are some great minds at HHS thinking
long and hard about this important issue, particularly through
the work of the Health Information Security and Privacy
Collaboration. HHS should also at some point consider revising
the regulations to ensure HIPAA is adequate and strong enough
to protect our privacy.
Technology has been booming in America and in the world
over the past couple of decades. As always, change has been
harder for some to accept than others. Change is always hard,
especially technological change because it involves a change of
culture as well.
Some doctors see the benefits of electronic health records,
and some are stuck to paper. Some carriers are leading change
and providing carrier-based electronic health records and
personal electronic health records to their members as the bill
proposes, and some are waiting for the last possible moment
before they have to provide this level of information to their
members.
The Federal Family Health Information Technology Act is not
for show or some kind of exercise in futility; it's about
improving the quality and the delivery of healthcare within the
Federal Employees Health Benefits Program. The technology is
available today. The technology will save and improve lives.
It's here today, it's being used around the country. We cannot
in good conscience continue to deny existing information held
by carriers to be used for treatment. To keep ignoring the
substantial benefits associated with the health information
technology is to allow senseless deaths caused by preventable
medical errors to continue to prevent the highest possible
quality of healthcare to be delivered. This is akin to a
hospital rushing an individual to a hospital without using an
ambulance. The Federal Employees Health Benefits Program cannot
afford to wait any longer; to do so would unnecessarily cost
lives, health and productivity and of course money.
I look forward to the discussions today and to all of our
witnesses' testimony, and I would now like to introduce my
colleague, Mr. Lacy Clay, for some comments.
Thank you for being here.
[The text of H.R. 4859 follows:]
[GRAPHIC] [TIFF OMITTED] T3251.057
[GRAPHIC] [TIFF OMITTED] T3251.058
[GRAPHIC] [TIFF OMITTED] T3251.059
[GRAPHIC] [TIFF OMITTED] T3251.060
[GRAPHIC] [TIFF OMITTED] T3251.061
[GRAPHIC] [TIFF OMITTED] T3251.062
[GRAPHIC] [TIFF OMITTED] T3251.063
[GRAPHIC] [TIFF OMITTED] T3251.064
[GRAPHIC] [TIFF OMITTED] T3251.065
[GRAPHIC] [TIFF OMITTED] T3251.066
[GRAPHIC] [TIFF OMITTED] T3251.067
[GRAPHIC] [TIFF OMITTED] T3251.068
Mr. Clay. Thank you very much.
Mr. Chairman, let me begin by expressing my gratitude to
you, Mr. Chairman, for inviting me to formally address the
Federal Workforce Subcommittee this afternoon. It has been both
an honor and privilege working with you on health IT issues.
As I believe, health IT has the potential to benefit our
public health infrastructure for generations to come. In 2003,
the Institute of Medicine estimated our total national
expenditures on healthcare to be approximately $1.7 trillion of
our economy. Much of this is driven by government efforts to
make the provision of healthcare a public good for all to
benefit from. Through programs such as Medicare and Medicaid as
well as some insurance programs for Federal employees, we have
sought to provide equality among all individuals needing
healthcare, regardless of socioeconomic need or circumstances.
From this perspective, I believe it is time for the Federal
Government to lead in the development and adaptation of a
nationwide health information network that can diminish such
barriers and improve upon the quality of care provided to all
of our citizens.
The widespread adoption of health information technology
will provide a platform for delivering higher quality care more
efficiently and economically than current paper-based record
information systems.
No better example of this can be offered than from my home
State of Missouri where Medicaid providers and chronically ill
patients are working to develop Web-based collaborative medical
records that will ensure improved case management and treatment
options for our participants. Since the enactment of the Health
Insurance Portability and Accountability Act of 1996, the
adaptation of electronic health information among private
industry has made significant progress. A recent report from
the Center for Study in Health System Change validates this
assessment, as recent surveys indicate that the number of
doctors having access to information technology for key
clinical activities such as e-prescribing has nearly doubled to
about 20 percent since 2001.
Nevertheless, this is still only one-fifth of our Nation's
doctors, and more needs to be done in order to achieve
widespread access across geographic and socioeconomic
boundaries.
Furthermore, vendor requirements for information security
and stringent uniform privacy standards that exceed current
HIPAA regulations must be established if patients are to have
confidence in e-health solutions. The only way to achieve these
outcomes, I believe, is through the leadership of the Federal
Government. This is why I have partnered with Chairman Porter
on legislation that will strengthen the Federal Government's
role in health information technology.
I am a proud co-sponsor of H.R. 4859, the Federal Family
Health Information Technology Act of 2006, as authored by
Chairman Porter. Simply put, this bill utilizes the market
power of the Federal Government by establishing a process for
the development of electronic health records for all Federal
employees.
By utilizing our Federal Employees Health Benefits Program
as a model for electronic health record adaptation, we are
creating a model for consumers, employers and insurers to build
comprehensive electronic health records for all individuals.
I've also introduced H.R. 4832, the Electronic Health
Information Technology Act of 2006, along With Chairman Porter.
H.R. 4832 seeks to accomplish two major goals: First, it will
codify the current Office of the National Coordinator for
Health Information Technology at HHS and preserve its role as
the leading health information technology standard setting
authority in the Federal Government. Second, the bill seeks to
partner with the private sector through grants in a direct loan
program that will provide key economic assistance for
institutions seeking to expand their electronic health record
capabilities.
If we continue our pursuit of utilizing IT throughout the
healthcare delivery system, we are sure to experience shorter
hospital stays, improved management of chronic disease and the
reduction in the number of needles tests and examinations
administered over time. While it is not a panacea, I believe
the creation of such a network will prove far more efficient in
both economic and human terms than its financial cost.
Mr. Chairman, this concludes my remarks, and I ask that
they be included in the record.
Mr. Porter. With no objection.
Thank you, Mr. Clay. I appreciate your hard work and your
efforts to improve healthcare. Thank you very much.
We are going to go into recess for a few moments to go have
votes on the floor. But shortly after the recess, I am going to
embarrass a couple of friends that are here, so I'm first going
to recess.
[Recess.]
Mr. Porter. I'd like to bring the meeting back to order.
Thank you for your patience. I appreciate everyone still being
here.
And as I was rushing out to vote, I did have an opportunity
to recognize my good friend, Ron Martinson, on his 25th wedding
anniversary, he and Wanda. And again, it's an honor for me to
do that, and I'm sorry we had to do that in a hurry, but
congratulations.
Also, I would like to formerly acknowledge that Mr. Clay
will be serving as part of the committee.
Lacy, again, thank you for your testimony earlier.
And I'd like to now turn over to Mr. Davis for an opening
statement.
Mr. Davis of Illinois. Well, thank you very much, Mr.
Chairman. And let me apologize for coming a bit late, but I
also want to congratulate Mr. Martinson on his 25th wedding
anniversary. Anybody who stays married for 25 years in this day
and age deserves some commendation. As a matter of fact, that's
what kept me away; we had a bill promoting responsible
fatherhood on the floor that I was managing, so that's why I
wasn't here. So he fit right in with that.
But let me just thank you, Mr. Chairman, for calling this
hearing and for calling this meeting, but also for the
leadership that you've provided to this subcommittee. And it
has certainly been a pleasure working with you.
Chairman Porter, H.R. 4859, the Federal Family Health
Information Technology Act, which you sponsored with
Representative Clay, is a very forward-thinking bill with a
very worthwhile objective, to improve the quality and delivery
of healthcare for Federal Employees Health Benefits Program,
the FEHBP participants.
An integrated system of medical records could be
particularly beneficial to a patient being treated for a
complex condition by a number of different specialists. All of
the treating physicians would be able to access all of the
patients' records, lessening the possibility that one physician
would prescribe a treatment that would interact improperly with
the treatment prescribed by another physician.
While the bill pushes us in the direction of using
technology to collect, store, retrieve and transfer health
information electronically, many important questions and
concerns remain. For example, one, do insurance providers
collect the type of data that would be useful for diagnosis and
treatment as the bill requires? The insurance claims data may
record the date and cost of a patient's blood tests, but do
they record the results of the blood tests? Under the bill,
providers would be required to create and make available a
carrier-based--that is, electronic health record--for all
covered individuals and to a healthcare provider treating the
individual. As unwise as it may seem, what if an enrollee
simply does not want an electronic health record and if such a
file were created, which health provider would the file be
transmitted to?
In addition to the privacy concerns, there is the question
of interoperability. The Office of Personnel Management and
America's health insurance plans indicate that the bill would
create a proliferation of numerous personal health record
models and make standardization and interoperability very
difficult to achieve. It has been suggested that a pilot
program testing personal electronic health records of FEHBP
enrollees may be a better way to proceed. I hope that our
witnesses will address this option in their testimony.
Again, Mr. Chairman, I want to thank you. And I was just
thinking that when I first worked in the community health
centers, the first task that I had was to help develop
something called a problem-oriented medical records program
some years ago. So I come to this with a little bit of not only
interest, but also some experience, and it's delightful to see
us move in this direction. And so I commend you and Mr. Clay
for introducing this legislation and look forward to our
witnesses.
Mr. Porter. Thank you, Mr. Davis. We do need your
expertise, so we're glad you're a part of this team.
Mr. Clay, anything you would like to add at this time?
You're more than welcome to.
Mr. Clay. No.
Mr. Porter. I'd like to do some procedural matters. First
all of, I ask unanimous consent that all Members have 5
legislative days to submit written statements and questions for
the hearing record and any answers to the written questions
provided by the witnesses also be included in the record.
Without objection, it is so ordered.
I ask unanimous consent that all exhibits, documents and
other materials referred to by Members and the witnesses may be
included in the hearing record, and that all Members be
permitted to revise and extend their remarks. Without
objection, it is so ordered.
And it's also the practice of this committee to administer
the oath to all witnesses. If all the witnesses would please
stand, I will administer the oath at one time.
[Witnesses sworn.]
Mr. Porter. Let the record reflect all witnesses have
answered in the affirmative. And please be seated at this time.
I'd like to invite our first witness to the table, I
believe he is already with us. The witness will be recognized
for an opening statement. I would ask you to summarize your
testimony in about 5 minutes if at all possible. Any further
statements you may wish will be included in the record.
Of course we have heard from Mr. Clay at this point, so we
will now move into Mr. Dan Green. We appreciate you being here.
Deputy Associate Director with the Center for Employee and
Family Support Policy at the Office of Personnel Management,
and I thank you for being here.
STATEMENT OF DAN GREEN, DEPUTY ASSOCIATE DIRECTOR, CENTER FOR
EMPLOYEE AND FAMILY SUPPORT POLICY, OFFICE OF PERSONNEL
MANAGEMENT
Mr. Green. Thank you, Mr. Chairman.
Mr. Chairman and members of the subcommittee, thank you for
your invitation to discuss H.R. 4859. I am here to speak about
OPM's role in administering the Federal Employees Health
Benefits Program. The FEHBP program covers approximately 800
employees and their families. The program offers competitive
health benefits products for Federal workers like large private
sector employers by contracting with private sector health
plans. OPM has consistently encouraged FEHBP plans to be
responsive to consumer interests by emphasizing flexibility and
consumer choice as key features of the program. In our call
letter last year, we encouraged carriers to take steps to
expand and improve on their health information technology
efforts. While there are wide variations in the scope and
extent of information technology currently being used by FEHBP
carriers, most are focusing their efforts on providing claims-
based information through their Web sites linking disease
management problems to HIT initiatives and prescribing e-
prescribing incentives.
This year, we encouraged FEHBP plans to make personal
claims data available to enrollees, to continue working with
their pharmacy benefit managers to provide incentives for e-
prescribing, to link their disease management programs to HIT
and to ensure compliance with Federal requirements that protect
the privacy of individually identifiable health information.
In our call letter, we also ask FEHBP carriers to develop
business plans with action items and milestones for
accelerating HIT for the remainder of 2006 and for 2007. We
also plan to expand our Web site information to highlight the
HIT capabilities and plans so that prospective enrollees can
view this information in reviewing their health plan choices
for 2007.
We are committed to confronting the rising cost of
healthcare, to help members of the Federal family afford the
insurance coverage they need. We believe transparency in
healthcare costs and quality can help patients better control
their medical expenses. Therefore, we are taking steps in the
FEHBP program to raise the level of transparency.
This year's call letter asks carriers to make pricing
information available to enrollees. Director Linda Springer and
senior staff personally met with a number of carriers to urge
them to provide specific information on their Web sites to help
consumers make better informed choices during this year's open
season. We are encouraging carriers to administer online
decision tools with cost estimators related to both diagnosis
and drugs to group costs for common illnesses and conditions by
geographic area, and to ensure that they describe the sources,
limitations and currency of the data clearly and prominently on
their Web sites.
Our commitment to transparency aligns with our efforts to
promote wider use of HIT. IT will provide for standardized
interoperable medical, pharmaceutical and laboratory costs and
utilization information. Making this information more
transparent to consumers will help them to understand the value
of personal health information in managing their own health
needs and their healthcare expenses.
There is much HIT research and development activity
underway. Under an HHS contract, the Health Information
Technology Standards Panel is developing a process for a set of
health IT standards that will support interoperability among
healthcare software applications. The HITSP standards, the
first of which are expected to be delivered this September,
will form the basis for implementation of new HIT initiatives.
OPM intends to join other Federal health programs in ensuring
that these standards are adopted as soon as possible.
OPM appreciates your interest in health information
technology as shown by your introduction of legislation H.R.
4859. And while we agree with the legislation in principle, we
do have some concerns with some of its provisions. We believe
that rather than stressing the need for a carrier-based
personal health record, the bill should focus more on the
implementation of interoperability standards covering carrier
information. Health information, whether it originates from the
carrier or the provider, can be most useful to consumers when
the information is available in a standardized format.
The bill provides for an incentive plan that will allow OPM
to provide funds to carriers to help their contract and medical
providers adopt interoperable technology systems. This is an
innovative concept. The FEHBP program, though, has no
experience in operating a charitable trust fund as envisioned
in the bill for administering the grant process.
Finally, I would like to express our support for your
attention to the very important issue of privacy and security
of personal health information.
H.R. 4859 recognizes that consumers have a right to
privacy. We believe privacy is an important consumer concern,
and that no compromise will be acceptable.
We appreciate this opportunity to testify before the
subcommittee and look forward to working with you on furthering
the Health Information Technology Initiative. I'll be glad to
answer any questions you may have.
[The prepared statement of Mr. Green follows:]
[GRAPHIC] [TIFF OMITTED] T3251.001
[GRAPHIC] [TIFF OMITTED] T3251.002
[GRAPHIC] [TIFF OMITTED] T3251.003
[GRAPHIC] [TIFF OMITTED] T3251.004
[GRAPHIC] [TIFF OMITTED] T3251.005
[GRAPHIC] [TIFF OMITTED] T3251.006
[GRAPHIC] [TIFF OMITTED] T3251.007
[GRAPHIC] [TIFF OMITTED] T3251.008
[GRAPHIC] [TIFF OMITTED] T3251.009
Mr. Porter. Thank you, Mr. Green. We appreciate you.
And certainly all of your colleagues at OPM have been very
responsive to all of our needs, and I appreciate that.
For the audience, and for the record, could you explain how
a call letter works and what it means, what it does?
Mr. Green. Certainly, yes, sir. We contract with some 270
plan choices in the Federal Employees Health Benefits Program.
In late March, early April, of each year, we issue a call
letter which calls for carriers to provide to us their proposed
benefit and rate changes for the next plan year. For instance,
this year, on April 4th, we issued the call letter for the 2007
contract year. In that call letter----
Mr. Porter. Excuse me, Mr. Green. So what would be a
contract year? Is it October to July? Is it January----
Mr. Green. A contract year is a calendar year, yes, sir.
We have an open season in November, and enrollees are
allowed to change plans effective the first pay period of the
next year. So working backward from that, we like to, by
September of the previous year, we need to have ready for all
the members information about how their plans will change in
the upcoming year, what the rates will be, what the benefit
changes will be. And then we share that information and market
that information to enrollees during the fall. So we're working
backward. We need the summer to negotiate rates and benefits.
So the call letter in April asks the carriers what changes
they propose for the upcoming year, and we give our guidance,
the things that we expect from carriers in both rates and
benefits as well as in the administration of the program and
the types of things that we want them to work toward. And
health information technology was one of those things. We
receive their rate and benefit proposals May 31st by
regulation.
Mr. Porter. Plus it's purely optional for a company even to
submit a bid or a--what is it called when they submit? Is it
called a bid? Is it called a proposal?
Mr. Green. Well, they apply to join the FEHBP program. But
all carriers that are currently in the program the previous
year are sent the call letter under the assumption that they
will continue. But, yes, that is correct----
Mr. Porter. So if they choose not to follow your
guidelines, or Congress, they don't have to submit a proposal.
Mr. Green. No, absolutely not. They can withdraw from the
program at the end of any contract year.
Mr. Porter. Thank you. So if they actuarially determine
it's not profitable for them to submit their proposal again, it
is purely optional.
Mr. Green. Precisely.
Mr. Porter. As I said, the bill does not intend in any way
to get ahead of standards, provides flexibility for appropriate
market determinations and for OPM to administer the program.
Will you and HHS continue to work with my staff in providing
technical assistance before the subcommittee mark-up on H.R.
4859 so we can get it right and do it right the first time?
Mr. Green. Absolutely, sir.
Mr. Porter. Well, I knew the answer to that, but I still
needed to ask that question.
Mr. Green. Absolutely, we will.
Mr. Porter. Your call letter that you sent out to the
businesses did mention the accelerating HIT. Have any plans
been submitted yet to address this?
Mr. Green. Yes, sir. We have received the rate and benefit
proposals from all of our carriers as regulations proscribe by
May 31st. That information is now being sifted through. We will
analyze it, and we will work with carriers where we see they
were incomplete in their answers or where they have innovative
ideas. And during the negotiation season, during the summer, we
will be analyzing that and consolidating that information and
finding out where they propose to go and if that fits in with
our plans as well.
Now, this is proprietary information and is not releasable
until rates and benefits are announced.
Mr. Porter. Absolutely. And I understand that.
The companies, when they receive the call letter, do you
use a scoring system? What if they choose on your call letter--
because it addresses other issues, not just HIT, what if they
choose not to address an issue that is not in the call letter?
Is there a matrix or anything else that you use to determine
responsiveness?
Mr. Green. Yes, sir, we do have a matrix. There's a number
of points. If they aren't responsive to our call letter's
information, do not provide information, we go back to them and
work with them until we do get the information. If they are
still not responsive, we have a system that provides penalties.
We negotiate profit with the plans as well, and if plans are
not cooperating with our program initiatives, then they could
receive a reduction in profit.
However, I hasten to add that rarely happens. Our plans, as
you point out, voluntarily participate in the FEHBP program,
and we've found them all to be very supportive of our
initiatives, and we try to work with them to make sure that the
ways we are going are the ways that benefit our common
customer, our Federal employees and retirees. We have that in
common with all of our health plans.
Mr. Porter. Do you think that we'll be able to address some
of the concerns that have been brought up regarding privacy and
those issues? Do you think we'll be able to address that
appropriately and provide the proper privacy for our
participants?
Mr. Green. Yes, sir, I do. And we share those concerns with
you and with the others that have brought them up. We have
that, along with the health and welfare of our enrollees,
uppermost in our minds; their right to privacy is extremely
important to us. But I do believe that those issues can be
addressed effectively.
Mr. Porter. And there are a lot of success stories in the
industry, and I will point out Blue Cross and Blue Shield,
right after Katrina, in preparation for Rita, successfully
transitioned an additional form of HIT for their company and I
think to protect their participants. There are, as I said in my
opening comments, I've met with dozens of folks, including
insurance carriers, and there are some carriers that openly
embrace this concept, and there are some that don't. And having
been in the insurance industry 20 years, I understand the
language; sometimes, I may not agree, but I understand the
culture of the insurance industry, not that I always agree with
it.
But it seems to me that there are a lot of carriers that
are implementing this quite successfully across the country.
Are you hearing of problems with some of the carriers? And you
don't have to mention names. What are you hearing?
Mr. Green. Well, what we're hearing from the carriers, they
generally are very interested in this. I mean, after all, our
FEHBP carriers are like any other companies; they will adopt
changes that will make them more efficient and will allow them
to better compete in the marketplace.
As you point out, the initiatives that have already been
underway have proven the value of using technology, health
information technology and personal health records, to not only
improve operations and to save both benefit and administrative
costs, but they've also attracted enrollees because they've
demonstrated the company's interest in the health and well-
being and the involvement of their members and their own
healthcare. So I think you're going to see more and more of
that adoption.
And yes, there are issues that need to be overcome. I think
that the positive movement will carry forward with correct
support from the government and having interoperable standards
in place so that those investments--they're not buying a Beta;
they're buying a VHS.
Mr. Porter. Well said. My last comment, in having met with
a lot of companies, there are those that are now using as a
marketing tool to attract customers HIT, some of the hospitals
and some of the insurance companies, and I see 1 day when
that's going to be a TV commercial: We offer HIT because it
will save lives, and it will reduce premiums.
I just appreciate all of your efforts and trust your
opinion, and know that all these areas that have been
addressed, it's healthy to have the debate and a discussion,
and I look forward to working with you more in the future.
And with that, Mr. Davis.
Mr. Davis of Illinois. Thank you very much, Mr. Chairman.
I was just thinking, Mr. Green, what are your thoughts
about the possibility of creating a pilot health information
technology program for the FEHBP participants?
Mr. Green. We believe that a pilot can provide a good
approach to evaluate how the adoption of HIT initiatives
affects the healthcare system in a particular geographic area.
And we are particularly interested in how FEHBP consumers deal
with the availability of health information technology. So
pilots can be very productive.
Mr. Davis of Illinois. And so you have no problem--I mean,
no disposition toward not----
Mr. Green. No, no disposition toward not working with
pilots.
Again, while we do need standards in place that apply to
all pilots, we need privacy protections as would apply to all
initiatives, so some things need to be across the board.
Mr. Davis of Illinois. H.R. 4859 makes a distinction
between carrier electronic health record and a personal
electronic health record; could you share with us the
difference between the two? And which one, if either, in your
estimation would be most useful?
Mr. Green. Yes, sir. There's a lot of nomenclature issues
out there in the industry about defining EHRs and PHRs and EMRs
and that sort of thing, so it can be quite confusing. But the
way it works for me, sir, is I think of it in terms of where
the information is generated. Some information the carrier
holds. And that's claims-based information; how much was paid?
There is identification information about the enrollees. There
are claims information. There is identification information
about providers. There is laboratory cost or tests done. There
is prescription drugs that are used. That's the sort of
information that's carrier-based information.
There is personal health information that the individual
provides that may be in other systems of records but definitely
is provided by the individual, obviously identifiable
information; the vaccines or the immunizations that their
children have had that might not be in every provider's record.
There's family history information. There's over-the-counter
drugs that an individual is taking, and aches and illnesses,
symptoms that the individual provides.
And then there is provider-based information, which are the
diagnoses, the results of tests, the test scores as opposed to
which test is performed, the actual results of the tests, some
background information on why a particular test was provided,
x-ray information.
So it works for me best to think about in terms of where
the information came from rather than what particular title is
put on any particular bit of information.
Mr. Davis of Illinois. Aside from the call letter, do you
see any other role for OPM?
Mr. Green. Yes, sir. We work with our carriers 365 days a
year, and 1 more day on leap years. We are there to--and we
hear from our enrollees as well every day of the year. So we
think we are in a very good position to help them understand
the needs of our enrollees and the needs of the government that
is funding the insurance plan.
So, yes, we work with them regularly, not just during the
negotiation season but on individual cases and around the clock
doing oversight and administrative review.
Mr. Davis of Illinois. Do you feel that privacy and
interoperability concerns are adequately addressed in the
legislation?
Mr. Green. I think that, while they are addressed, we can
work with the staff to improve on them and address other
additional concerns. But I think they're there. I think the
intent is there, and we want to make sure that they comply with
the law and the HITSP standards that I addressed.
Mr. Davis of Illinois. I have no further questions. Mr.
Chairman, thank you very much.
Mr. Porter. Mr. Clay, any questions?
Mr. Clay. I will be very brief, Mr. Chairman.
OK, Mr. Green, please identify the deficiencies that you
see in the interoperability standard setting process at HHS
right now. Would OPM require its carriers to adopt the
technical standards for employee records that have been
developed through the Consolidated Health Initiative and the
AHIC activities?
Mr. Green. Our Director, Linda Springer, is a member of the
community, the AA community, and we are working very closely
with HHS, and we intend to support the initiatives coming out
of the--both by the administration and by the HITSP standards
that are in place and the other initiatives as well. How we do
that is--we are still working out, but we are committed to
being as supportive as we can be in this process.
Mr. Clay. Would you insist that all carriers utilize the
same set of standards that are available now and as they are
implemented in the future?
Mr. Green. The standards aren't available as of yet. The
first set of standards are due in September. But we will be
working to, ultimately, as the whole program--the whole 10-year
initiative is designed to do, having a set of standards that
are used universally. How we go about that, we have to work
with the carriers and we have to work with HHS to make that
happen.
Mr. Clay. Thank you very much for your response. I have no
further questions, Mr. Chairman. Thank you.
Mr. Porter. I have an additional question, Mr. Green; and
then we are going to go vote. But there is only two, so it
shouldn't take very long.
I know a real concern, and rightfully so, for this
committee and for the employees is the cost of insurance. Also
of equal importance is saving lives and saving injuries, and if
not even greater concern. Because literally, as we have said
earlier, paper kills--and we already know it--80,000 or 90,000
people a year. But I know one of the concerns is that by trying
so--and, by the way, I don't think this science is new. But, to
some, this is new in the culture. I hear from sectors, from
employees and from insurance carriers that this could drive up
the cost of insurance.
Have you heard any of that yet or any indication of your
call letter of any of your carriers saying we are going to have
to charge more for your premiums because of what you have
requested?
Mr. Green. No, sir, I have not heard that.
Mr. Porter. I am really surprised. Because I heard that
from a number of insurance carriers, that this may well cost
more money, which has also frightened some Federal employees,
that the costs could be passed on to them. So you haven't heard
from any company that, by implementing this, this could save
funds or cost more?
Mr. Green. Sir, I have not. But I can understand that
might, that is out there, that it would cost. The fact is that
capital improvements and expenses do cost money in the short
term; and you have to spend some money to make some money. That
is part--we fund administrative expenses and capital expenses,
our fair share of those expenses, regularly. And it is our
job--it is OPM's job to make sure that we get our return on our
dollar both in benefit costs and in administrative costs. That
is our job to do, and we will do that. So we are not likely to
spend money wantonly. But investments cost some money. It is
the return on investment that we look for.
Mr. Porter. Including saving lives, and I know that is----
Mr. Green. That is important, too.
Mr. Porter. I know that is a priority.
Back to the cost issue and possible increases in premium, 9
million participants has to be one of the largest group
programs in the country; and I assume it is highly competitive.
If--you say we have 270 some different plans.
Mr. Green. Different choices, yes.
Mr. Porter. Different choices. Must be highly competitive.
There must be insurance carriers that would like to have this
business. We are not having a shortage of companies asking for
our business, correct?
Mr. Green. No, sir. That's correct.
Mr. Porter. Any additional questions?
What we will do is take a recess again; and we will be back
with the next panel, should be about 20 minutes. Thank you. We
are going to combine the panels to help all of your schedules,
help expedite it once we come back. Thank you.
[Recess.]
Mr. Porter. I would like to bring the meeting back to
order.
Again, thank you for your patience. Legislative time is one
of those very unpredictable items. So, again, thank you very
much; and I appreciate being able to combine the panels.
I would like to begin with Mr. Charles Fallis, president of
the National Active and Retired Federal Employees Association.
You have approximately 5 minutes. Thank you. Welcome.
STATEMENTS OF CHARLES FALLIS, PRESIDENT, NATIONAL ACTIVE AND
RETIRED FEDERAL EMPLOYEES ASSOCIATION; COLLEEN KELLEY, NATIONAL
PRESIDENT, NATIONAL TREASURY EMPLOYEES UNION; JACQUELINE SIMON,
DIRECTOR OF PUBLIC POLICY, AMERICAN FEDERATION OF GOVERNMENT
EMPLOYEES; ARCHELLE GEORGIOU, M.D., EXECUTIVE VICE PRESIDENT,
STRATEGIC RELATIONS, SPECIALIZED CARE SERVICES, UNITEDHEALTH
GROUP; STEPHEN W. GAMMARINO, SENIOR VICE PRESIDENT, NATIONAL
PROGRAMS, BLUE CROSS AND BLUE SHIELD ASSOCIATION; AND JOE
WITKOWSKI, VICE PRESIDENT, GOVERNMENT EMPLOYEES HOSPITAL
ASSOCIATION, INC.
STATEMENT OF CHARLES FALLIS
Mr. Fallis. Thank you Mr. Chairman. I appreciate the
opportunity to be here today and to testify on the H.R. 4859
legislation that would implement electronic health records
within the Federal Employees Health Benefits Program.
NARFE appreciates your commitment to involve us in the
development of H.R. 4859, and we thank you for your willingness
to meet with us in an open exchange of ideas looking toward
improvement of the legislation.
NARFE recognizes that there are medical benefits stemming
from the adoption of HIT; and we believe greater coordination
of individual medical records for use by providers could save
lives, improve efficiency, and help control health care costs.
NARFE is also supportive of the legislation's commitment to
protect individual privacy. Protection of personal medical
information is an extremely critical issue for our members, so
we are pleased that the bill assures full compliance with
HIPPA.
NARFE also supports this bill's provision for voluntary
participation. We are confident that many Federal workers and
their annuitants will want to build their own electronic
records in order to maximize their health care. We are pleased
that the creation of such records will be initiated only at the
enrollee's request.
While savings may well result from this change, the up-
front costs will be significant. The fund's startup of phases I
and II of the record system, H.R. 4859, directs OPM to utilize
the unused portion of the 1 percent fee the agency receives
from FEHBP contributions to cover their administrative cost of
managing the plan.
Heretofore, this administrative fee has always been used
for its intended purpose, and any remaining or unused balances
have been allocated to contingency reserves established for the
health insurance plans. Tapping into those contingency reserves
to satisfy additional program spending on HIT would represent a
significant and unwelcome departure from OPM's past practice in
the administration of the plan.
The precedent of using the fee for other than FEHBP
administration, including spending for HIT, could create
pressure to increase the fee and thus increase enrollee
premiums to cover any number of nonadministrative costs. NARFE
believes that, to the extent possible, it is essential to
maintain the current framework to ensure adequate contingency
reserves which help to ensure that premiums are predictable and
affordable.
This is especially important at a time of escalating health
care costs, coupled with a graying work force and with almost
half of the health plan composed of annuitants who have not yet
been given the privilege of paying their health care premiums
with pretax dollars.
Chairman Porter, we understand and appreciate your
willingness to remove from the bill provisions accessing the
OPM administrative fee.
While statutory language included in the bill prohibits HIT
costs from being taken into account in future FEHB contract
negotiations, HIT spending, as currently described in the bill,
could nonetheless directly result in higher premiums, which
would be opposed strongly by our members.
NARFE is also grateful for your active consideration of
adding a provision to the bill that would enable all plan
participants, including those who aren't computer savvy, to
establish electronic health records. NARFE is concerned that
those who don't have access to an Internet portal might not be
able to input the necessary data to establish their electronic
health records. NARFE suggests incorporating a new language--or
incorporating new language into H.R. 4859 to clarify that such
individuals could access their electronic health records
through a call center where information could be added or
checked for accuracy.
Finally, Mr. Chairman, I pledge to you that NARFE will work
with you to successfully implement electronic health records
within FEHBP and that together I hope that we can work together
to address the outstanding issues that I have identified and
others have identified today.
I want to thank you for the invitation to share our views
and to thank you for your able leadership of the subcommittee.
Thank you, sir.
Mr. Porter. Thank you very much for your testimony. I
appreciate your comments and appreciate working with you on the
bill. Your comments have made a substantial difference. So
thank you very much.
[The prepared statement of Mr. Fallis follows:]
[GRAPHIC] [TIFF OMITTED] T3251.010
[GRAPHIC] [TIFF OMITTED] T3251.011
[GRAPHIC] [TIFF OMITTED] T3251.012
[GRAPHIC] [TIFF OMITTED] T3251.013
[GRAPHIC] [TIFF OMITTED] T3251.014
[GRAPHIC] [TIFF OMITTED] T3251.015
Mr. Porter. Is there anyone here that has a time constraint
or who has the worst time constraint? Is there planes to catch
or anything that we can help you with at this point?
We have one at 6:30.
We are going to be here until probably midnight so--no
problem.
Next, Colleen Kelley. She is the national president,
National Treasury Employees Union. It is always a pleasure to
see you. Thank you for being here.
STATEMENT OF COLLEEN KELLEY
Ms. Kelley. Thank you, Chairman Porter, Congressman
Cummings. It is truly a pleasure for me to have the opportunity
to testify on behalf of the 150,000 employees represented by
NTEU.
Federal employees and retirees are very concerned about the
quality and the cost of the health insurance that they received
through the FEHBP. National Treasury Employees Union has been
involved in several initiatives to improve the program,
including legislation to hold down the cost for enrollees.
At a time when Federal pay rates lag behind the private
sector and attempts are being made to reduce employee rates in
several departments and workers are being subjected to
determined efforts to contract out their work, health insurance
becomes one of the most attractive features to both recruit and
retain the best and the brightest to the Federal service. A
decline in the quality or an increase in the cost of health
insurance may be the last straw for a productive employee or
applicant.
FEHBP must be modern, efficient and well-functioning. It
must embrace what is best in emerging technology to better
serve its beneficiaries. The Federal Family Health Information
Technology Act, properly implemented, can serve that goal.
Requiring FEHBP carriers to create electronic health records
available to individual enrollees, these records have the
potential to provide important benefits to the enrollees,
including better coordination of medical records, easier access
to those records and, as you have noted, could save lives.
National Treasury Employees Union agrees with the important
and worthy goals of this legislation.
Having said that, I would like to outline a few concerns
and propose some improvements that we feel would be beneficial
to this legislation; and they fall into four categories:
privacy, oversight, access and funding.
On the privacy issue, from my discussions with NTEU
members, privacy is a significant concern. Most important is
the need to protect Federal employees from any inappropriate
access to their personal medical records. In particular, their
employer should not have that access. Further, this information
needs to be kept from disclosure to sales and marketing
entities, such as pharmaceutical vendors and others, not just
written prohibitions of such disclosures but systems that
really protect the privacy with rigorous enforcement. FEHBP
enrollees must have recourse to remedies when their privacy
rights are violated.
The opt-in provision in the legislation helps to make sure
that those in FEHBP who have privacy concerns are not forced
into participating in a program they are not comfortable with.
I agree with former House Speaker Newt Gingrich who
testified before the subcommittee recently when he said it can
be expected that substantial numbers of FEHBP enrollees would
elect to opt in. I agree with that. But enrollees must have
that choice, and NTEU strongly supports the opt-in provision of
this legislation.
On oversight, NTEU believes that, to ensure proper privacy
standards, OPM and HHS must, in a formal way, engage Federal
employee and retiree representatives. This legislation should
require HHS's Office of the National Coordinator for Health IT
to meet periodically with Federal employee and retiree
organizations to consult with them, to provide them with all
information needed to make a thoughtful review of these
matters, including the number and nature of all privacy
complaints made by FEHBP participants, and to give great weight
to any recommendations made by these organizations.
The chief privacy officers at both OPM and HHS will play
key roles in protecting privacy. These positions need to be
made full-time positions. They also need their authority
enhanced by having the power to undertake investigations and to
issue reports as they deem necessary, as well as having
subpoena power. In order to ensure the independence and the
integrity of the privacy officer, any removal or transfer
should require a notification to both Houses of Congress.
I believe it is also important that HHS and OPM both report
back on a regular basis to this subcommittee as well and that
the subcommittee perform proper oversight of FEHBP privacy
issues. That way, there will be ongoing congressional review;
and any laxness or shortcomings either in enforcement or
legislative authority can be resolved.
On the access issue, improved access by enrollees to
personal medical information is obviously an important feature
of this legislation. As already noted, electronic Web-based
access is the means most enrollees will utilize. However, as
you, Chairman Porter, also already recognized, some of
enrollees need access other than through the Web portal.
Provisions need to be made so that they have the opportunity to
access their medical records as well.
On the funding issue, the passage of this legislation will
put the Nation's largest employee health benefits program
behind the development of medical IT. In the long run, both
Federal and private sector employees will benefit. Therefore,
it would be unfair for FEHBP participants to bear even a short-
term premium increase for what is a social benefit.
I note that the bill prohibits increase in FEHBP premiums.
In this provision, strict enforcement will be a key issue.
Given the legislation's potential benefit to the private sector
as well as the Federal sector, it would seem proper and
reasonable that costs associated with short-term development be
provided for by an appropriation from general revenue.
On the funding issue language, NTEU very much appreciates
your decision and your commitment to remove the language prior
to markup that would have allowed the unused portion of the 1
percent administrative fee to be made available to fund this
system.
You and this subcommittee and your staff have been very
open to listening to NTEU's concerns on this issue, and we very
much appreciate it and look forward to working with you on the
development of an electronic health record system that does
protect the privacy and promote the health care efficiency for
Federal employees.
I would be happy to answer any questions you have. Thank
you.
Mr. Porter. Thank you, Ms. Kelley.
I said it to Mr. Fallis. Your comments have played a big
role, both of you; and I appreciate working with you. These
adjustments have come about after we have had our numerous
meetings and discussions. So thank you for your input, and I
certainly agree with your insights as to those areas. Plus,
this could well be a landmark piece of legislation in changing
health care not only for Federal employees but for the country.
I am very pleased to have your help, and I really appreciate
it. Thank you.
[The prepared statement of Ms. Kelley follows:]
[GRAPHIC] [TIFF OMITTED] T3251.016
[GRAPHIC] [TIFF OMITTED] T3251.017
[GRAPHIC] [TIFF OMITTED] T3251.018
[GRAPHIC] [TIFF OMITTED] T3251.019
[GRAPHIC] [TIFF OMITTED] T3251.020
[GRAPHIC] [TIFF OMITTED] T3251.021
[GRAPHIC] [TIFF OMITTED] T3251.022
Mr. Porter. Next, we have Jacqueline Simon, Director of
Public Policy, American Federation of Public Employees. Thank
you.
STATEMENT OF JACQUELINE SIMON
Ms. Simon. Mr. Chairman, I want to thank you for your
personal attention to this legislation and the access that you
provided AFGE during your deliberations. We know that the plan
is extremely well intentioned.
My testimony, however, will focus on the many questions
Federal employees have regarding privacy, costs, accuracy,
access and the potential difficulties that may emerge from the
implementation and maintenance of electronic health records in
the context of FEHBP's current structure and regulatory
framework.
The No. 1 concern is privacy and security, which I address
at length in my written testimony. There is enormous concern
among Federal employees that EHRs will not be secure from
either loss or unauthorized access, as the recent theft of data
from an employee from the Department of Veterans Affairs
attests.
Although the privacy rule acquired under HIPPA requires
medical professionals to limit disclosure of medical
information to the minimum necessary and this rule will be
applicable to Federal EHRs and FEHBP, the rule is not absolute.
In fact, the regulatory regime for protecting privacy of health
information is quite complex and fragmented throughout the
country. And even if HIPPA and its regulations were adequate,
the current reluctance to enforce Federal regulations makes the
bill's conformance with HIPPA almost an irrelevancy.
The Washington Post reported last week that in the 3 years
since HIPPA's enactment no fines have been imposed, even though
more than 19,000 grievances have been filed. The grievances
included allegations that, ``personal medical details were
wrongly revealed, information was poorly protected, more
details were disclosed than necessary, proper authorization was
not obtained and patients were frustrated getting their own
records.''
Although the insurance companies, hospitals, health plans
and doctors interviewed for the article were reported to be
quite satisfied with the lax enforcement, patients and patient
advocates were not. Especially troubling for Federal employees,
the representative from HHS whose office is responsible for
enforcing the law was quoted saying that, ``challenges with our
resources,'' was part of the explanation for why more has not
been done to enforce the law.
Federal employees are more intimately aware than anyone
that inadequate funding for agency staffing and political bias
have made regulatory enforcement a low priority. They will not
find credible promises that OPM will enforce HIPPA-like privacy
protections, and they will not find credible assurances that
the data or the program will be implemented in ways that serve
their interests.
Privacy is such an enormous concern because a health record
reveals some of the most intimate and personal aspects of one's
life. Medical records include the details of family history,
genetics, diseases and treatments, illegal drug use and sexual
orientations and practices. Subjective remarks about a
patient's demeanor and character and mental states are also
sometimes part of a record. The bill does not address how
variations in business policies, State laws that affect privacy
and security practices, including those related to HIPPA, and
other challenges to health information exchange could result in
the mishandling or misinterpretation of patient health records,
even assuming that HIPPA protections were enforced.
If the government cannot guarantee generally impregnable
firewalls to protect privacy and control access, then no
Federal employee's health information should be placed in an
electronic record without his or her affirmative permission,
permission that must be able to be withdrawn and given entirely
at will.
Another troubling aspect of the bill is the assumption that
its adoption will result in significant savings, the EHRs will
pay for themselves. While there may be some clinical savings
and gains from greater physician productivity as a result of
using EHRs, there is every reason to believe that most or all
of these savings will be offset by administrative costs. The
added administrative costs will be real and the savings are
only hoped-for projections.
Even if the money is saved by better coordination of care
or use of preventive services, forcing every practice that
participates in an FEHBP plan to submit yet another set of
medical data will be extremely costly.
The startup costs to fund EHRs in the Federal Government
will be considerable. AFGE strongly opposes the use of the
FEHBP reserves for this purpose, and we are glad to hear that
you have agreed to delete this provision from the bill.
We believe this program should be started as a pilot or a
demonstration project within FEHBP and be open to a small
population of volunteers. If the projections of savings are
realistic, insurance companies should be eager to participate
and should be willing to subject themselves to the government
cost accounting standards in order to prove that the savings
are real.
Once the pilot has had a sufficient period of time to allow
objective evaluation of its costs and benefits, the decision
can be made whether to expand it. If it is as successful as the
bill's advocates believe it will be, it is likely that both
insurance companies and Federal employees will be comfortable
participating.
This concludes my statement. I will be happy to answer any
questions you may have.
Mr. Porter. Thank you very much for your testimony, Ms.
Simon. I appreciate you telling us what you think.
Ms. Simon. Thank you for the opportunity, sir.
Mr. Porter. No problem. We appreciate it.
I, too share, the majority of your concerns; and that is
why we have spent a lot of time and will continue to do so
making sure we get it right.
You know, I have met with--and if this subcommittee would
allow--I met with a veteran the other day who is in the
Veterans Administration under its health care plan. He was
about 80 years old, sitting in my office. He was a disabled
American vet, had a substantial handicap and a friend for many
years. He spent a lot of time talking about the advantages of
the veterans' health care system and access to his health care
records and being able to communicate with his doctor and being
able to communicate via technology.
Just know that there are areas of concern, and I share with
you. But there is also great successes, and we want to make
sure we can emulate those. So, again, your points are well
taken; and we appreciate your testimony.
Ms. Simon. Thank you, sir.
As you probably know, AFGE represents most of the employees
of the Veterans Administration; and they take great pride in
the health care they provide our veterans. I am really glad to
heard that. Thank you.
Mr. Porter. Thank you very much.
[The prepared statement of Ms. Simon follows:]
[GRAPHIC] [TIFF OMITTED] T3251.023
[GRAPHIC] [TIFF OMITTED] T3251.024
[GRAPHIC] [TIFF OMITTED] T3251.025
[GRAPHIC] [TIFF OMITTED] T3251.026
[GRAPHIC] [TIFF OMITTED] T3251.027
[GRAPHIC] [TIFF OMITTED] T3251.028
[GRAPHIC] [TIFF OMITTED] T3251.029
[GRAPHIC] [TIFF OMITTED] T3251.030
[GRAPHIC] [TIFF OMITTED] T3251.031
Mr. Porter. Next, we have Archelle Georgiou, Doctor,
executive VP, strategic relations, specialized care services,
UnitedHealth Group. Thank you for being here.
STATEMENT OF ARCHELLE GEORGIOU, M.D.
Dr. Georgiou. Thank you, Chairman Porter and distinguished
members of the committee, for the opportunity to testify before
you at today's hearing on how the use of health information
technology can improve the health of Federal employees and
annuitants and their families.
I am Archelle Georgiou, physician and executive vice
president of strategic relations with specialized care
services, a specialty health and well-being division of the
UnitedHealth Group. Headquartered in Minneapolis, MN,
UnitedHealth Group offers a broad spectrum of products and
services through six operating businesses: UnitedHealth Care,
Ovations, AmeriChoice, Uniprise, Specialized Care Services and
Ingenix. Through its family of businesses, UnitedHealth Group
serves approximately 65 million individuals nationwide.
UnitedHealth Group has extensive experience providing
health care services to the Federal Government, State
governments and private payers in many types of competitive
environments. Currently, we offer health benefits to Federal
employees under the Federal Employees Health Benefits Program
in 14 States. We have more than 322,000 members enrolled in our
various FEHBP plans and have been a carrier in our FEHBP for
over 20 years.
As Jeannine Rivet testified before this subcommittee in
March, UnitedHealth Group is a strong supporter of using health
information technology to advance the quality of care provided
to individuals and to improve the efficiency of our health care
system. Over the past 5 years, we have invested $2.5 on
technology in an effort to bring simplicity and enhanced
administrative efficiencies to the U.S. health care system.
In 2000, UnitedHealthcare introduced its consumer service
Web site, myuhc.com, to provide members with easy access to
health information and services so they can manage their health
care effectively. Members logging on to UnitedHealthcare's Web
site can find physicians and other providers, find information
on hospital quality and order prescription refills online and
compare the cost of drug alternatives.
In March 2005, UnitedHealthcare expanded the functionality
of our consumer Web site, myuhc.com, by integrating personal
health record capability. Easy access offers a secure Web site
which protects the privacy and security of members' data with
user name and passwords, in keeping with industry
authentication and validation standards.
Members can use their personal health records to access a
comprehensive record of their medical, surgical, radiology,
pharmacy and laboratory health care claim history. This easy-
to-read format includes a summary of medical conditions, doctor
visits, visit dates, medication history including prescription
names, dosages and refill dates, as well as laboratory and
radiology tests, including the date and location of these
services.
They can enter there and manage self-reporting data,
including tracking and charting of wellness indicators. They
can also enter and track self-reported data such as glucose
levels and blood pressure, as well as information on lifestyle
issues such as weight and sleep habits.
Finally, they can print their personal health summary for
their personal records and/or use with their practitioner.
While the personal health record is available to all of our
members, as of March 2006, 4\1/2\ million consumers have
accessed their personal health record through our Web portal,
myuhc.com.
Of course, the privacy and security of personally
identifiable information is of great concern to us all.
UnitedHealth Group currently protects members' privacy through
the use of standard industry security measures. We are planning
to add additional layers of protection to provide our members
with even greater assurance that their personal health records
are completely secure.
In addition, we automatically suppress data on sensitive
health issues to help gain member trust and acceptance of the
personal health record feature.
The overall response to our consumer portal and personal
health record capabilities has been extremely positive, and we
feel it reflects a strong level of comfort on the part of the
members regarding the level of privacy and security offered.
Specific to H.R. 4859, we do support your efforts with this
bill and look forward to continuing to work with you and your
staff as it moves through the legislative process. UnitedHealth
Group believes that the use of appropriately designed
electronic personal health records will make a significant
difference in improving health outcomes for Federal Employees
Health Benefits Program participants and will make it easier
for them to manage their health care effectively.
Since the FEHBP covers such a large member population, we
believe requiring the use of electronic personal health records
by program carriers and providers could have a significant
impact on driving the entire industry forward on this very
important matter. Moreover, the use of electronic personal
health records could help reduce disparities in health care.
As Speaker Gingrich stated in previous testimony before
this committee, participants for whom English is a second
language would be better served by being able to provide their
physicians with access to their complete health record, rather
than having to try to explain complex medical issues in a
second language. They could also provide access to their
records to family members with greater proficiency in English
to assist in their medical encounters.
In conclusion, our experience in offering consumers a
personal health record as well as our research to determine the
key needs of consumers as related to a personal health record
have enabled us to identify a number of requirements for
facilitating widespread adoption. These requirements for
success include a strong and consistent information and
education campaign that clearly shows the value of using a
personal health record to consumers; a tailored consumer
experience, organizing data and features in a manner that makes
it easier to navigate and access information of choice, with
health information displayed and described in ways that are
easy to understand; secure and private infrastructures and
processes; accurate and timely information to build trust and
credibility; flexibility to address consumer needs, preferences
and desires; health records integrated so that individuals have
easy access to the PHR from the carrier's consumer portal and
easy access back; and interoperability with provider office
technology.
Chairman Porter, we appreciate your continued leadership in
this matter and commend you and the members of the subcommittee
for your appreciation of the benefits and value that health
information technology can bring to the quality, efficiency and
effectiveness of health care.
Thank you.
Mr. Porter. Thank you, Doctor. I appreciate your testimony
and the fact that you are a Nevadan. We appreciate that.
And I tell you, having talked to some of your participants
from across the country, they like the fact that they now know
what information you have on them, which they didn't know
before; and they are happy to have that access. So thank you
very much.
Dr. Georgiou. Thank you. And it is helpful because at times
we can get misinformation when claims are submitted from
physicians, and they can help us correct that information as
well.
Mr. Porter. Thank you.
[The prepared statement of Dr. Georgiou follows:]
[GRAPHIC] [TIFF OMITTED] T3251.032
[GRAPHIC] [TIFF OMITTED] T3251.033
[GRAPHIC] [TIFF OMITTED] T3251.034
[GRAPHIC] [TIFF OMITTED] T3251.035
[GRAPHIC] [TIFF OMITTED] T3251.036
[GRAPHIC] [TIFF OMITTED] T3251.037
[GRAPHIC] [TIFF OMITTED] T3251.038
[GRAPHIC] [TIFF OMITTED] T3251.039
Mr. Porter. Next, we have Stephen Gammarino, senior vice
president, national programs, Blue Cross and Blue Shield
Association. Welcome.
STATEMENT OF STEPHEN W. GAMMARINO
Mr. Gammarino. Thank you, Chairman Porter and members of
the subcommittee, for giving the Blue Cross and Blue Shield
Association an opportunity to present our views on H.R. 4859.
I will cover three main areas in my testimony today: First,
a strong support of Blue Cross Blue Shield plans in advancing
health information technology; second, an overview of OPM's
market-oriented approach to health information technology; and,
third, our concerns and recommendations related to this
important issue.
First, we commend, Mr. Chairman, you and the subcommittee
for your support for health information technology.
Now, for my first point, Blue Cross Blue Shield plans and
the Association are committed to advancing health information
technology. We are committed to a health care system that
delivers safe, efficient and high-quality care. We recognize
that the goal requires nationwide standards for
interoperability, and we have a record of support and
commitment. For example, we serve on Secretary Leavitt's
American Health Information Community. We are collaborating
with America's health insurance plans to develop industry
standards related to health information records, and we
supported legislation that would require and spur development
of industrywide interoperability.
My written statement provides several examples of plan
leaderships and lessons learned. For example, we have learned
that nonproprietary interoperability standards are critical to
facilitate data exchanges; second, we know that providers must
see value in records and they must be integrated into the
providers' workflow; and, three, perhaps most important, we
learned that members must see value in using the personal
health records.
The second point is an overview of the OPM's market-
oriented approach.
As most of us know, the FEHBP has a long history of being
cited as a model for employer-sponsored health benefit
programs. A lot of that strength is reliance on market forces
of competition and consumer choice.
Historically, Congress has exercised a light touch in
imposing statutory mandates, and we believe this market-
oriented approach has resulted in innovation in the program
over the last 40 years.
As you know, most recently, OPM, in their 2007 call letter,
provided for short-term information technology objectives which
focus on enhanced member education, payer-based personal health
records, incentives for e-prescribing, linking disease
management programs to health information technology, having
requirements to protect individual health information, and
providing financial incentives for carriers.
The market-oriented approach has already led to health
information advances in the Blue Cross Blue Shield Service
Benefit Plan.
Over the last couple of years, we worked with the agency in
a program called Care Coordination.
We are currently applying health information technology to
an integrated data base to ensure that, among our sickest
members, that they receive the right treatment at the right
time.
We think a market approach is superior to any legislative
mandate. It relies on marketing incentives, rather than one-
size-fits-all. Carriers that are slow to offer personal health
records, for example, risk punishment in the marketplace as
consumers who value them gravitate to other carriers. It also
allows each carrier to meet a member's needs.
In responding to one of the questions that Congressman
Davis has put before the panel earlier today, we think pilot
projects are critical. Without members use and provider
acceptance, the health records will not have the impact we all
hoped for.
My third point focuses on our concerns about this bill and
our recommendations for establishing health records in this
program.
First concern, we think the bill is premature until the
necessary standards have been developed and fully tested;
second, OPM's current market-based approach, as exhibited in a
recent call letter, makes this legislation we think unnecessary
at this time; third, the bill does not recognize cost being
allowed to be charged to the program and being reflected in a
carrier's premiums; and, fourth, the bill imposes unprecedented
mandates on a carrier's resource and therefore we think sets a
bad precedent.
In closing, Blue Cross Blue Shield has two recommendations:
first, that OPM and carriers follow a market-based approach on
health implementation technology as outlined in OPM's most
recent call letter; and, second, strong congressional oversight
to hold both the agency and the carrier accountable for
introducing the introduction of appropriate health records. We
are confident you will find Blue Cross Blue Shield a leader in
effective introduction of those health records.
Mr. Chairman, that concludes my oral statement. I will be
happy to address any questions you may have.
Mr. Porter. Thank you very much.
I know I mentioned earlier but I would like to reiterate it
again, I applaud Blue Cross Blue Shield because literally in 78
hours or 42 hours or 20 hours--I can't remember what it was--
you transferred your participants after Katrina in preparation
for Rita so they wouldn't lose their files.
Mr. Gammarino. It was probably within 700,000 and 800,000.
Mr. Porter. How many days?
Mr. Gammarino. It was a matter of days.
Mr. Porter. Well, I applaud you for those efforts. So thank
you very much for taking care of those folks.
[The prepared statement of Mr. Gammarino follows:]
[GRAPHIC] [TIFF OMITTED] T3251.040
[GRAPHIC] [TIFF OMITTED] T3251.041
[GRAPHIC] [TIFF OMITTED] T3251.042
[GRAPHIC] [TIFF OMITTED] T3251.043
[GRAPHIC] [TIFF OMITTED] T3251.044
[GRAPHIC] [TIFF OMITTED] T3251.045
[GRAPHIC] [TIFF OMITTED] T3251.046
[GRAPHIC] [TIFF OMITTED] T3251.047
[GRAPHIC] [TIFF OMITTED] T3251.048
Mr. Porter. Next, we have Joe Witkowski, vice president,
Government Employees Hospital Association. Welcome.
STATEMENT OF JOE WITKOWSKI
Mr. Witkowski. Thank you, Mr. Chairman.
My name is Joe Witkowski, and I am vice president of
Government Employees Hospital Association.
GEHA is a not-for-profit association of Federal employees,
headquartered in Lee's Summit, MO. We are the third largest
national health plan within FEHBP and have participated in the
program since its inception in 1960. We serve more than 425,000
Federal employees, retirees and their dependents nationwide.
We at GEHA agree with the conclusion that H.R. 4859 has the
potential to improve health care quality and reduce medical
errors. We also believe it can be used to increase the
efficiency of the delivery of medical care, which will result
in decreased health care costs.
Easy access to health records is an important goal. Today,
I can be in any city in the country; and should my car
completely break down I can purchase a new automobile that same
day. This can happen because the dealership can electronically
access my personal financial health history in a matter of
minutes.
We believe that individuals and health care providers
should also have that same ease of access to a health record.
In fact, we have implemented several initiatives, with
significant investment in time and technology, to meet those
very goals. We are participating in several pilot projects and
have begun implementation of other relevant initiatives. Please
allow me to highlight some of our efforts.
GEHA's participating in an employer-based initiative to
create a community health record. The organization is called
HealthE Mid-America and is a joint effort between major
employers in the Kansas City metropolitan area and Cerner Corp.
Cerner is a world leader in developing software for hospitals
and physician practices. The goal is to build a patient health
record that includes claims data, prescription medication
information and clinical data such as diagnosis, procedures and
lab results. The patient's health record will also include
detail provided and maintained by patients, including
information on allergies and any other personal medical
history. We believe that our participation in this joint
venture will help us develop and grow our health information
technology capabilities.
That organization met this morning and formed their board
of directors and is starting to move forward in this venture.
We are also participating in a number of HIT initiatives in
conjunction with our pharmacy benefit manager [PBM]. Those
programs have a special impact on senior citizens. While only
comprising 13 percent of the U.S. population, older Americans
use 35 percent of all medications dispensed. Twenty-five
percent of these seniors fill prescriptions for at least 10
different medications annually. Often, these multiple therapies
are prescribed by multiple physicians. Adverse drug events can
result from this high medication utilization. Studies show that
nearly one in five hospitalizations of older adults each year
is due to problems with dosage or interaction with prescription
drugs. The estimated economic impact of these preventable
hospital stays is $177 billion annually.
Our programs are working to counteract this problem. We at
GEHA send medical claim data to our PBM on a bi-weekly basis.
Our claims data is integrated into the PBM's proprietary
software and data base engine which then analyzes patient
medical and pharmacy and lab data. Comprised of thousands of
clinical rules, the engine uses a predictive model to identify
members with an increased near-term risk for hospitalization.
We then send alerts to physicians to inform them of our
findings.
Using the same integrated data from pharmacy, medical and
laboratory sources, our PBM stratifies GEHA members into four
patient populations: well, acute, chronic and complex. The
pharmacists use this real-time integrated data to effectively
manage, prioritize and optimize specific drug therapies on an
ongoing basis. This technology links patients to pharmacists
and customer service representatives who act as patient
advocates.
In addition, we are participating in a pilot program with
our PBM to accelerate the development and adoption of real-time
and electronic prescription writing tools for physicians. The
goal is to develop a secure, HIPPA-compliant tool that allows
patient prescription and medical data to be checked for
potential errors as a medication is prescribed.
A new project in development is prescription drug pricing
transparency, which we expect to have in place by the end of
the year. Members will be able to review and analyze the drug
utilization and spend for themselves and their family through
the GEHA mail order pharmacy. Using an online tool, members can
review their annual drugs and see what generic and brand
alternatives are available. The members annual savings for the
new therapy will also be shown. If a member opts for a less
expensive drug therapy, they can use the same tool to initiate
that change online.
Mr. Chairman, I hope that I have made it clear that GEHA
embraces information technology as a tool that will help us
improve health care quality and reduce medical errors. GEHA has
taken several steps toward meeting the spirit of this
legislation and will continue to do so.
We respectfully would like to provide some commentary, and
first is the issue of liability protection. Providers may be
making treatment decisions based on information which is
contained within the health record. Data within the record may
be incomplete or incorrect. We are concerned we would be
included in litigation where medical errors may be made because
of the incomplete or incorrect patient health data and need
protection from this real possibility.
Chairman Porter, you have publicly stated that you do not
want to get ahead of the standards; and your legislation
reflects that desire. However, there is a possibility that
standards may not be developed in 4 years; and we would be
required to move forward during that time. That would cause
GEHA and other carriers within the FEHBP program several
problems.
GEHA has committed time, money and human capital toward
meeting several of the goals contained within the legislation.
We are prepared to move forward with plans to offer our Federal
members greater information about their claim history and
provide them with tools to build personal health records. We
eagerly await the creation and implementation of standards that
will move us in this direction. With these in place and further
direction from OPM, we will continue to work toward improving
the quality of care our members receive and make delivery of
health care more efficient.
Mr. Chairman, we look forward to providing additional
commentary on this legislation as it moves forward. Thank you
for bringing this important discussion to the table and for
allowing the GEHA to offer our comments.
Mr. Porter. Thank you very much for your testimony.
[The prepared statement of Mr. Witkowski follows:]
[GRAPHIC] [TIFF OMITTED] T3251.049
[GRAPHIC] [TIFF OMITTED] T3251.050
[GRAPHIC] [TIFF OMITTED] T3251.051
[GRAPHIC] [TIFF OMITTED] T3251.052
[GRAPHIC] [TIFF OMITTED] T3251.053
[GRAPHIC] [TIFF OMITTED] T3251.054
[GRAPHIC] [TIFF OMITTED] T3251.055
[GRAPHIC] [TIFF OMITTED] T3251.056
Mr. Porter. I would like to begin. I guess--one comment.
Being from the insurance industry, I don't have a lot of
sympathy for some of the insurance industry's comments
regarding cost and passing them on to participants, especially
the insurance companies that are doing business with a group
the size of 9 million people; and I know that has come up a
couple of times.
The impact on the bottom lines of some of our carriers, I
don't think that is a problem for any of our carriers. I would
like to let that be known for our employee base that the last
sympathy I have is for the bottom line of some of our carriers,
seeing that they are all very substantial and very solvent.
Regarding comments on unprecedented mandates, and I guess
this is for Blue Cross Blue Shield. As I made it pretty clear
in my questioning earlier today and in my comments, it is
purely voluntary to apply to be a part of this system of health
care. Whether it be the purchase of a xerox copy machine or
whether it be other standards, the Federal Government does
expect that we provide the best services available for our
employees; and I guess we disagree on mandates.
You have a choice whether Blue Cross Blue Shield would like
to participate in our plan or not. We are not requiring that
you be one of our carriers. That is purely your option.
I think, from our discussions, Blue Cross has done quite
well with probably 60 some percent of our participants and have
been very profitable; and it would be your choice whether you
choose to apply again in the future.
Also--I guess this would come in for Blue Cross, Mr.
Gammarino--the last time we spoke, your objections were almost
identical and you hadn't read the bill. And today I assume you
have read the bill, but the objections haven't changed, and I
appreciate your feelings and your expertise in the field.
But, currently, Blue Cross Blue Shield represents customers
all over the country; and I would assume you probably have
millions of participants currently in HIT, correct?
Mr. Gammarino. Each of our local Blue Cross Blue Shield
plans, depending upon where they are in health information
technology, would be providing that to their local members.
So, for example, you mentioned I believe the post-Katrina
and the Texas plan who put together those records which is on
short notice. They did that for their population in that
particular area based upon whatever standards that they were
going to employ for that local community.
The same thing could be said for each of our plans, meaning
whatever local community needs that they have relative to the
standards that they have felt were appropriate for that market.
Relative to the Federal Employee Benefits Program and
specifically the Blue Cross Blue Shield service benefit plan,
what we are engaged in is taking those individual plans,
customized approaches and working with the agency to develop
something that is consistent nationwide.
Mr. Porter. So how many participants do you have nationwide
currently?
Mr. Gammarino. We have 38 Blue Cross Blue Shield plans that
participate.
Mr. Porter. So how many of your customers would currently
be able to use an HIT system?
Mr. Gammarino. Well, none of them are available to use the
HIT system right now of the local plan. What they do, Mr.
Chairman, is that we have a separate system that we have for
this particular line of business because it is so large and it
demands, really, customization relative to what is required to
meet the needs of this customer, which is actually not just
nationwide but it is worldwide.
Mr. Porter. Again, this is why I appreciate the insurance
speak. Let me ask it a different way. Blue Cross transferred
how many files after Katrina?
Mr. Gammarino. If you are talking about the Texas Blue
Cross Blue Shield, I think it was something in the order of
over 700,000.
Mr. Porter. So we know at least 700,000. Would we assume
that is all that Blue Cross has in its system, is 700,000
participants?
Mr. Gammarino. Well, it is--in that particular area, that
is what they decided to do. Nationwide, Blue Cross Blue Shield
enrolls over 90 million Americans.
Mr. Porter. How many of those will have something similar
to the Texas participants?
Mr. Gammarino. I wouldn't know, Mr. Chairman. Each plan has
their own approach to dealing with this. Some of them are
probably further along than others. That is why, historically,
what we have done as we roll out a program of this magnitude
for this population is we work with the agency to put together
a consistent uniform application for them. Otherwise, Mr.
Chairman, they may be picking up the cost of each individual
plan's initiative; and that is something that, at least
particularly for efficiency reasons, we would want to do it in
one time.
Mr. Porter. OK. Let me ask it a different way. How many
participants; 90 million in the Blue Cross and Blue Shield
family are customers?
Mr. Gammarino. That's correct.
Mr. Porter. Would you guess in a percentage that have this
information available to them?
Mr. Gammarino. No. I would not want to guess. The
definition of information probably reflects what they're doing
for each particular plan. For example, the example you
mentioned was put together for one isolated potential event,
and as we know, they didn't really have to access that because
the subsequent event didn't really occur at the level that they
thought they needed to. So this is what--in the Texas Blue
Cross and Blue Shield plan was dealing with an emergency
situation. It wasn't fully integrated, for example, in the
plan's local infrastructure.
Mr. Porter. I would think that it would be good business
practice for an association to know how many are participating,
especially before you object. It's obvious that you don't know,
or you would have answered my question; but I wonder how you
can object when you don't know this information. I'm confused.
Mr. Gammarino. In objecting to the legislation?
Mr. Porter. Yes.
Mr. Gammarino. Well, Congressman Porter, as I think I've
said it in my statement, the objection is to a mandate relative
to this program versus an endorsement of the approach in
allowing us to work with OPM, the agency, to develop and
implement something that we think is useful and effective for
this enrolled population. It hasn't shown to be beneficial, for
example, for us to independently use each plan's local system
because they're meeting the needs based upon what they have
locally. And it may or may not be consistent with what would be
applicable, Mr. Chairman, for a program of this size and the
scope relative to it being nationwide.
Mr. Porter. You talk about communities and different
markets and the needs of those communities. Do you feel that if
the need of the Texas community was fulfilled, that was a
mandate?
Mr. Gammarino. No, as a matter of fact, it was just the
opposite of a mandate, Mr. Chairman. They've actually took a
specific instance and, based upon what they felt was
appropriate, developed records that they felt would be
appropriate at that time for their particular population.
Mr. Porter. Do you think, then, that the civilian
population should have different tools available to them than
Federal employees?
Mr. Gammarino. No. No. I think, as a matter of fact, I
would endorse the approach the Texas plan took relative to this
FEHBP, allowing the carriers to develop records that they think
are meaningful for their membership under the oversight of this
body and the specific direction of the agency.
Mr. Porter. The Federal program is really a huge associated
health plan, I guess if we put it in perspective. Whether if
you're in Nevada or California, you're still a Federal
employee. So what you're saying is that if Nevada--one of the
Blues in Nevada chooses not to do this, and California does, a
Federal employee in Nevada may not have the same tools
available to them to check their own records as someone living
in California; is that what you're saying?
Mr. Gammarino. Well, right now it might be true.
Mr. Porter. Are you suggesting it should stay that way?
Mr. Gammarino. No. As a matter of fact, I'm suggesting just
the opposite, that working with the agency with your oversight,
that we develop appropriate health records for this particular
program to meet the nationwide and actually the worldwide needs
of the Federal enrollees and retirees.
Mr. Porter. Thank you. I appreciate it.
Mr. Davis.
Mr. Davis of Illinois. Thank you, Mr. Chairman.
Dr. Georgiou, Mr. Gammarino and Mr. Witkowski,
interoperability seems to be critical if electronic health
records are to be useful and work as intended. How would you
ensure that the electronic records you create would be
interoperable?
Mr. Witkowski. Thank you, sir. What we're doing is we're
starting the initiative in the Kansas City area with a group of
employers, and we hope that some of the initiatives that take
place may end up being a model, or it may not, but if it does
not become a model on a national level, then what we've got to
do is wait and see what standards do get developed and move in
that direction.
So our position right now is going to be wait and see what
sort of standards are there and then start complying with what
gets put in place.
Dr. Georgiou. Yes. United Health Group certainly supports
the development and application of standards as well. We also
think that it's important to remain flexible as we learn about
how to effectively produce personal health records, that we
remain flexible in the design so that we can continue to meet
marketplace and, most importantly, consumer needs to make these
effective in improving health care quality and decreasing cost.
Mr. Gammarino. Congressman Davis, this is a big challenge,
interoperability, and that's one of the reasons why we think
the standards are so important before we go forward.
A number of our Blue plans are gaining experience in some
areas of the country, like Arkansas, for example. They actually
are employing interoperability between both the providers and
the health plans, in some cases the members themselves. So we
are learning. It's one reason why I value Congressman Davis, I
think, your question about piloting. I really think that we
have a lot to learn before we employ significant resources on
this to make sure we do it right.
Mr. Davis of Illinois. Thank you very much.
And let me ask Mr. Fallis, Ms. Kelley and Ms. Simon, what
is your response to the question of developing a pilot perhaps
as a way to really move into the implementation of this
activity?
Ms. Kelley. NTU would support a pilot. I think no matter
what the issue is, there are always things to be learned. I
think it's clear from the work that has been done by the
subcommittee and the changes that Chairman Porter has already
agreed to make that we've learned things just from the
beginning of this conversation. So when you actually put this
in place, I'm sure there are many things to learn that would
help avoid problems, many of which we have identified that we
have concerns about, whether it's in the privacy arena or
enforcement or all those areas. So NTU would be pleased to work
with the subcommittee on a pilot.
Mr. Porter. Ms. Simon.
Ms. Simon. Yes, thank you. We recommend a pilot in our
testimony. The last hearing when the Christiana medical system
in Delaware was cited as an example of success, we thought
immediately that it was quite unrepresentative of many of the
large plans in FEHBP. You've got a small, relatively
homogeneous community covered by one plan. In fact, for
example, in Blue Cross and Blue Shield, there are hundreds of
thousands of providers.
And just anecdotally, we've heard from small providers
whose response to the idea of one more administrative
responsibility under FEHBP would be to drop any coverage, any
insurers that required that additional reporting requirement.
And we've been very, very concerned that participation in
this plan on the part of the consumer be entirely voluntary,
and that participation be able to be withdrawn at any time at
will on the part of the participant.
Mr. Porter. Mr. Fallis.
Mr. Fallis. NARFEA would support a pilot program. I think
inherent in all this is the necessity that we have a means to
educate people about the electronic system and the fact that it
can be kept private. You know, privacy is a very, very critical
issue, as I mentioned earlier, with our people. We have an
organization whose average age is 74. And I was at a meeting
fairly recently in Florida, and this business of HIT was
mentioned, electronic records. And of course they think it's on
the Internet and would be available to everybody, and quite
frankly, they raised the roof, no, no, no, no, we don't want
that.
So there is a barrier and a hurdle that has to be crossed
with members in my organization, and that's to assure them that
privacy would really be there. And that's the main issue, as
far as I'm concerned.
Mr. Davis of Illinois. Thank you very much, Mr. Chairman.
Mr. Porter. Thank you, Mr. Davis.
I'd like to once again address--before we go to another
question--the purpose of this legislation.
Close to 100,000 people a year are dying. I support test
projects, I support pilot projects, but the reason this
legislation came forward is one of the downsides of Federal
Government is we study things to death, and I say that 90,000
to 100,000 people a year are dying, 700,000 people are being
hurt every year. And to help Blue Cross, there is 10 or 11
million of your participants in Illinois, Texas, Oklahoma,
Mexico right now in the health information technology system
today.
The reason I brought this forward--and I appreciate the
caution, and I'm with you, and we're trying to make sure we
cover all these problem areas, whether it be in the financial
institutions. It's not perfect, but all this information is out
there today, but the participant can't get it. I can't get my
own information, and I don't think that's right.
So I appreciate the pilots. And I know we have to move
forward, but if we study this for another 5 years, a half
million people are going to die. How many of those are
participants in the Federal system? There are so many tests
happening out there, we're testing this to death. My goal was
to look at the best--and you guys in the insurance industry in
this room are the best in the country, if not in the world. You
have the best accountants, you have the best technology, you
have the best resources. You're able to make it work, if
anybody can make it work, because you're already doing it. And
the purpose of this legislation is if we study this for another
5 years--there's going to be another 100 million in the system,
but our Federal employees aren't going to benefit from it, and
I don't think that's right. I think our Federal employees
deserve the best. And currently the civilian force out there,
the private sector, has this available to them.
So again, I appreciate the concerns, and I struggle with,
of course, trying to get answers to questions. That frustrates
me. But there is 40, 50 million people today in America that
are in this system. Why can't we make this work by following
all the proper tests and balances with HHS and with OPM? And we
have some of the best minds in the world, and certainly there
is room for improvement, and, as you know, I'm open for
suggestions. But my goal is to save a life. 500,000 Federal
employees now in the Blue system in those States I mentioned
are going to have this. Why can't folks in Nevada or Virginia
have it?
So my frustration is I want to save some lives. And
insurance carriers that we're working with are not insolvent,
and this is not going to be a problem for them financially. It
should not be carried on to our participants because it's
already being done.
So again, thank you. And to my Congresswoman that
represents me in my home here, Ms. Holmes, thank you for being
here. And do you have any questions?
Ms. Norton. Thank you very much, Mr. Chairman. And I really
do the best I can for you while you're in Washington.
I'm trying to get us both on the same page here. And I
don't know, I think I hear from the carriers and the
representatives of the employees a way to do that.
First of all, Mr. Chairman, I think what you just said in
your most recent remarks is why the majority of the American
people, and I think Members of Congress, yes, and Federal
employees would be interested in the bill; that if we can, by
providing a little information, save people's lives and improve
their health care, and they're already in some kind of IT
system, how come we can't somehow use it? It's pretty hard to
say anything but amen to that. And as with all hard problems,
it gets down to the nuts and bolts that you really get to the
questions we have to ask, and that's what I want to raise here
today.
I have really two concerns. These were raised previously
when we have had hearings on this bill. One, of course, were
the upfront costs. If you say to anybody--and we're talking
about Federal employees--and there is one dime to be added to--
costs keep going up or anything, except what you tell me is for
health care costs, you will get the book, eggs and anything
else they can find thrown at. And this whole notion about the
reserves and pharmaceuticals and some nonprofits, very
bothersome. We're talking about 3.1 million retirees and
Federal employees, and frankly, that's what makes this idea a
good one. This is your, you know, optimal control group, the
Federal employees. And if somebody has to go first, why not a
group like this, where we have more control than we would have
in the ordinary population?
But if we have learned anything about IT, it is that the
jerry-built systems will kill you. So you think you're being
killed because somebody can't get your records? One of the
things you don't want to do is let loose a weapon like IT that
you're not absolutely sure of.
Now, Mr. Chairman, I think I heard--and I would like
everybody to correct me if I'm wrong, if anyone disagrees with
this--does anybody on the panel believe that the best way
available for us to proceed is through some form of pilot
program where we would--whatever group we may all perhaps in a
hearing like this choose as the appropriate group, but would
take some of these 3.1 million as opposed to all of them to
begin to implement this in phases? Is there anyone who
disagrees that a pilot program would be the most responsible
way to begin? I just want to establish that for the record.
Let me tell you why I raise it. How short are our memories?
Who remembers the prescription drugs fiasco, where the program
literally fell apart on the first day? Why? Because it really
had many component parts, and because IT was central to making
it work. That would otherwise be known as an unintended
consequence. It was not perceived in advance. In my judgment it
could have been avoided if we had phased in seniors, saying
everybody will be in by X date. But we threw them all in there,
and a terrible price was paid. Half the States of the United
States, including the District of Columbia, ended up rescuing
the Federal program.
So you will find me believing in very large part because I
ran an agency--when I came to the agency it was very troubled,
and what you really wanted to do, since I thought I knew what
to do, was to take the whole agency and begin. And I started
with 3 of the offices, and there must have been 15 in the
country, and tested it out. So I really don't believe in the
infallibility of government bureaucrats. I think we are like
everyone else and should try everything out.
I am totally confused, Mr. Chairman, because in your case-
by-case analysis you say--and I want to from the carriers
particularly--certainly from the employee representatives--what
is going to be made available is what is available, like
carrier information is available now, and so no one knows from
carrier information, for example, what the blood test is for,
what the results were. That's still private information. But
when I looked at this analysis--Mr. Chairman, this is in your
memo to us--under carrier-based electronic health record, then
I get lost, because it says that each carrier-based electronic
health record must contain the carrier's health information for
the particular FEHBP member enrolled to the extent that the
information is necessary.
Now, then, it--and this is the part that I don't
understand, and maybe the panel can help me understand. The
primary purpose of section B is to, ``convert claims data into
a format that is useful for diagnosis and treatment,'' like a
patient summary. But I thought the claims information was not
like individual information that we would make available to
your doctor, for example. See, that's who we want to save lives
with; we want your doctor and all your doctors to have it. But
we begin with the carrier information. But in this hand--help
me out, please--useful for diagnosis and treatment. But I
thought it couldn't be used for diagnosis and treatment, and
that's why it's all right we can make it available because it's
only claims data.
Would somebody--this just may be me, but I'm confused by
this analysis of what the bill will do and what we are told
that the claims information stops it doing.
Mr. Porter. If you would yield for just a moment. I know
you have a flight to catch, so if you need to go----
Mr. Witkowski. I don't think I'm going to make it, sir.
Mr. Porter. If you decide to stay----
Ms. Norton. Are you opting out?
Mr. Porter. He's opting in.
Dr. Georgiou. If I could offer maybe some clarity in an
answer to your question. Carrier-based health information
includes the claim submissions from all of the providers,
hospitals, facilities, physicians that care for an individual
patient. Each of the claims that are submitted, however, is a
single event in time, and so I believe--correct me if I'm
wrong, Chairman Porter, but I believe that what you would like
to suggest in the bill is that all of those separate events
that exist for an individual be consolidated in a way that
provides a holistic picture of the individual and the
conditions that are part of their history.
I don't think that any claim-based personal electronic
health record should be used to practice medicine or make a
diagnosis, but it could assist and support the practice of
medicine and prevent errors, accelerate diagnoses and improve
the quality of care.
Ms. Norton. Do you think that the claims-based information
should go first? That would be what nobody could opt in or out
of, right, because we already provide that kind of information?
Dr. Georgiou. That information is currently available, I
would expect, in all of the data bases that exist.
Ms. Norris. But do you really think that one could
construct from that claims information a, ``patient clinical
summary?'' And if so, why is it mandatory, why is that an
invasion of privacy?
Dr. Georgiou. I absolutely believe that can be constructed.
We actually have already constructed that for over 15 million
members, and it's available today.
Ms. Norris. So you have already opted in because whoever
has your claims information already can do a patient clinical
summary from it. So what's the difference between opting in and
opting out if it's mandatory, and if, in fact, the primary
purpose is to use this claims data in a format useful for
diagnosis and treatment, like a patient clinical summary, then
why haven't you essentially opted in, because whoever has this
information can, in fact, reconstruct, as it were, a clinical--
a patient clinical summary?
Dr. Georgiou. I'm not sure I completely understand your
question, but let me make a few points. No. 1 is that United
Health Group would support an opt-out provision to this in this
bill.
Ms. Norris. For the carrier----
Dr. Georgiou. For the carriers, yes.
And No. 2 is that an individual always has the personal
choice to access it or not access that information through the
portal. Did that answer your question?
Ms. Norris. Well, yeah, it's opting out and not opting in,
of course. Yes--no, it does--what I am saying is that this says
you can, in fact, use this information to, in fact, get the
information I thought was not available through the claims data
because you can use this information like a patient clinical
summary. And the last time I looked, when you said patient
clinical summary, it means that somehow you can find this
private information about what, in fact, transpired. On the
surface it may look like I took a blood test, but if it says
that it will be used for--useful for diagnosis and treatment
like a patient clinical summary, it must mean that somebody
did, in fact, reconstruct what the uses are. And I just don't
understand--I still don't understand if that's the case, what
the difference is here between the carrier-based electronic
information is and what the so-called individual information is
where you have to somehow say whether you want that information
released. So I am--no, you have not answered that, except by
saying you could opt out of it.
Could I just ask this? You know, here we are--this opting
in, opting out, and whether or not people understand what they
can do and what it really means, and what can be constructed or
reconstructed from the carrier information, all of these nuts-
and-bolts questions I'm getting into, I think, Mr. Chairman,
could be easily cleared up by just taking a portion of the work
force that voluntary agrees--perhaps even given some
incentives, I don't know what they would be--but perhaps
voluntarily agrees to test this out so that some of these
questions simply answer themselves. Because we have real-time,
real-life people, we see where the mistakes are made, but on
such a level--with such a group sufficiently small that we
don't do harm to as many as 3 million employees just through
the carrier-based data alone, for example.
So I don't know see yet the answers to the questions I've
raised, others have raised, and what looks to be the consensus
of employees and carriers alike is not try to focus in on a
target group to test this new and very wonderful idea, but not
to subject every Federal employee at one time to it,
prescription-drug style that is so recently in our minds. Thank
you, Mr. Chairman.
Mr. Porter. Thank you very much. I have another 20 or 30
questions to ask, but let me say thank you very, very much for
your time. And many of you have spent literally hours on this
project, and I appreciate that.
This program--and possibly I'm not always making myself as
clear as I would like. I would just like 8 or 9 million Federal
employees to have available to them what 15 million have
currently at United HealthCare, or the 10 or 20 million--maybe
it's 50 at Blue Cross and Blue Shield, I'm not sure, a million
and a half. I would like Federal employees to have those same
benefits.
And I agree with my colleagues and every one of you that
privacy is critical. I believe that keeping the premiums where
they are, if not less, is a priority. But I think I said it
probably earlier that our Federal employees deserve what the
private sector can have and our retirees deserve, and that I
would hope that this voluntary program that I'm proposing could
move forward and change health care for millions of Federal
employees and health care across the country. And I appreciate
all of you, GEHA, United HealthCare, for expressing support and
willingness to work and move forward.
You know, of course, I pick on you, Mr. Gammarino. It's
difficult for me to hear no on our first meeting and still hear
no today even before you read the legislation. So I see other
health carriers stepping up to the plate because they think
they want the business because it's profitable business, but we
still have some time, and I'm still open for ideas as we fine-
tune this.
And to our employees, Ms. Simon, I understand the concern
of families. I mean, they don't want to be a test, they want
the best, and they don't want to pay more. I understand that. I
certainly understand--I understand the employees more than I
understand the insurance industry's objections, but we're going
to try to do everything we can to address those concerns, and I
appreciate your comments.
So I want to thank you all. This is very historic, and I
think that collectively we can do some great things. And to my
committee, I know that they've had other meetings to go to but
it's been a very thoughtful process, and I appreciate all of
you being here and being here late in the evening.
So the meeting is adjourned. So thank you very much.
[Whereupon, at 6:01 p.m., the subcommittee was adjourned.]
<all>