Category Archives: Population Health

MACRA MIPS Software platform

By | Analytics, Care Coordination, Population Health, Value-Based Care | No Comments

MACRA is a game changer for providers.   It represents the most significant change in healthcare payments since Medicare was introduced 60 years ago.   The baseline for calculating MACRA payment adjustments starts January 1, 2017.   The purpose of MACRA is to lead healthcare providers from a fee-for-service payment model to a value-based care model where reimbursement is determined by patient outcomes that includes quality of care, utilization of care, improved patient outcomes, and improved cost control.

The MACRA payment program has to be budget neutral so there will be winners and losers.  Under MACRA, providers will have to choose to operate under a merit-based incentive program (MIPS) or transition to an Alternative Payment Model (APM).  While there are a few exceptions for providers new to Medicare and/or with low Medicare payment volume to participate in MACRA,  most providers will be impacted by MACRA.

Under the MIPS default option,  there is a potential for a maximum plus or minus 4 percent or payments in the first year (2019). A bonus payment (not to exceed 10 percent) for exceptional performance is part of this program for the first five years. An overall MIPS score will be calculated according to performance in four measures (weighted by performance, with potential changes in weight by year):  Quality =50%, Cost (Resource Use) =10%, Advancing care information (interoperability, etc.  = 25 percent, and Clinical practice improvement activities (care coordination, etc.) = 15 percent.

Under the Alternative Payment Model (APM), Medicare providers will be paid based on value of services rather than service volume. Providers meeting the criteria for this track cannot move to the MIPS track. Physicians receiving a significant portion of their payments through eligible APMs can be exempt from MIPS—and they receive a lump sum payment of 5 percent of covered services.

In regards to software requirements – some requirements can be met with a certified EMR system – while other requirements such as care coordination and interoperability will require software beyond most EMRs.   eTransX’s XCare Community system provides a solid robust software as a service platform that can be used to maximize value based payments under either MIPS or Alternative Payment Models (APM).

A robust MACRA software plaform will not only need to support capturing and reporting metrics and sharing information electronically,  it will also need to support robust team based  care coordination to maximize payments and performance bonuses.   For example, to maximize performance, patients will need to be an integral part of their care and really understand their care plans.  The care plans should be evidence based and personalized.   In addition to the physician,  the care team for the patient may include a nurse, a pharmacist, and a social worker who are all managing a group of patients with chronic conditions to make sure their needs are being met, such as arranging transportation, solving prescription problems, planning meals and exercise…this will require a robust care coordination software platform.

Providers can start generating value based payments now with the eTransX XCare Community system – through programs such as the Medicare Chronic Care Management program and/or Transitional Care Management program.   In addition, using the XCare Community system now – will help practices improve their patient outcomes and quality metrics in 2017 which will serve as the basis of future value based payments under MACRA.

Now is the time to start evaluating your software options to maximize MACRA payments.

Advanced Health Models: Healthcare’s Future?

By | Care Coordination, Population Health, Value-Based Care | No Comments

05-11-16  by Richard Taylor, Director of Business Development for eTransX Inc.

 

Recently,  the Advanced Health Model workgroup of the ONC’s Health IT Policy Committee issued their initial findings and recommendations*.  This workgroup, chaired by Paul Tang, MD, the chief innovation and technology officer at Sutter Health’s Palo Alto Medical Foundation, is charged with finding ways to facilitate the effective use of health IT to support and scale advanced health models.

Their findings and recommendations can be summarized as follows:

1.  Recognizing the significant impact of the social determinants of health

Providers seeking to improve individual health outcomes are increasingly acknowledging the reality that an individual’s health is shaped largely by life circumstances that fall outside the traditional health care system. An extensive body of research has shown that social, psychological, and behavioral factors, such as family support systems, stress, housing, nutrition, income, and education explain far more about an individual’s health outcomes than the results of medical care.

  1. Expanding the traditional medical “continuum of care”

The Advanced Health Platform (AHP) Workgroup recognizes that improving health will require a broad expansion of the traditional medical “continuum of care” to encompass all of the entities and individuals within a community that influence an individual’s health. The IT solutions and systems that are used to support a holistic approach across all of these entities must evolve as well to enable truly seamless services to the right individual at the right time.

  1. Defining a new  “Advanced Health Model”

The AHM workgroup has sought to describe a range of emerging, community-level interventions that strive to bring together clinical, social, psychological, and behavioral data to improve and to coordinate health across settings for individuals. In many cases, these Advanced Health Models start within the medical system but seek to bridge gaps with a wider set of relevant services. In other cases, these models may be driven by community-based organizations seeking to incorporate clinical services to meet individuals in their preferred setting, such as where the individual lives, or another community setting. Rather than prioritizing clinical outcomes dictated by the medical system, these models seek to drive sustainable health improvements by focusing on person-centered goals and priorities that matter most to the individual.

  1.  Utilizing technology to support Advanced Health Models

Selecting and implementing technology to support AHM models requires recognizing a wider  ecosystem of technology solutions beyond the traditional electronic health records system used in clinical care. In the clinical setting, these include technology applications that may exist outside the traditional EHR, such as care management modules and population health management and analytics applications,  as well as third-party services, such as those offered by health information exchange organizations. Meanwhile, organizations such as schools, food banks, and social services agencies that are focused on supports that are non-clinical in nature may have a wide range of software solutions that support case management. At the community level, technology platforms that link human-services information and deliver consumer education are also integral to improving health.

Advanced Health Models that bring together these disparate systems frequently rely on an additional layer of information management that can match, normalize and aggregate data to support individuals and inform targeted service provider decision-making.

An Ideal IT Platform for supporting Advanced Health Models

eTransX offers a robust IT Platform to support Advanced Health Models.  This platform is the XCare Community system a hosted software as a service application.   This platform was designed from the ground up to support a fully integrated care coordination solution that connects healthcare providers with community based social service providers.

For any organization seeking to implement an Advanced Health Model, the eTransX XCare Community system provides a robust IT platform that can be integrated with existing healthcare delivery systems already in place.

 

* Source:  Advanced Health Model Workgroup June 2, 2015 Hearing summary,  6/21/15

 

Is your HIT infrastructure ready for value-based healthcare?

By | Health Information Exchange, Population Health, Value-Based Care | No Comments

The CMS and Healthcare Transformation Task Force recently announced the rapid acceleration of value-based health care:

A group of the nation’s largest healthcare systems and payers, together with purchaser and patient stakeholders, have announced the creation of a new private-sector alliance dedicated to accelerating the shift to value-based business and clinical models in the U.S. healthcare system that are aligned with improving outcomes and lowering costs. Called the Healthcare Transformation Task Force,  the alliance includes six of the nation’s top 15 health systems and four of the top 25 health insurers. The Task Force has issued a challenge to providers and payers to put 75 percent of their business into value-based arrangements that emphasize better health, better care, and lower costs by 2020 1

According to new federal guidelines, the U.S. Department of Health and Human Services wants 50 percent of all ACO payments and 90 percent of all traditional Medicare payments tied to quality or value by 2018. 2

For healthcare providers, now is the time to assess their information systems infrastructure in relation to supporting value-based healthcare.

As a starting point, value-based healthcare will require core information systems functionality addressing four key areas: – data exchange interoperability, advanced population health analytics, community care coordination, and patient empowerment.

  1. Data Exchange Interoperability– the ability to support real time data exchange interoperability between multiple organizations and systems. Integrating information and workflows across EHRs, care teams, providers, community resources and health information exchanges (HIEs) with a reliable and robust master patient index system.
  2. Advanced population health analytics – the ability to support three levels of analytics: descriptive, predictive, and prescriptive for population health management and accountable care for improving population health outcomes.
  3. Community care coordination systems – the ability to support automated workflows and closed loop referrals with community partners engaged with your member/patient population. This includes the use of built-in rule engines that can trigger alerts and manage interventions, and can support the ability to systematically manage health pathways for members/patients – particularly those with multiple chronic illnesses.
  4. Patient empowerment systems – the ability to interact with members orpatients beyond simple portals, to include automated interfaces with phone apps and personal health monitoring devices. It also works to support members or patients in their self-care responsibilities, prescription drug adherence, lifestyle improvement and wellness programs.

Existing Electronic Medical Record (EMR) systems may be able to provide basic reporting on some of the value-based healthcare quality measures, but they may be inadequate at meeting the triple aim goals of improving care, enhancing patient health outcomes, and reducing per capita healthcare costs. Likewise, existing health information exchanges (HIEs) may be able to support direct messaging and transmit a continuity of care record for patients at the point of care, but may not be able to integrate or share care treatment plans, document patient interventions, support task workflows, capture non clinical social and demographic information.

In most cases, value-based healthcare delivery systems will require the adoption of new information systems and tools beyond current EMR and HIE systems.

Some healthcare providers may have purchased one, two, or even three of the four key component systems for value-based healthcare, and just need to fill the remaining gaps.  Others have yet to make any of these investments and will need to purchase all four components.

Until now, acquiring these four core value-based healthcare IT capabilities often required buying software applications from multiple vendors and then integrating those applications to work together. Today, some vendors are able to offer all four value-based healthcare IT capabilities, and eTransX is one of those vendors.

Purchasing a fully integrated value-based healthcare IT solution saves time, money, implementation efforts and shortens the learning curve. In addition, data flows more efficiently and smoothly between the four applications and security management is more manageable and secure.

eTransX welcomes the opportunity to show you a fully integrated value-based healthcare information systems infrastructure.   Contact us today for a presentation and demonstration.

 

Footnotes:

1 http://www.healthitoutcomes.com/doc/task-force-aims-to-accelerate-value-based-payment-model-shift-0001, 2/6/15

2 Setting Value-Based Payment Goals — HHS Efforts to Improve U.S. Health Care, HHS Secretary Sylvia M. Burwell, 1/26/15 New England Journal of Medicine