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Health IT and Payment Reform Update

May 27, 2014
by John DeGaspari
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One regional CMS official’s take on successes and challenges in initiatives to drive quality and cut costs

How successful has the Affordable Care Act been in leveraging health information technology and payment reform?  During a presentation in April at the New York State HIMSS Chapter conference, Frank Winter, partnership manager for the regional office of the Centers for Medicare and Medicaid Services (CMS) in New York, said that healthcare IT is at the core of several initiatives that have shown promise in improving care quality while reducing costs. The group is a state chapter of the national Health Information and Management Systems Society (HIMSS), based in Chicago.

“We have lots of initiatives, many through our [CMS] Innovation Center, that are trying to accomplish that, all of which involve health information technology,” he told an audience of several hundred in Manhattan.

Winter said that the Triple Aim—a concept being promoted by the Cambridge, Mass.-based Institute for Healthcare Improvement (IHI), and aimed at improving the patient experience of care, improving the health of populations, and reducing the per capita cost of healthcare—and further, promoted by former Acting CMS Administrator Donald Berwick—remains the agency’s touchstone. However, he said, expanded care is often what most of the public associates with healthcare reform under the Accountable Care Act (ACA). He described that as the biggest part of the law in terms of the number of initiatives and the amount of work involved, which is changing the way healthcare is delivered.

The newly insured—many of whom have health insurance for the first time or for the first time in many years—need to be educated, Winter said. “They will have to be sold on the idea of prevention, providing consent to participate in information sharing as part of these [health] networks,” he said.

Winter gave an update to the CMS’ electronic health record (EHR) Incentive Program, citing an interim report that was issued by CMS in November 2013, noting that 86 percent of hospitals and 63 percent of eligible professionals were receiving incentive payments. When the program started, hospitals were behind eligible professional professionals in terms of EHR adoption, he said.

He also cited a poll that showed a large uptake in the number of physicians who reported using EHRs, some of whom may not have gone through the process of getting an incentive payment or attesting. Nonetheless, he said attestation has been successful, particularly in terms of Medicare eligible professionals trying to attest, and achieving a high (99 percent) success rate.

Much of the work on payment reform has been taking place at the CMS Innovation Center, Winter said, adding that the regional office has been trying to link the work at the Innovation Center with the regional partners. One challenge at the regional level is that many of the partners are not aware of each other, and of the resources available in their communities, he said. “This is a team approach, not just a physician’s office or a hospital, but it also a team approach in terms of different organizations,” he said.

He noted that there are many different payment reform programs, with demonstrations going on through the Accountable Care Act (ACA), and many through the Innovation Center. “Improving data systems and using evidence-based care is a big part of the success of these initiatives,” he said. He added that part of that is targeting what is successful and putting it to work. “Different organizations are finding different strategies as part of limiting costs and improving quality,” he said.

The “biggest fish in the pond of payment reform” is accountable care, with more than 4 million beneficiaries across the country participating in 252 accountable care organizations (ACOs) nationwide, he said. He noted that it is a growing part of Medicare programming, with 10 percent of fee-for-service beneficiaries receiving care through an ACO—in addition to those receiving care through other initiatives such as the patient-centered medical home, Home Health, or the Comprehensive Primary Care Initiative.

Winter said the idea behind these initiatives is to measure quality, and one challenge for CMS is to align quality improvements with the payment incentives. “We want to make things easier, even as we experiment with different models, to see which models work best,” he said.

Winter noted that the Northeast region has the greatest concentration of ACOs in the nation, as well as many of its success stories as part of the Pioneer ACO program as well as the Medicare Shared Savings Program. He noted that the Northeast region has a high number of high-cost areas, but even in areas where there is not high across-the-board cost ACOs have been able to identify areas of cost and targets for improvement.

He said that Pioneer ACOs take on risk not only through the Medicare program, but also, through their contract with CMS, risk from other payers. “We want providers participating in payment reform across the board,” he said. Among the factors that contributed to the success of ACOs include communication, transparency, redesign of practices, the use of dashboards, and the patient-centered medical home model. At least one ACO in the region required all participating practices to be certified as medical homes by the National Committee for Quality Assurance (NCQA), and it reported significant savings, he said.

Winter said that there was widespread improvement in terms of quality measures by ACOs. He also said that, in general, payment reform programs are considered to be successful if costs go down and quality goes up. Yet, even in programs that shave showed quality improvements without much cost savings shouldn’t be written off, he said: in the long run, quality improvements likely will translate into cost savings. A snapshot a successful ACO over a period of a year or two will reveal quality improvements in terms of changed systems that resulted in better practices, and the use of more technology. “In the long term we think that is going to be successful, even though in the short term you might not see savings,” he said.

Winter also named several other CMS programs that have been successful:

  • Community-Based Care Transition Program, which has been effective improving transitions from the hospital and reducing readmissions for high-risk Medicare beneficiaries. “We have seen a huge improvement in New Jersey,” he said.
  • Million Hearts initiative, aimed at preventing a million heart attacks and strokes by 2017, with a focus on eliminating delayed treatment.
  • Health Care Innovation Awards, many grants having a healthcare IT component, aimed at driving innovative practices in healthcare improvement.
  • Medicaid Incentives for the Prevention of Chronic Diseases, aimed at using evidence-based research and resources for goals including tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or in the case of a diabetic, improving the management of the condition.

Winter summed up by saying payment reform in the healthcare system is a long-term effort that will take years. He said the CMS innovation Center is a good resource, because it has the ability to test different models and scale them. “We want to align incentives, define the goals, pick the right measures, and support quality improvement as well as engage patients in the community,” he said.

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