Mike Miliard

The U.S. Department of Health and Human Services issued a long-awaited proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, on Wednesday, ushering in some big changes for the ways physicians are assessed for quality of care and use of information technology.    

EmblemHealth, the $10 billion New York-based health insurance plan, informed its IT staff this week that 250 workers would face layoffs as it outsources operations to Cognizant.

The Office of the National Coordinator for Health IT said it can harness data it already has to help providers make better electronic health record purchasing decisions.

More widespread implementation of gaps in care programs is essential to realizing the value of population health management, according to a new report from the Workgroup for Electronic Data Interchange. In its study, "Closing Gaps in Care through Health Data Exchange," WEDI defines those gaps as the discrepancy between evidence-based best practices and the care that's actually delivered to the patient. At too many providers, that chasm is still too wide, according to the report. Better IT infrastructure – enabling more robust exchange health data, automating identification of information gaps and streamlining care coordination – is needed to bridge it. Toward that end, WEDI offers five key takeaways: 1. Education and communication are essential to making providers aware of the value of identifying and closing gaps in care. "Providers appear to lag behind health plans in implementing gaps in care programs," according to the report. "Challenges include the lack of sufficient resources or education about how to maximize workflow changes and effectively close gaps in care." 2. Gaps in care can adversely affect provider performance. "Surveyed providers are significantly more concerned than health plans that gaps in care pose a threat to their organization by affecting clinical performance, financial performance and the ability to retain patients," according to WEDI. 3. Programs to address gaps in care offer a high return on investment. "Improvements were observed in quality outcomes such as access to behavioral healthcare, pediatric and adolescent check-ups and medication adherence," according to the report. "Reductions in utilization of ambulatory care, hospital admission and hospital readmission were also observed." 4. Better consensus is needed to develop and standardize quality measures and methodologies for data exchange among payers, providers and patients. "The terminology, standardization and scope of gaps in care measures need more clear definition and alignment between health plans and providers before actionable data harmonization can occur," WEDI researchers say. "Best practices need to be disseminated that illustrate stakeholder roles, automation of workflow and quality improvement. The report also points to other barriers such as the "provenance, quality, completeness, timeliness, transparency and accuracy of data." More widespread use of open API and element - based exchange could help address these 5. Fixing care gaps will only grow in importance as value-based models evolve and access to care and coverage expands. "As newly eligible consumers continue to enter the health insurance marketplace and access healthcare, it will be essential for stakeholders to develop effective healthcare communication, prevention and education and intervention strategies to improve the quality of patient-centered care," the report says. "As we increasingly grow fee-for-value arrangements in our nation, it is critical that we look to methods  automate gaps-in-care – to not only ensure that data moves seamlessly between clinical systems and payment systems but that the information is useful and actionable for clinicians and patients," WEDI founder and former HHS Secretary Louis W. Sullivan, MD, said in a statement. Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

Care coordination, quality measurement, patient engagement and population health management strategies are routinely used by physicians with electronic health records who participate in accountable care organizations or patient-centered medical homes, according to a new study published in the American Journal of Managed Care. Aiming to find out whether doctors using health IT and working within new reimbursement models were actually employing improved care processes, researchers Jennifer King, Vaishali Patel, Eric Jamoom and Catherine DesRoches examined cross-sectional data on office-based physicians from the 2012 National Ambulatory Medical Care Survey Physician Workflow Survey. "Early indicators suggest strong physician participation in initiatives to support health IT adoption and to reform healthcare payment and delivery," they said. "However, evidence on whether provider participation in these initiatives has translated to better care delivery is just beginning to emerge. "Although studies prior to HITECH and the ACA found health IT and external reporting or payment incentives to be associated with a higher likelihood of performing these care processes," they added, "they are performed at low rates even when these factors are in place." [Also: 4 surprising benefits of PCMH] King et al. examined how ACO and PCMH docs used their EHRs for 14 specific processes in four categories: population management, quality measurement, patient communication and care coordination. They found that those factors were independently associated with better processes: "Physicians who were using EHRs in combination with participation in ACO or PCMH initiatives had the highest likelihood of routinely performing the care processes." Indeed, those docs "were between 6 and 22 percentage points more likely to routinely perform the care processes than physicians with EHRs alone." While fewer than half (44 percent) reported routinely doing quality measurement, substantial majorities of docs said they routinely engage in care coordination (89 percent), patient communication (69 percent), and population management (67 percent). "Given the cross-sectional nature of this study, these results do not establish a causal relationship between payment reform, EHR use, and these care processes," researchers said. "Nonetheless, this finding is consistent with other research that shows that healthcare providers are most likely to perform these care processes when practicing in a payment environment that incentivizes and supports such care." Moreover, many U.S. physicians are still "not performing these processes routinely," researchers said. "Our analysis highlights several specific areas – including population management processes that require the aggregation and analysis of individual patient data and communication with patients and other care team members – where additional technology and policy supports may be important to facilitate wider adoption of these activities." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

A U.S. district court jury in Wisconsin has found in Epic Systems' favor, awarding the EHR giant $940 million in damages in its trade secrets lawsuit against Mumbai-based Tata Consultancy Services. The massive settlement seems likely to be reduced on appeal.

Now that Apple is no longer issuing security updates for the software, known vulnerabilities are wide open to exploitation, the security experts say.   

The move toward population health and alternative payment models has seen providers embracing innovative approaches to care delivery, including significant investments in health information technology, according to the spring 2016 Economic Outlook survey from Premier. The study – which polled health system chief executive officers, chief financial officers and chief operating officers – found the requirements of the Affordable Care Act and the demands of population health management leading to big changes in care processes. Most notably, Premier found that the expansion and integration of post-acute care networks is a major priority, cited by 95 percent of C-suite respondents as a key area of focus over the next three years. At the same time, almost as many execs said that project is the biggest challenge their health systems will face in the coming years. "As healthcare continues to transition from an acute-care hospital focus toward an integrated system of providers, the creation of high-value post-acute care networks is essential for success within alternative payment models, such as bundled payment programs and accountable care organizations," Premier COO Michael Alkire said in a statement. Health IT, of course, is an essential enabler to this task, and 84 percent of respondents indicated that technology continues to represent a place for significant capital outlay. Still, challenges remain. More than two-thirds (68 percent) of respondents said their health systems are successfully accessing data from the ambulatory EHRs of their employed physicians. But barely one-third (38 percent) said that they're successfully accessing data from affiliated or non-employed physician networks. "Many affiliated practices lack the proper incentives to invest in high-cost data sharing agreements and interoperable interfaces. We urgently need public policies that require health IT interoperability standards so that providers can access data from any system," said Alkire. Interestingly, one area that's often overlooked with regard to pop health is one that's also ripe for innovation, according to Premier: the supply chain. Many providers are running disparate software systems to track procurement, accounting and contract management, according to the report – leading to "system-wide blind spots" that can hamper efficiency efforts. The expansion of affiliated practices have only complicated matters, according to more than half of poll respondents. "By marrying all the functions associated with purchasing across the continuum on a single IT platform, materials managers can close gaps and generate the significant savings needed to succeed in the new world of payment reform and cost cuts," said Alkire.

Kaiser Permanente this week launched a new database that enables researchers to examine participants' DNA in conjunction with environmental and behavioral health.

In his first year at the helm of Geisinger Health System, David Feinberg, MD, has continued to hone the longtime population health leader's intense focus on evidence-based care and improved patient experience.