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Adam Boehler Officially Named CMMI Director

April 9, 2018
by Rajiv Leventhal
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The Center for Medicare and Medicaid Innovation (CMMI) officially has a new director—Adam Boehler, the former CEO of home-based care startup Landmark Health.

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma told staff in an email that Boehler will start as the director of the office next week, according to a report in The Hill. Another report in Health Exec noted that “Boehler’s selection has been rumored for months.” In fact, Politico reported in December that Boehler would be the new CMMI head, but that it would take some time before it became official due to some potential conflicts.

Further regarding CMMI, Politico reported last month that “There’s been a recent exodus of top officials at the CMS Innovation Center, and the installation of a new leader at the office has been on hold because of financial conflicts. The Obamacare-created office, which many Republicans have viewed with suspicion, has so far received minimal attention from administration leaders.”

The Health Exec report noted that Boehler “doesn’t bring any government experience, with his resume mostly centered on venture capital and startups. Before founding Landmark Health, he was running another healthcare startup, lab management company Accumen. Other past roles include executive vice president and general manager at analytics provider MedeFinance and a principal healthcare investor at Accretive.”

According to the Health Exec report, Verma told her staff on Friday, “Adam is widely regarded as an innovative leader in the private sector and in him we are lucky to have someone who has designed and implemented new, patient-focused approaches to healthcare delivery.”

Created under the Obama administration, CMMI is charged with piloting, testing and evaluating alternative payment models—such as bundled payment models, for example—with the intent of increasing quality and efficiency, while reducing program expenditures under Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

Last September, Verma wrote an op-ed in the Wall Street Journal where she said that the Trump administration would lead CMMI “in a new direction” to give providers more flexibility with new payment models and to increase healthcare competition. Verma said at the time that CMS was analyzing all Innovation Center models “to determine what is working and should continue, and what isn’t and shouldn’t.” The agency also issued an RFI for ideas on how to determine the best path forward for CMMI, to which various healthcare associations responded with comments and suggestions.

Verma has previously voiced skepticism about some CMMI initiatives, including mandatory bundled payment programs. However, new HHS (Department of Health & Human Services) Secretary Alex Azar recently said during a Senate Finance Committee, when asked about mandatory pilots, that he believes the industry needs “to be able to test hypotheses. And if we need to test a hypothesis, I want to be a reliable partner, I want to be collaborative in doing this, I want to be transparent and follow appropriate procedures, but, if to test a hypothesis there around changing our healthcare system, if it needs to be mandatory as opposed to voluntary to get adequate data, then so be it,” Azar said.

 

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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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Medicaid Transformation Project Expands to 24 Health Systems

December 6, 2018
by Heather Landi, Associate Editor
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Seven new health systems have joined the Medicaid Transformation Project, a national effort to transform healthcare and related social needs for the nearly 75 million Americans who rely on Medicaid.

In total, the project now includes 24 health systems that comprise 342 hospitals, more than 65,000 beds, in 25 states with over $121 billion in combined annual revenue.

The Medicaid Transformation Project, which was announced August 28, was formed with the vision that healthcare organizations can work collaboratively to enable better health and outcomes for vulnerable populations, while also reducing costs, through the adoption of digitally-enabled care models. The project is led by AVIA, a network of healthcare organizations committed to digital transformation, and Andy Slavitt, former Acting Administrator of the Centers for Medicare & Medicaid Services (CMS).

The project initially began with 17 health systems, with five health systems anchoring the work—Advocate Aurora Health in Chicago and Wisconsin; Baylor Scott & White Health in Dallas; Dignity Health in San Francisco; Geisinger in Danville, Pa.; and Providence St. Joseph Health in Renton, Wash.

The project worked with health systems to target four critical challenges over the next two years to better meet the needs of vulnerable, low-income populations: behavioral health, women and infant care, substance use disorder, and coordinating community care to reduce avoidable emergency department (ED) visits.

The seven new health systems joining the Medicaid Transformation Project span distinct geographic and socioeconomic markets: BayCare Health System in Clearwater, Fla.; Boston Medical Center in Boston; Cedars-Sinai in Los Angeles; Carilion Clinic in Roanoke, Va.; Children’s Hospital Colorado in Aurora, CO; Jefferson Health in Philadelphia; and University Hospitals, in Cleveland.

According to Medicaid Transformation Project leaders, underpinning this action is an acknowledgement of the current health disparities seen in communities across the country. A leading indicator of such disparity is life expectancy, which is highly correlated with ZIP code, income, and race because care delivery varies greatly based on those factors. Insufficient healthcare access, patient engagement, and social determinants create variations in life expectancy that can be as great as 16 years between communities that are just a mile or two apart. The Medicaid Transformation Project’s commitment is to close the gap in care and outcomes in communities in need through a renewed focus on innovation and investment, leaders say.

“The current healthcare delivery system needs to be disrupted to dismantle health inequities. At Jefferson Health, we believe that collaboration and creativity will drive this necessary transformation,” Stephen Klasko, president and CEO of Jefferson Health, said in a statement. “We’re joining the Medicaid Transformation Project to learn from others across the country and to find the best innovations that improve care and outcomes for the most vulnerable among us.”

The 24 participating health systems have decided to initially focus on transforming the role of the emergency department, and leaders recently convened in Chicago to discuss how to better position EDs for sustainability and care coordination.

To do this, project participants are seeking to improve linkages from the ED to other critical parts of the delivery system, namely primary care, behavioral health, specialty care, and social services and supports. The underlying goals are reducing unnecessary ED visits, reducing avoidable ED visits, and improving patient disposition and sustainable transitions at the moment of discharge, project leaders say.

“By bringing together the nation’s leading health systems, we have a unique opportunity to improve the health of underserved populations in a way that hasn’t been done before. We’re committed to sustainable, durable solutions that improve care and outcomes for people. We must consider the best existing and new ideas and invest in the right ones,” Andy Slavitt, Medicaid Transformation Project Chair, says.

At the Action Forum, Medicaid Transformation Project participants discussed care models that had shown success—but had been previously limited by barriers in labor, cost, or technology. They viewed 10 on-site demonstrations of scalable solutions and engaged directly with company founders to explore relevant care models, ranging from community health worker (CHW) programs to virtual triage. They gathered insights from one other and from leading Medicaid experts, including Molly Coye, M.D., former Commissioner of Health for the State of New Jersey and Director of the California Department of Health Services, and Vikki Wachino, former Director of the Center for Medicaid and CHIP Services.

“The collaborative model of the Medicaid Transformation Project is providing us with a new and necessary lens to view a long-standing challenge, which is improving access and coordination to community care,” Thomas M. Priselac, president and CEO of Cedars-Sinai, said in a statement. “Our team is excited to share what we’ve learned working with our community partners, and to scale new digital solutions that lower long-standing barriers to care.”

The health systems in the Medicaid Transformation Project will next select scalable solutions to extend care models and begin early implementation. “These 24 health systems have put a stake in the ground around transforming the function of the Emergency Department in communities with heightened vulnerability. By acting locally and collaborating nationally, we can create a force-multiplier effect that will inspire ripples across the country. We’re honored to help lead this work,” AVIA President Linda Finkel said in a statement.

The Medicaid Transformation Project will launch its next body of work on behavioral health in January 2019.

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At UVM Health Network, Advancing an Integrated Health System’s Initiatives through Data Governance Strategies

December 5, 2018
by Mark Hagland, Editor-in-Chief
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At the Burlington, Vermont-based UVM Health Network, Leah Fullem is helping to lead data governance processes intended to speed the advancement of key IT strategies

The Burlington, Vermont-based University of Vermont (UVM) Health Network was created in October 2011, when what was then known as Fletcher Allen Health (now the University of Vermont Medical Center) in Burlington, Vermont, and Central Vermont Medical Center in Berlin, Vermont, signed an affiliation agreement. Six hospitals—the University of Vermont Medical Center, Alice Hyde Medical Center, Central Vermont Medical Center, Champlain Valley Physicians Hospital, Elizabethtown Community Hospital, and Porter Medical Center—and the UVM Health Network Home Health & Hospice (formerly the Visiting Nurse Association of Chittenden and Grand Isle Counties) make up the network. As the organization’s website notes, “Working together to better serve our communities makes us stronger, focused on collaboration instead of competition. As a team, The University of Vermont Health Network improves the lives of our patients by delivering outstanding care cost-effectively, as close to patients’ homes as possible,” it adds. “The University of Vermont Health Network cares for communities on both sides of Lake Champlain, from the Adirondacks to the Green Mountains and beyond.”

Bringing together those diverse hospital facilities and healthcare services has necessitated formal data governance processes. And, in that context, Leah Fullem, vice president of enterprise information management & analytics at the UVM Health Network, reached out for consulting support to Stephanie Crabb, co-founder and principal in the Tampa, Florida-based Immersive consulting firm. Recently, Fullem and Crabb spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the journey around data governance at UVM Health Network. Below are excerpts from that interview.

Can you share with me the origins of your initiative to create a formal data governance structure at UVM Health Network?

Leah Fullem: A couple of things made this time the right time to pursue this work. The UVM Health Network—we came together several years ago, anchored by UVM Medical Center, and affiliated with community and critical access hospitals in Vermont and in northern New York. And we had some network structures in place. And a few years ago, we decided to implement a common cost accounting and financial services solution; and now we’re in the initial phases of a rollout of Epic system-wide. The medical center has been on Epic for several years now on inpatient and ambulatory; and revenue cycle components will be included in November 2019. So we’re looking at implementing common tool sets across the network, with common workflow and documentation standards.


Leah Fullem

We’re trying to improve the way in which we capture information, so that we can better work together as a network. That’s why it’s a good time to initiate enterprise-wide data governance. But we still have multiple different areas in which data are consumed, produced, and analyzed, with a lot of different ways of doing that. So we contracted with Immersive about a year ago, and then did a scan, looking at our data resources, tools, data governance and standards we had in place, and gave us a nice set of recommendations and a roadmap.

What were the biggest gaps you found?

Our story is not uncommon; we found that we had multiple areas where we were duplicating effort; analysts in the finance area and quality area, or multiple different areas, were writing different queries with different parameters, across the same subject areas, for reports. And they were using different metrics to calculate from. So we had data silos, which meant that data analyst teams being directed by different supervisors, weren’t able to partner with each other. So there were a lot of knowledge gaps; we had a huge amount of analyst talent, but we weren’t able to leverage the talent we have. We have SQL servers, many other forms of storage, of data; and the Epic rollout will include an enterprise-wide data platform that we’ll implement over the course of the next year, and that will allow us to make sure we’re on common platforms with common platforms.

Stephanie Crabb: One unusual thing about UVM is that UVM has had incredible executive support and sponsorship around data for a long time. Dr. John Brumsted, the current CEO, was the network CMO and chief quality officer; so he’s an individual who’s always been very bullish and visionary around the use of data and information.  And he himself had taken the first pass at implementing data governance when he was the CMO. So it’s really important—we talk a lot about executive sponsorship in data governance, and about whether it’s really there, whether it’s real. And one success factor at UVM was the fact that Dr. Brumstead was a stalwart supporter and leader. And he put forth from the very first meeting that failure was not an option. So he really set the tone, and was open to creative ideas, and was focused on putting ideas into action. That’s how Leah’s position was created.


Stephanie Crabb

What have been the biggest lessons learned so far in all of this?

Fullem: I’m still early on in my involvement in all this; I’ve been in this position six weeks so far, but much work has already been done. We’ve set up a network-wide data governance council with broad representation across business functions and institutions; created a network-wide data governance policy; we’ve begun a project on provider dictionaries/better data management processes; and we’ve been focusing on data governance, stewardship, and moving forward with a new structure. When Dr. Brumsted first started talking about instituting data governance, there was no locus of authority for participating in data governance or collaboration efforts; now, that’s here.

And in the first six weeks of my job, I’ve been going around speaking with as many people as possible in Vermont and northern New York. And we’re talking about the way people access data, and what tools analysts might be using. So I had expected some pushback, but overwhelmingly, people across this network have been enthusiastic and supportive of this, which was surprising. The commonality is someone saying, “I had something that I thought was easy, but it wasn’t, and no one could get back to me in a timely way, and I had to wait six months, and by then, it wasn’t relevant to me.” And we’re moving heavily into population health and care management, so there’s a great deal of interest.

The biggest lesson we’re learning in process is that this is a cultural change more than anything. Yes, data is involved. I report up to the chief population health and quality officer. This is a cultural change. We will improve access to data, improve the quality and accessibility of data and information, to allow us to make better decisions on behalf of our patients and people. We have people who still only trust the data given to them by their analysts, or data they’ve extracted themselves. And yet there are conflicting numbers all over the place. So creating trust, to open people up to changing the way people receive or experience data, through new ways of looking at the information, involves a huge change effort.t So above all, I need change agents.

Crabb: Lessons learned from our point of view through the work—to augment the change piece—have been several. One thing that UVM has done very well is that they didn’t just do an assessment and roll forward with a roadmap; they were really honest about their strategic, tactical, and cultural readiness. And I applaud Leah up and down, because she has a really tough job, it’s an ambitious agenda. But in the first year of their preparation, they’ve been really attentive, have set the right objectives, have taken the best of what they’ve learned and are trying to apply that very tactically. Second, they’ve focused on the people and organizational structure piece. One of our recommendations to them was, don’t throw a bunch of tools at this; if you don’t have the people and processes and organizational structure that make sense, it won’t help. Creating Leah’s position as a network organizational position, that was a huge demonstration of good faith and commitment. Not only did they say they wanted Leah, they agreed to a leadership team of eight or nine positions in her office that she’s currently fulfilling, positions in data management that are needed.

So, the lesson is, not just giving lip service to it, but putting skin in the game and following through. And this 25-person-plus data governance council that started meeting in February of this year, was incredibly important. It was incredibly well constructed, with critical business functions. That team has rallied from day one, and has gotten an incredible amount of work done in five short meetings. And the charter they created for themselves, and coupled with creating a good operating environment to carry out the mission, are two very important things, and indications of the seriousness with which they’ve taken this.

What would your advice be to CIOs and CMIOs who will be facing similar data and IT governance situations and challenges?

Fullem: This is common advice, but we need to make sure that we’re meeting the needs of our clinicians, our finance departments, our operational leaders, since data is the key to making good decisions. All of this has to be done in a way that we make technology available to our users in ways that are easy to use and access, with the right information security principles, to move forward as a business.

Crabb: That our data land information leaders are important partners to our CIOs and CMIOs. This initiative originated out of IT, was led by Dr. Doug Gentile, our CIO. But the goals far exceeded the boundaries where IT is drawn in that organization today. And it wasn’t a tug of war of any kind; it was a natural extension of work that was incubated in IT. It’s been a healthy, symbiotic relationship that was first incubated in IT, and allowed to fly, understanding that data as an asset deserves its own center of excellence, just as IT is a center of excellence.

 


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