Health Information Exchange (HIE)

The analytics software used by the staff at St. Joseph Healthcare in Bangor, Maine, sits on top of the statewide health information exchange, allowing providers to access real-time data from all hospitals connected to the HIE.

In the first major overhaul of Medicaid managed care requirements in more than a decade, the Centers for Medicare and Medicaid Services published new rules on April 25 that affect how Medicaid works for the nearly two-thirds of beneficiaries who get their coverage through private managed care plans. It aligns key rules and practices with those of marketplace and Medicare Advantage, including the addition of reporting medical loss ratio to Medicaid to ensure managed care plans focus on delivering care, not profits, CMS said. The rule finalizes a medical loss ratio at 85 percent. Insurers must spend at least 85 percent of their Medicaid revenue on medical care to improve quality. The remaining 15 percent may be spent for administrative reasons such as salaries and marketing, CMS said. Health plans that don't meet the goal will face future penalties in having their state rates lowered. On the health information technology front, the rules encourage – but don't require – commitment to the principles of health information exchange "Health information technology and the electronic exchange of health information are important tools for achieving the care coordination objectives proposed," according to the final rule. HHS "supports the principle that all individuals, their families, their healthcare and social service providers, and payers should have consistent and timely access to health information in a standardized format that can be securely exchanged among the patient, providers, and others involved in the individual’s care," it states.   "Further, the Department is committed to accelerating health information exchange through the use of health IT across the broader care continuum and across payers. Health IT that facilitates the secure, efficient and effective sharing and use of health-related information when and where it is needed is an important contributor to improving health outcomes, improving health care quality and lowering health care costs." Specifically, the rule points to ONC's Nationwide Interoperability Roadmap and 2016 Interoperability Standards Advisory as containing the "best available standards and implementation specifications to enable priority HIE functions." Providers, payers, and vendors are encouraged to take them into account "as they implement interoperable HIE across the continuum of care, including care settings such as behavioral health, long-term and post-acute care, and community service providers." CMS also sets the conditions for broader applications of telehealth, specifically as a way to bolster network adequacy standards. "Several commenters recommended that CMS add elements (to the rule) to include triage lines or screening systems, as well as the use of telemedicine, e-visits, and/or other evolving and innovative technological solutions," officials write. "We agree with commenters that such services and technological solutions could impact the needs of enrollees in a particular area and could change the manner and extent to which other network providers are needed and utilized. We encourage states to consider how current and future technological solutions could impact their network adequacy standards." An estimated 72 million Americans currently rely on Medicaid as their source of health insurance coverage, 14 million more than in 2013, CMS said. This is largely due to the Affordable Care Act's coverage expansion. The improvements modernize the way managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers, according to Monday's announcement by Andy Slavitt, CMS acting administrator and Vikki Wachino, CMS deputy administrator and director for the Center for Medicaid and CHIP Services. The rule strengthens states' efforts to support delivery system reform and authorizes the first-ever Medicaid and CHIP quality rating system so that states can publicly report plan quality information, and people can use that information to select plans, CMS said. The rule also addresses quality of care standards, as well as focusing on improved communications, such as electronic notices to beneficiaries and creating online provider directories. "States are making gains in using population based payments, episodes of care and quality-based payments," write Slavitt and Wachino in a blog post. "In addition, states operate 30 health home programs that focus on coordinating care for people with chronic conditions like obesity, diabetes and mental health conditions. Over the last several years, sates have undertaken significant efforts through State Innovation Models, integrated care models, and delivery system reform incentive programs to create alignment with physicians and hospitals to provide the highest quality of care. And we have proven that when we and states dedicate ourselves to changing the delivery of care, we get results." Read the final rule here.

Mariann Yeager, Chief Executive Officer at The Sequoia Project, talks with Justin Barnes on HIMSS Radio about emerging trends at HIMSS16, especially around interoperability.

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

National Coordinator Karen DeSalvo, MD, is stepping away from the co-chair role on the ONC Health IT Policy Committee. Kathleen Blake, MD, vice president of performance improvement at the American Medical Association, will replace DeSalvo, according to Politico, which reported the announcement was made Tuesday at the joint meeting of the Health IT Policy and Standards Committees. Blake will serve alongside DeSalvo's current co-chair, Paul Tang, MD, chief innovation and technology officer at the Palo Alto Medical Foundation. Tang is also the head of ONC's meaningful use workgroup.  [Also: How satisfied are you with your EHR? Satisfaction Survey results]  DeSalvo currently serves as both National Coordinator for Health IT and Acting Assistant Secretary of Health and Human Services. She's been with ONC since January 2014. Health and Human Services Secretary Sylvia Burwell brought DeSalvo to HHS in October 2014 to help coordinate the federal government respond to the Ebola outbreak – touting her public health qualifications after having served as New Orleans Health Commissioner in the wake of Hurricane Katrina. In May 2015, President Barack Obama appointed DeSalvo HHS Acting Assistant Secretary for Health. If she gets a Senate confirmation hearing and is approved, she would step down from the National Coordinator post at ONC.   Twitter: SullyHIT Email the writer: tom.sullivan@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

The potential next EHR would more closely resemble modern interfaces such as Google and Facebook and leverage FHIR, if the VA indeed opts to move away from VistA. Undersecretary David Shulkin said the department is evaluating the best way forward. 

As part of the Vermont Health Care Innovation Project, the Green Mountain State has tapped Boston-based PatientPing for data exchange among its hospitals.

A new Black Book report also suggests that new payment models, private health information exchanges, patient locator systems and healthcare analytics will wield more influence driving interoperability forward than government or EHR makers. 

The cross-vendor data exchange using IHE and FHIR specifications showed off promising strides, while the industry is still working toward more widespread, real-world use cases.

A new report based on customer scores found that the two companies outperformed other EHR-dependent and EHR-independent vendors.