How ACOs could better utilize EHRs

Accountable care organizations (ACOs) are “composed of doctors, hospitals, or other healthcare providers that come together voluntarily to coordinate high-quality care for their patients and agree to be accountable for the total cost and quality of the care provided.” The idea behind the ACO concept is to enable independent physicians to realize the benefits of being a part of a larger organization while retaining autonomy in their own practices. ACOs also work to improve population health.

In May 2019, the U.S. Department of Health and Human Services Office of Inspector General published the results of its research into six Medicare ACOs that use health information technology for care coordination. The study offers “insights into how select ACOs have used health IT tools to better coordinate care for their patients.”

The Office of Inspector General conducted interviews during site visits to four Next Generation ACOs and two ACOs that participated in the Medicare Shared Savings Program. The ACOs were selected for the study based on “their performance on a quality measure focused on care coordination and patient safety, a minimum of 3 years of experience as a Medicare ACO, geographic variation, and recommendations from CMS and ONC (Office of the National Coordinator for Health Information Technology).”

After reviewing how each of the ACOs used information technology, including electronic health records (EHRs), the study concluded that “the full potential of health IT has not been realized.” The ACOs that used a single EHR system across all of their provider networks had the ability to share patient data in real time, optimizing their ability to coordinate care for their patients. However, ACOs that used multiple EHR systems faced challenges.

Interoperability, the electronic sharing of patient information between different EHR systems and healthcare providers, is a major concern for ACOs relying on health IT tools. Coordinating care effectively depends on EHR interoperability. “Achieving the interoperability needed for seamless care coordination places burdens on ACOs to either invest in a single EHR system, or use additional methods, such as non-health IT means like faxes and phone calls, to communicate health information.”

The study concludes by suggesting that “Some of HHS’s proposed initiatives might address concerns and challenges that we heard from ACOs. For example, ONC’s Trusted Exchange Framework and Common Agreement has the promise of facilitating interoperability across health IT networks, which might mitigate the problem that ACOs had in accessing data from HIEs (Health Information Exchanges) with little or incomplete data. With interoperability, an ACO would be able to access patient data even when patients visit providers outside the ACO.”

Nick Dealtry
July 8, 2019

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New data shows patient satisfaction and care quality improvements with EHRs

Patients are finding that more physicians are taking advantage of electronic health record (EHR) capabilities than just ten years ago. In addition, those patients believe that their physician’s use of an EHR improves the quality of the care they receive as well as their interactions with their physician. These findings are included in the January 2019 KFF Health Tracking Poll, published by the Henry J. Kaiser Family Foundation.

The poll found that the number of physicians entering patient data into a computer-based medical record, according to the patients responding, almost doubled from 46 percent in 2009 to 88 percent in 2019. Patients participating in the research mostly see the use of EHRs as helpful, although many also had concerns about data security and accuracy.

Among participants in the survey who said their physician uses an EHR, 45 percent said the EHR use has made the quality of care they receive “better.” Almost as many, 44 percent, of those patients also said the physician’s use of an EHR has made their interactions with that physician “better.”

Patient responses differed according to their age group. The youngest patients reported the “most positive effects.” A majority of the poll participants in the age group 18-29 said that the quality of the care they receive is “better” since their physicians uses EHRs. No one in this age group reported their quality of care as “worse.”

Data security was a concern for many of the patients responding to the poll. Over half (54 percent) reported that they felt “very concerned” or “somewhat concerned” that someone might be able to access their confidential medical information who was not authorized to do so. Again, the younger age group had fewer concerns about their privacy with only 42 percent reported being “very” or “somewhat” concerned about an unauthorized person gaining access to their medical record.

Although some patients were concerned about errors in their medical records, 54 percent said they were “not too concerned” or “not at all concerned.” The majority did not think that errors or discrepancies would negatively impact the quality of care they receive from their physicians.

Nick Dealtry
May 30, 2019

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What is care collaboration?

Proper and effective medical care often involves multiple providers as well as the patient and the patient’s family. Coordinating that care can mean the difference in the quality and consistency of the patient’s healthcare plan. Communication is a key factor in care collaboration, whether electronic or in person.

In care collaboration, physicians communicate and coordinate with each other to ensure they are treating the patient appropriately. Providers communicate and coordinate with the patient and the patient’s caregivers to ensure that instructions are being followed properly.

The AMA states that collaborative teams “are defined by their dedication to providing patient-centered care, protecting the integrity of the patient-physician relationship, sharing mutual respect and trust, communicating effectively, sharing accountability and responsibility, and upholding common ethical values as team members.”

Care collaboration can be beneficial in crisis situations as well. Researchers at the University of Michigan have found that a collaborative team-based approach, along with the use of medication assisted therapy (MAT), can have a significant impact on the rate of opioid addiction in the US. The researchers found that “many of the two million Americans addicted to opioids can receive treatment and assistance in getting off prescription painkillers or heroin from a primary care team.”

Additionally, a study published by the AMIA Annual Symposium, the authors stated that “experts have agreed that more collaborative, team-based care will be required to meet the increasing burden of chronic disease.”

Collaboration through the use of advantaged technology significantly improves the quality of care coordination by helping to ensure the accuracy of the information being shared as well as speeding up the process by which it is shared. Taking advantage of collaborative health record technology can help with the physician’s main focus – providing the highest quality care for patients.

Elation’s Collaborative Health Record (CHR) enables providers to immediately share updates so that all providers caring for the patient can take action based on the most up-to-date clinical information. Most importantly, the CHR closes care gaps. Providers can decrease duplicative testing and avoid medication errors with uninterrupted communication. Timely sharing of patient information helps ensure care is as efficient and as effective as possible.

Nick Dealtry
May 30, 2019

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The movement around independent physician associations

Independent physicians who want the advantages of belonging to a larger organization while at the same time retaining their autonomy are choosing to join independent physician associations (IPAs). An IPA is, according to the AAFP, “a business entity organized and owned by a network of independent physician practices for the purpose of reducing overhead or pursuing business ventures such as contracts with employers, accountable care organizations (ACO) and/or managed care organizations (MCOs).”

IPAs are growing, as more independent physicians recognize that they need collaborative power when negotiating contracts or navigating complex reporting requirements. In fact, the IPA Association of America (TIPAAA) says that it represents over 300,000 physicians who are associated with IPAs.

Independent physicians find that they are able to focus more on their patients and less on administrative tasks when they are part of an IPA. One study, conducted of 1164 practices that had 20 or fewer physicians, has shown that “physicians participating in IPAs provided about three times as many care management services for their patients with more than one chronic conditions as compared to non-participating practices: 10.45% over 3.85%.”

When asked about the movement around IPAs, Scott Kronlund, MD, MS, the President and CMO at Northwest Physicians Network in Tacoma, the largest IPA in Washington, confirmed that there is definitely an increased interest in IPAs among independent physicians. Dr. Kronlund noted that “The marketplace is too complex for private practice physicians to survive on their own — they need help synthesizing data and responding; they need support so they can be flexible in this ever-changing environment.”

Dr. Kronlund added that his group began with 375 members and has grown to over 1,000 independent physicians. He attributes the movement around IPAs to the many challenges faced by independent physicians, including clinical integration, administrative burdens, and negotiating power that helps increase revenue. Many independent physicians are not able to participate in shared savings programs due to the economies of scale. IPAs can also benefit independent physicians by playing a key role in the implementation and optimization of healthcare technology, including electronic health records.

Nick Dealtry
March 27, 2019

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Interoperability a focus at HIMSS 2019

Among the many pertinent and educational topics featured at HIMSS19, held in February 2019, was Health Information Exchange, Interoperability, Data Integration & Standards. Participants were encouraged to explore “all aspects of information exchange, interoperability, data integration and standards across technical and administrative strategies that contribute to sustaining the healthcare enterprise and enabling a positive consumer experience.”

HIMSS19 brought together over 45,000 healthcare professionals, including health information and technology professionals, clinicians, executives and market suppliers, featuring the theme “Champions of Health Unite.” Interoperability was a key focus at the conference. In fact, according to an article published by Mobihealth News, interoperability stood out among the extensive list of educational topics presented at the annual conference.

Mobihealth noted that interoperability has been on the conversation and seminar list for several years at the HIMSS conferences, but “this time there was a sense that all the effort that’s gone into creating HL7, FHIR and other data standardization and sharing tools is finally paying off.” The topic of interoperability also included discussion of the new rules proposed by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).

Several sessions featured interoperability and the move to artificial intelligence (AI) in the medical field. Sessions included Style Standards to Improve Data Quality and Interoperability, focused on improved interoperability’s accuracy as well as the overall process. Another session, From Print to Interoperability: Cancer Staging in the EHR, looked at leveraging the EHR for cancer staging and transitioning from print to a truly interoperable electronic format for medical records.

The session, Enabling Data Interoperability Across the Continuum of Care, was presented by leaders from CMS and ONC. Presenters discussed the organizations’ goals around health information technology (HIT) vocabularies and how Fast Healthcare Interoperability Resources (FHIR) can enable data exchange.

The conference also featured an Interoperability Showcase where attendees could see technology solutions and learn more about interoperability topics that may impact them.

Nick Dealtry
March 22, 2019

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CMS proposes new interoperability rules to close care gaps and improve data sharing

In 2018, the Centers for Medicare & Medicaid Services (CMS) announced a new initiative, My HealthEData, that would “empower patients by giving them control of their healthcare data, and allowing it to follow them through their healthcare journey.” The initiative was led by the White House Office of American Innovation and included participation by the Department of Health and Human Services (HHS), CMS, Office of the National Coordinator for Health Information Technology (ONC), and National Institutes of Health (NIH), as well as the Department of Veterans Affairs (VA).

In February 2019, CMS proposed policy changes to support the My HealthEData initiative, including new interoperability rules designed to close care gaps to improve data sharing between physicians and patients. The Interoperability and Patient Access Proposed Rule “outlines opportunities to make patient data more useful and transferable through open, secure, standardized, and machine-readable formats while reducing restrictive burdens on healthcare providers.”

Some of the proposed changes and updates include:

  • Patient Access Through Application Programming Interfaces (APIs)
  • Health Information Exchange and Care Coordination Across Payers
  • API Access to Published Provider Directory Data
  • Care Coordination Through Trusted Exchange Networks
  • Improving the Dual Eligible Experience by Increasing Frequency of Federal-State Data Exchanges
  • Public Reporting and Prevention of Information Blocking
  • Provider Digital Contact Information
  • Revisions to the Conditions of Participation (CoPs) for Hospitals and Critical Access Hospitals
  • Advancing Interoperability in Innovative Models

At the same time, the ONC proposed a rule that “places a strong focus on a patient’s ability to access their health information through a provision requiring that patients can electronically access all of their EHI (structured and/or unstructured) at no cost.” Regarding the CMS proposed rule and the ONC proposed rule, HHS Secretary Alex Azar said, “These proposed rules strive to bring the nation’s healthcare system one step closer to a point where patients and clinicians have the access they need to all of a patient’s health information, helping them in making better choices about care and treatment.”

In addition to the policy proposals, CMS is releasing two Requests for Information (RFIs) to obtain feedback on interoperability and health information technology (health IT) adoption in Post-Acute Care (PAC) settings, and the role of patient matching in interoperability and improved patient care.

CMS will accept comments on the major provisions in this proposed rule and the RFIs (CMS-9115-P) until early April (exact date will be updated upon posting at the Federal Register); it can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.

Nick Dealtry
March 5, 2019

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California payers, providers, and regulators are working together to improve data sharing

Accurate and current data is critical in the healthcare industry. Patient data as well as provider data must be properly maintained to ensure the quality of healthcare services. In particular, physician data has to be easily accessible and has to have the correct information for patients who are searching for a provider and for providers who need to connect with each other when coordinating services.

Unfortunately, given a number of factors, physician data is not always accurate or current. Healthcare payers may change their list of providers who are considered in-network. Physicians may change locations or employers, information that has to be updated with every appropriate healthcare payer. Providers may even venture into a new specialty area. These changes are not always reflected in available provider data. It is estimated that over half of all data found in provider directories is inaccurate.

In California, however, a new centralized online provider directory is changing all of that. Integrated Healthcare Association (IHA) has launched a new service, the Symphony Provider Directory, formerly known as the California Provider Directory Utility (PDU). The new directory, funded by a $50 million grant from Blue Shield of California, will serve “as a platform for plans and providers to exchange and reconcile provider information, resulting in improved data quality and more efficient processes.”

The new service is the result of a “cross-industry collaboration of plans, providers, purchasers and regulators.” The directory “enables health plans to maintain more up-to-date and accurate information such as provider demographics, panel status and health plan product and network details in their consumer-facing directories so that consumers can make informed decisions about their coverage and care.”

Jeffrey Rideout, M.D, President and CEO of IHA, notes that the Symphony Provider Directory is “much more than a complex IT project. This is an industry-wide commitment to improve the healthcare system in California. IHA’s role is to drive alignment and establish an effective and sustainable platform that supports the complex needs of health plans, providers and ultimately healthcare consumers.”

Nick Dealtry
February 6, 2019

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Is case management the same as care coordination?

Coordinating a patient’s care properly can mean the difference in that patient’s healthcare outcomes. The primary care physician, in particular, must be able to coordinate care for patients who are seeing multiple providers, undergoing tests, or staying in healthcare facilities for treatment of chronic or complex illnesses. This type of care coordination is not the same as case management.

The Case Management Society of America (CMSA) defines case management as “provided by healthcare professionals working with people to identify issues and barriers that may prevent them from getting better and uncovering mutually agreed upon solutions to achieve their healthcare goals.”

The Agency for Healthcare Research and Quality (AHRQ) describes care coordination as “deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care.” The AHRQ emphasizes that care coordination necessitates communicating the patient’s needs and preferences at “the right time to the right people.” The information must be shared and used in a secure manner and in a way that provides “effective care to the patient.”

Care coordination’s main goal, as the AHRQ defines it, “is to meet patients’ needs and preferences in the delivery of high-quality, high-value health care.” Given the shift toward value-based reimbursement structures, independent physicians are investing in tools that help them more effectively direct their efforts toward the specific and immediate needs of their patients.

Similar to and working with the primary care physician’s care coordination efforts, CMSA states that case management is “a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.”

Further, case management “helps identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value” for patient, payer, and provider.

Nick Dealtry
January 28, 2019

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Breaking down the major ACO changes from the MSSP final rule

On December 21, 2018, the Centers for Medicare & Medicaid Services (CMS) published its Medicare Shared Savings Program (MSSP) final rule for accountable care organizations (ACOs). The program is now referred to as Pathways to Success and encourages ACOs “to transition to performance-based risk more quickly and, for eligible ACOs, incrementally, to increase savings for the Trust Funds.”

The final rule does away with the previous tracks (Track 1, 1+, 2, and 3) and offers two participation options: BASIC and ENHANCED. Beginning on July 1, 2019, ACOs will enter into agreements under one of these new tracks for at least 5 years.

  • BASIC track, which would allow eligible ACOs to begin under a one-sided model and incrementally phase-in higher levels of risk that, at the highest level, would qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program
  • ENHANCED track, based on the program’s existing Track 3, which provides additional tools and flexibility for ACOs that take on the highest level of risk and potential reward.

CMS states that one of the goals of the new structure is “Promoting accountability by accelerating the move to two-sided risk while promoting competition by encouraging participation by low revenue ACOs.” Under the Pathways to Success program, ACOs will be classified as “low revenue” or “high revenue.”

  • Low revenue ACOs identified as experienced with performance-based risk Medicare ACO initiatives, such as ACOs identified as having previously participated in the program under Track 2, Track 3 or the Track 1+ Model, are restricted to participating in either the BASIC track’s highest level of risk and reward or the ENHANCED track.
  • High revenue ACOs determined to be inexperienced with performance-based risk Medicare ACO initiatives would be limited to no more than a single agreement period under the BASIC track. High revenue ACOs determined to be experienced with performance-based risk Medicare ACO initiatives would be restricted to participating in the ENHANCED track.

CMS is offering an application cycle for a one-time new agreement period start date of July 1, 2019, and will resume the usual annual application cycle for agreement periods starting on January 1, 2020, and in subsequent years.

Nick Dealtry
January 22, 2019

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Value-based care and care management

Value-based care, as opposed to fee-for-service care, has been shown to improve the quality of care management, particularly for those patients with one or more chronic conditions. Those are the findings of a recent study conducted and published by Humana, the Value-based Care Report.

Worthe Holt Jr., M.D., M.M.M., Humana V.P., Office of the Chief Medical Officer, writes in the report that “By integrating care at all levels, we can better coordinate prevention and wellness of populations to slow and prevent the advancement of disease. We are rapidly moving from a focus on episodic care to one that addresses the whole person, inside and outside the clinical setting, by practicing value-based care.”

The study, Humana’s fifth annual, found that “Physicians who practice value-based care are achieving higher rates of patient engagement in preventive screenings, medication adherence and management of chronic conditions as measured by HEDIS (Healthcare Effectiveness Data and Information Set).”

Value-based care and care management are connected in that physicians are more focused on the need for preventive care and chronic condition management in a value-based care setting. They are better able to manage care for their patients, particularly those who may face challenges with social determinants of health, such as food insecurity or other socioeconomic factors, and who may also tend to experience more chronic conditions.

In fact, the report stated, that “on average, Americans with five or more chronic conditions spend 14 times more on health services than people with no chronic conditions.” Proper care management, including preventive care and medication management, that is part of a physician’s value-based care plan for the patient can catch these conditions early and enable the physician to properly treat the patient, keeping the patient healthier.

Roy A. Beveridge, M.D., Humana’s Chief Medical Officer, stated that “Practicing value-based care works to address the nation’s chronic disease epidemic by giving physicians the support and data they need to focus more on prevention and reduce acute care episodes. This model allows physicians to focus time and energy on those patients who need the most support to stay well at home, and out of the hospital. Physicians are clearly seeing the benefit of improved patient outcomes and more shared savings.”

Nick Dealtry
January 18, 2019

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