Susan Morse

LAS VEGAS - The Staten Island Performing Provider System is running into all of the challenges inherent in implementing a value-based model for Medicaid payment reform in New York State. The Delivery System Reform Incentive Payment Program has as its goal to reduce avoidable hospital use by 25 percent over the next five years, according to Staten Island’s Executive Director Joseph Conte, speaking at HIMSS16 in Las Vegas. Asked how the program was going, Conte said, “In 11 months that’s the expectation to achieve. We’re not there yet. Looking at information we have from two hospitals, it’s a positive trend.” [Also: See photos from Day 2 of HIMSS16] Staten Island Performing Provider System is a corporation formed by Richmond University Medical Center and Staten Island University Hospital. Over 60 healthcare agencies and community-based organizations have joined Staten Island in the effort to reduce costs while increasing the quality of health for a very diverse population including 130,000 Medicaid recipients and 50,000 uninsured residents.  The big challenge, Conte said, is that timely data is not available from the state.  “It’s at least a six to nine month retrospective,” he said. “Everyone’s in a different place as far as electronic health records.” As of October 2015, an IT assessment showed that of the 26 healthcare systems partnering with Staten Island, 92 percent had an EHR platform or were in the process of getting one and 14 of them had different EHR vendors, Conte said. The overarching mission is to align IT strategy and execution, said Raj Lakhanpal, MD, CEO of SpectraMedix, and member of HIMSS Clinical and Business Intelligence Committee. To this end, Staten Island will be collecting data from providers and data feeds, and integrating it to create longitudinal records. They will apply population risk assessment models to predict high-risk patients and to flag those who should be included in disease registries and to identify gaps in care. [Also: See photos from Day 3 of HIMSS16] Conte said, “Data needs to be turned into business intelligence. Everyone needs prompt, accurate performance feedback.” The partners will need to make some IT investments to connect to state, Staten Island and other health IT platforms, he said. They’re starting to realize the value of receiving real-time measures of population health, he said. “Data six and nine months old is of zero interest to them,” Conte said. “What’s of interest to a doctor, (he or she) never knows that their patient is in the emergency room, or has been hospitalized.” Twitter: @SusanJMorse This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

Group will serve as a  matchmaker between organizations that would like to develop and pilot solutions.

LAS VEGAS -- When Inova Health saw that Affordable Care Act initiatives for value-based care would cut 7 percent, or $220 million, out of the $3 billion health system’s successful fee-for-service revenues, the northern Virginia provider knew it needed to change, said President and COO Mark Stauder. “Thinking through our strategic plan, we are a fee-for-service community of chiefly independent private practicing physicians,” Stauder said during HIMSS16. “We were a great fee for service; we needed a new revenue source.” The result was a partnership with Aetna and the creation of a new health plan called Innovation Health. [Also: See photos from Day 1 of HIMSS16] From 2012 to 2014, the partnership has realized an 8-20 percent cost reduction per employer; 17 percent reduction in the number of unnecessary hospital days after surgery; 15 percent fewer hospital admissions; and 21 percent fewer hospital readmissions, Stauder said. Despite the success Stauder said he feels the health system is still in “Population Health 101.” “This is a difficult journey that’s going to take us another five years or more to get good at it,” Stauder said. The strategic plan through 2020 focuses on population health, individualized wellness and the aggressive pursuit of personalized medicine, Stauder said. In 2012, the health system had no risk. Today it’s 50 percent. There are 90,000 commercial risk patients and the system purchased a Medicaid health plan from Amerigroup of 60,000 members. “We wanted to build critical mass with covered lives and build a shared savings construct,” Stauder said. “We’re in a market with many commercial payers. We needed to broaden market share.” The goal by 2020 is to have a million covered lives. Aetna provides health plan administration; claims and customer service; analytics; technology and care management programs. Inova provides a nationally recognized healthcare system, and more member management at the primary care level of chronic conditions and lower unit costs. Innovation Health began in September 2013 and has grown to 180,000 members. The health system’s narrow network is supplemented by the national Aetna network, he said. “It’s about empowering the physician providers,” Stauder said, emphasizing the need to get their cooperation. Care coordinators steer members towards appropriate programs and there are alerts given if any members are in network hospitals, he said. For post-acute care, there are transitional programs; post-discharge community placement; and medical home for 30 days for high risk for readmission patients. The system is currently building out an advanced illness model to include home-based physician visits and EPIC community based visits. Analytics and IT tools include using, a fully integrated EMR through EPIC, a MyChart portable EMR patient engagement driver, telemedicine; analytics for risk stratification and predictive data analytics for clinical quality. The Aetna platform also interfaces with Epic. Twitter: @SusanJMorse This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

One success story is the Colorado Rural Health Center partnered with Cyberscience Corp. to speed up processes, a move that has saved time and money.

Rene Cabral-Daniels, CEO of the Community Care Network of Virginia, says some doctors are not effectively partnering in value-based models.

Providers range from linking some payments to the effective management of a population to full population-based management.

While it may not sound all that exciting at first blush, a working knowledge of the low-, mid- and high-risk stratification of populations is key to successfully moving toward value-based care. “The way stratification works is based on medical history and health history,” said Gaurav Nagrath, a senior strategist of population health and analytics at Cerner. “The population is classified into designated risk groups using claims data, clinical results, health assessments, and demographic information to predict future health risk levels and health care spend levels. Your highest risk patients are hard to manage without concerted effort.” Getting the needed stratification for population health models requires analytics, some of which are already available, Nagrath said. Registration and claims data are among the resources that can show the risk attributes of a population. [Also: 21 awesome photos from past HIMSS conferences] Identifying high-risk consumers, for instance, lets providers know who may become a user of inappropriate services, such as avoidable emergency room visits, Nagrath said. “It makes sure they’re being taken care of at right time in the right care setting and helps contain costs,” he said. “Something as seemingly simple as drug adherence.” Most of the time, healthcare providers don’t know if a patient is taking the prescribed medication. “If you have a care plan, and a care manager who’s calling, making sure that they’re complying, or making sure they’re coming in for monthly visits, then you can start managing complex conditions well,” Nagrath said. “When non-compliance starts happening, they’re not taking their meds, you start getting into episodes of high cost care.” The next step is to address what providers do with the information once they know the high-risk patients, he said. “Right now we’re in the middle of understanding the population,” Nagrath said. “We are beginning to identify the ‘at-risk’ population cohort.” [Poll: What topics will define HIMSS16?] Nagrath and Michael Aratow, MD, chief medical information officer at San Mateo Medical Center, will talk about the broad spectrum approach being taken at the health system in the move to value-based care at HIMSS16, which kicks off on February 29, 2016 in Las Vegas. Nagrath and Aratow will also address the need for providers to have an integrated data warehouse to reduce the lag time to actionable knowledge; having targeted metrics which educate and inform meaningful action; and creating risk models which give population disease patterns and preemptive risk assignments. In performance programs, Nagrath said, providers are dependent on data and metrics, trying to nudge the shift from volume to value by focusing on understanding the issues involved; understanding the role of restratification in the process; and understanding the part innovation plays. See all of our HIMSS16 previews “Changing data into knowledge that can be used in the clinical workflow,” Nagrath said, “will propel our healthcare system closer to Triple Aim objectives.” Aratow and Nagrath’s session, “The Drive Toward Value Based Care,” is scheduled for Thursday, March 3, 2016 from 8:30-9:30 AM in the Sands Expo Convention Center Palazzo E. Twitter: @SusanJMorse This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

For the first time, the Centers for Medicare and Medicaid Services and America's Health Insurance Plans have announced standard quality measures among payers, a move designed to reduce confusion and complexity for reporting providers. On Tuesday, CMS and AHIP released seven sets of clinical quality measures to help get insurers on the same page. This is the first set that will be used as basis for quality-based payments. They were developed by a Core Quality Measures Collaborative, made up of CMS, major commercial health plans, physician groups and other stakeholders. [Also: CMS, ONC seek feedback on quality measures reporting] These measures create a set of core standards for all payers primarily for physician quality programs. They are in the following seven sets: accountable care organizations, patient centered medical homes and primary care; cardiology; gastroenterology; HIV and Hepatitis C; medical oncology; obstetrics and gynecology; and orthopedics. The measures will be rolled out in several stages, said CMS, which is already using measures from each of the core sets. CMS also said it will apply the core measures to Medicare quality programs, eliminating repetitive measures. Partners in the collaborative recognized that physicians and other clinicians must currently report multiple quality measures to different entities, CMS said. [Also: NQF CEO urges better quality measures] CMS worked with commercial plans, Medicare and Medicaid managed care plans, purchasers, physicians and other care provider organizations, as well as consumers to identify core sets of quality measures that payers have committed to using for reporting. The Core Quality Measures Collaborative, led by AHIP and its member plans' chief medical officers, leaders from CMS and the National Quality Forum, established the broadly agreed upon core measure sets that could be used for both commercial and government payers. More measure sets will be added and updated over time. "In the U.S. healthcare system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality," said CMS Acting Administrator Andy Slavitt. "This agreement today will reduce unnecessary burden for physicians and accelerate the country's movement to better quality." "This agreement on a set of core measures for primary care and the PCMH represents a big step toward the goal of administrative simplification for family physicians and improved quality of care," said Douglas E. Henley, MD, executive vice president and CEO of the American Academy of Family Physicians. Commercial health plans will use these core sets of measures when contracts come up for renewal, or if existing contracts allow changes in the performance measure set. CMS is also working with federal partners including the Office of Personnel Management, Department of Defense, and Department of Veterans Affairs, as well as state Medicaid plans to align quality measures where appropriate. The Core Quality Measures Collaborative views the upcoming year as a transitional period, as it begins to work with the new measures and affected organizations. They plan to monitor progress, invite broader participation, and possibly add additional measures and measure sets. Patient groups were a vital part of the collaborative. [Like Healthcare IT News on Facebook] "What we released today is a start at achieving consensus on the best measures, but we need to continue pushing for even better ones," said Debra L. Ness, president of the National Partnership for Women & Families. "We need measurement that works for clinicians and helps them improve care, while also providing information that is meaningful and actionable for patients and families." This work will influence CMS's implementation of the Medicare Access and CHIP Reauthorization Act of 2015. It is part of CMS's commitment to ensuring programs work for providers while keeping the focus on improved quality of care for patients, CMS said. CMS has also developed a draft Quality Measure Development plan, fueled by the development of the core measure sets as well as the discovery of gaps in the measures.  Twitter: @SusanJMorse

The consultant, which proposes moving away from evaluating physicians independently to a methodology in which physicians are evaluated in clusters, will share insights at HIMSS16.

The administration's 2016 year-end goal was to have 10 million people covered through the exchanges.