Intel Healthcare IT

6 Posts authored by: justinbarnes

Whether the ICD-10 delay and Medicare payment fluctuations bring relief or frustration, there are still many ways to position your organization for a successful future.


In fact, despite the recent disposition toward delay, now is actually the time to energize or re-energize your focus on existing programs that create a strong foundation for evolving and future value-based and alternative payment incentive models, such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).


As you may know, the congressional stalemate on how to pay for long-term Medicare payment stability — coupled with the phasing out of fee-for-service (FFS) — brought ICD-10 into pre-midterm election politics. The result? A one-year delay of the advent of ICD-10 in the U.S. until Oct. 1, 2015. In addition, a one-year Medicare payment patch averted a 24-percent cut, instead increasing Medicare payments by 0.5 percent for the next 12 months.


Both actions temporarily slowed the momentum of the SGR Repeal and Medicare Provider Payment Modernization Act (SGR Repeal), which proposed to stabilize Medicare payments through 2018 and that same year institute a value-based purchasing program similar to accountable care structures while phasing out FFS.


Moving your healthcare organization forward

Keep in mind that throughout this process, congressional leaders said they will still work hard to resurrect the bipartisan SGR Repeal Act widely supported by Capitol Hill, provider groups and the health IT industry. This is the right thing to do to advance preventive, coordinated care and move toward a sustainable healthcare system.


In the case of ICD-10, many organizations were readying for the conversion this fall, respecting its merits toward advancing quality reporting, expanding performance measures and improving overall population health.


You can make the most of these changes by staying focused on creating strategies for implementing the value-based and alternative payment incentive models the SGR Repeal Act proposes:


Accountable care organizations — With more than 600 voluntary structures currently operational, many of your peers have moved into coordinated care programs based on quality incentives. Don’t be left behind. These programs are another example of how private payers and healthcare organizations have followed the lead of the original Medicare Shared Savings Programs.


Patient-centered medical homes — This equally successful program has been expanded to include specialty medicine, with the March 2013 launch of the Patient-Centered Specialty Practice (PCSP) program by the National Committee for Quality Assurance (NCQA).


Meaningful use Stage 2 — Stage 2 is an example of how quality measure incentive programs will come to pass. Keep in mind that for the 2014 reporting year, any 90-day or fixed-quarter attestation can be pursued, so there’s plenty of time to capitalize and ready your organization for success. There are incentive funds still on the table.


With aspects of healthcare coverage, payment and sustainability such a paramount issue for our country — intertwined with health IT adoption and improved population health goals — it’s essential to continually assess what programs are best for your organization and your patients.


It’s safe to say you will need to engage these programs despite periods of fluctuation to successfully compete in a future of healthcare dominated by accountable care, value-based purchasing and alternative payment models.


Justin Barnes is a vice president at Greenway Health, chairman emeritus of the Electronic Health Record Association (EHR Association) and co-chair of the Accountable Care Community of Practice (ACCoP).


Follow Justin on Twitter (@HITAdvisor)

See his other posts here

I recently joined a panel of learned colleagues working in public health, telemedicine and acute care at an Institute of Medicine (IOM) forum focusing on the state of our nation’s healthcare system relating to population health and emergency preparedness and response due to natural disaster or other factors.


Along with seeking programmatic opportunities within the Affordable Care Act (ACA), I was asked to represent the view of the healthcare information technology sector on ways to advance resilience through technology that keeps the focus on the patient.


Doing so means establishing an infrastructure around current national standards (such as Direct & C-CDA) for data exchange and readable content, as well as increasingly open architectures around application programming interfaces (APIs) that expand integration with emergency response departments, responders, hospital EDs and HIEs, along with the current integration of electronic health records.


The expansion of patient portals, personal health records and cloud technology must also keep pace with available standards such as Blue Button, along with the ability for providers to utilize mobile EHR innovations to access these standard and readable patient records. After all, hospitals and practices are not immune to disaster, as the nation experienced certainly with Hurricane Katrina and most recently during Hurricane Sandy.


Also, a national patient identifier strategy is equally crucial to develop, one that can link the needed clinical information to the right displaced patient.


Both the American Recovery and Reinvestment Act (ARRA, 2009) and ACA provide the means to put this infrastructure in place, and in fact such networks are already taking shape. The ACA’s Health Center Controlled Networks fund was primarily focused on EHR and meaningful use adoption in the front lines, and provides the opportunity for resiliency expansion.


ARRA’s HIE Cooperative Agreement Program seeded state and regional HIEs, from which a debut collaboration this year of 10 HIEs has formed under the name SERCH, specifically to manage emergency response using vetted exchange standards, all while some individual state HIEs are expanding linkage to include EMS and fire departments.


And yes, taking a measured, national and analytical approach to resilient, technology-driven strategies is a best practice for achieving best practices in the field. Here too, ACA can be leveraged through a pair of well-funded and important programs, the Patient Centered Outcomes Research Institute (PCORI) and the Prevention and Public Health Fund, where respectively analysis and additional research options for emergency healthcare and IT exist, and where implementation can follow.


And finally, it’s again not just emergency response, but also preparedness, where for example outbreak surveillance, immunizations and registries have long been a national goal. Here there are new and existing collaborations between ONC, CDC and EHR developers that can be further integrated.


Right now the opportunities far outweigh the barriers toward establishing a coordinated national approach to population health when we may need it most, and it’s important to continue this discussion as the health IT industry itself continues to mature.


See the IOM panel presentation slides here.


Justin Barnes is a vice president with Greenway Medical Technologies, chairman emeritus of the national Electronic Health Record Association (EHR Association), co-chair of the Accountable Care Community of Practice (ACCoP) and a board member of the CommonWell Health Alliance.

Below is a guest blog post from Tee Green, president and chief executive officer of Greenway Medical Technologies, Inc.


Should every health system, hospital or group practice CIO know that to do interoperability right they need to consider XDS or PIX at the core of functionality? That these cross enterprise document sharing and patient identifier cross reference protocols can reach into another EHR?


Health IT solution providers should, and it’s clear from a survey of CIOs commissioned by Greenway that CIOs want leaders who will partner in their pursuit of the data liquidity that fits their needs. Right now education outranks selling, as interoperability is arguably the most important factor in addressing the range of care coordination programs every healthcare entity is facing. Tee Green new headshot.jpg


It’s also clear that the growing EHR replacement market is being fueled by a reassessment of original platforms lacking in comprehensive data exchange at a point when the improvement of population health should not take any backward steps.


The survey specifically found that the primary concern CIOs have about utilizing technology in their healthcare system is of course interoperability. Twenty-six percent voiced it in basic terms, and another 18 percent specifically in terms of medical staff alignment, which is itself a function of interoperability through the alignment of hospitals and clinics on EHR platforms capable of seamlessly exchanging data. That’s 44 percent overall, which outweighed cost at 22 percent.


Who should carry the burden of interoperability? Forty-nine percent chose a shared process between health IT solution providers and the healthcare system. Thirty-three percent chose a shared approach additionally led by health IT. Taken together that’s 82 percent voicing the need for a shared partnership. That’s an overwhelming result the industry needs to listen to.


And don’t think that today’s patient-consumers are not aware that technology matters. We surveyed them too, and 56 percent notice when technology is used at the point of care, and believe it helps their doctors do a better job. They also realize, by a 3-to-1 margin, that technology beats paper when it comes to sharing data.


Where do we go from here?


National organizations like the EHR/HIE Interoperability Workgroup - a coalition of state agencies, EHR companies, HIEs and certification experts - are solidifying standards, from PIX to C-CDA, and must also foster and project a sense of selfless collaboration with CIOs and doctors and nurses.


This is a key example of how together health IT leaders can create a smarter and sustainable healthcare system, and takes away any skepticism that the industry is not in it for population health. And the movement to national interoperability must be led by the industry, not by external policy, to further assure CIOs that motivations are in the right place.


Our survey did not reflect an overly negative attitude, and that’s because health IT leaders are already showing the willingness to partner with each other.


Development agreements and data exchange pilots by perceived market competitors are starting to emerge that align hospitals and clinics and integrate with HIEs, and select EHR-to-EHR exchange has become a staple of an interoperability showcase near you.


I predict that by the time meaningful use Stage 2 gets underway in 2014, the thresholds for data exchange being tied to incentives - electronically transmitting 10 percent of care transitions, at least one to a different EHR platform - will be eclipsed. The healthcare industry expects it. It’s the primary concern, the primary need for partnership, and the primary way for health IT to deliver.


What do you think?


View the entire survey, “Healthcare Information Technology: Trends and Transformations,” at

As the headlines surrounding Stage 2 focus on specific interoperability tied to summary of care, information exchange in many forms is really the broader theme as meaningful use helps drive care coordination.


As Stage 2 nears, it’s time to nurture caregivers beyond the historical focus of interoperability as a jargon-heavy, system-to-system infrastructure. Interoperability not as a technical challenge, but a multi-faceted approach to coordinating care and advancing value-based medicine.


Today, we need to think about  interoperability as provider to provider, provider to patient, provider to device, provider to HIEs, registries and public health agencies for example, all tied to integrated EHRs and health IT platforms.


In terms of provider to patient, Stage 2 alone includes four patient engagement measures that call for the ability to exchange information. That’s interoperability with a human face. Taken a step further, if a provider is also part of a CMS Shared Savings program, patient satisfaction scoring – and therefore engagement – also becomes a measure of information exchange and a successful business goal with today’s patient-consumers.


Each of these facets of interoperability – menu items exchanging data with cancer registries, for example – is a technology tied to standards, creating a universal language and a longitudinal patient record, one that encompasses mobile technologies, scalable, flexible and customizable platforms that can expand throughout a care community.


As EHR-driven solutions establish the ability to exchange on all levels, caregivers can take the foundations achieved through meaningful use and apply them to the best fit for their practice, be it a patient-centered medical home, CMS ACO, private payer or hybrid payment and delivery model.


Interoperability is not the age-old debate between nature versus nurture. For true care coordination, it is both.


What questions do you have?


Justin Barnes is a vice president at Greenway Medical Technologies, chairman emeritus of the Electronic Health Record Association (EHR Association) and co-chair of the national Accountable Care Community of Practice (ACCoP).

See Part I of Justin Barnes' ACO blog


Statetate Medicaid officials are moving quickly to  understand and establish accountable care models around community ACOs, provider-led programs or hybrid models merging health plans and care providers.

This public-private initiative is being aided by organizations such as the non-profit Center for Health Care Strategies (CHCS) and the CMS Innovation Center, as all stakeholders realize the need for coordinated care for a patient population most in need of preventive and cost-efficient medicine that can build upon the Medicaid coverage expansion within ACA. Right now state Medicaid ACO pilot programs are being formed in at least seven states.

Meanwhile, many of the nation’s uninsured and elderly are increasingly taking advantage of the growth and accessibility of retail health clinics.
The number of Americans visiting these clinics for vaccinations, treatments for respiratory infections and preventive measures, for example, quadrupled – from nearly 1.5 to six million people - between 2007 and 2009, according to an August 15th Rand Corp. study published in Health Affairs. It is notable the study found that nearly 33 percent of these patients lack health insurance.

These rates will be impacted by the coverage mandate and the future of health insurance exchanges also within the Affordable Care Act, likely combining to fuel an increase in patient volumes at traditional practices as well, adding stress to our already strained delivery system in terms of the documented decline of the number of primary care physicians.

That dynamic will also continue to fuel expanding scope of practice debates on the roles of nurse practitioners (NPs) and physician assistants (PAs) moving within primary care. These issues are tied together provided that quality care can be achieved in retail settings, which I believe has been initially demonstrated and can continue to accelerate into more advanced primary care as an ambulatory option for more patients.

Steps to Accountable Care Success
Accountable care and care coordination in all of its forms is an essential building block for improved healthcare, along with EHR adoption, meaningful use and interoperability. In broad terms, this transformative journey seeks to improve patient safety and quality of care. The vehicle for that journey: further integration of care and a focus on disease management through new bundled payment models, value-based purchasing initiatives and benchmarking analysis. That’s where health information enters the picture. The robust use of data aggregation, analytics, and shared information directly support patient care coordination and population health management, which are the most critical clinical components of managing risk-based reimbursements.
For care providers and practices seeking to form or join an accountable care community, there are prerequisites to address:

1. Begin by assessing your EHR, interoperability and overall technology infrastructure, as well as your beneficiary patient volume. Then engage your peers, associations, payers, employers, and health systems in your community to identify government, private payer, or combined opportunities.

2. If your practice or organization is approached to participate in an ACO, evaluate it carefully. Consider your financial and strategic incentives for joining, data requirements, and access to bi-directional data and whether your commitment is binding or non-binding.

3. ACOs positioned for success should have three- to five-year plans that incorporate growth strategies and best practices. These include utilizing health information technology, engaging and educating patients, developing care management resources, and monitoring care delivery and follow-up.

4. It is also important to assess your own understanding of the different risk models being offered. Determine how much risk you can assume initially and over time.

The Supreme Court ruling on the ACA was a big step in this journey, and the next focal point is of course whether Shared Savings structures and the financial risk tracks succeed, causing more providers, health systems, private payers, and employers to embrace coordinated care and payment models.

We are seeing solid evidence of this already, which represents an encouraging sign of what the next several years will bring.


What questions do you have?


Justin Barnes is co-chair of the national Accountable Care Community of Practice (ACCoP), chairman emeritus of the EHR Association and a vice president at Greenway Medical Technologies. He has appeared before White House and Congressional panels on matters of health information technology on more than a dozen occasions since 2005, and has advised current and former presidential administrations on industry policy.

Now that the healthcare industry can work with clarity on care coordination strategies and programs, a new expansion of ACO models, trends in patient behavior and the companion issue of provider scope of practice have quickly emerged as critically-relevant spotlights.

And with a presidential political season upon us, mutual clarity on what the election returns could bring is also at hand based on conjecture that a GOP White House and/or Congress would attempt to counteract the Affordable Care Act. And here some historical perspective helps.

Simply put, even with the political leadership makeup potentially in flux this fall, there is strong bipartisan support for aligning payment and care delivery models with improving quality to create a smarter and sustainable healthcare system, backed by historical precedent.

For me and my colleagues in the trenches of pursuing fiscally sound care delivery nearly a decade ago, it is well remembered that the origins of accountable care reside within a 2004 HHS document entitled “The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care.” This “Framework for Strategic Action” (as it is also known) was delivered to then-HHS Secretary and GOP-appointee Tommy Thompson. And it was delivered by the nation’s first National Coordinator for Health Information Technology, Dr. David Brailer.

The document’s goals of introducing health IT solutions to clinical practices, electronically connecting clinicians, using “information tools” to personalize care and advance population health reporting followed an executive order calling for widespread adoption of interoperable EHRs within 10 years.

That core bipartisan support for these goals, also evidenced by the success of meaningful use, has weathered the political winds, and no doubt like many in health IT, I keep a copy of this foundational document at hand.

To continue to get us to where we are today, the report was followed the next year by the Physician Group Practice (PGP) demonstration, a five-year program of 10 sites pursuing early shared savings goals. This program was widely resurrected as a reference point when the current Medicare Shared Savings proposals were first issued.

A year later, Dartmouth Medical School’s Dr. Elliott Fisher began voicing the concept and vocabulary of accountable care during a Nov. 9, 2006, Medicare Payment Advisory Commission (MedPAC) meeting then put to paper by year’s end. MedPAC’s research over the past year only further supports this evolution.

Today, more than 27 state legislatures have proposed programs related to accountable and coordinated care, and there are more than 250 accountable care communities active in the vast majority of states. More than 70 of these are led by physicians, nearly double the number only eight months prior. And while closely associated with the CMS Medicare Shared Savings program (rightfully so now that an additional 10,000 Americans are becoming Medicare-eligible every day), health plan, private payer and even employer models are keeping pace.

Tomorrow in Part II: How Medicaid Models, Patient Trends and Scope of Practice Move Accountable Care Beyond Medicare Shared Savings


Justin Barnes is co-chair of the national Accountable Care Community of Practice (ACCoP), chairman emeritus of the EHR Association and a vice president at Greenway Medical Technologies. He has appeared before White House and Congressional panels on matters of health information technology on more than a dozen occasions since 2005, and has advised current and former presidential administrations on industry policy.

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