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CMS releases new proposal to improve Accountable Care Organizations

Shared Savings Program Proposed Rule reflects focus on primary care and improved incentives for participation, quality, and efficiency

The Centers for Medicare & Medicaid Services (CMS) today released a proposal to strengthen the Shared Savings Program for Accountable Care Organizations (ACOs) through a greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. The proposed rule reflects input from program participants, experts, consumer groups, and the stakeholder community at large. CMS is seeking to continue this important dialogue to ensure that the Medicare Shared Savings Program ACOs are successful in providing seniors and people with disabilities with better care at lower costs.

CMS Administrator Marilyn Tavenner said, “This proposed rule is part of our continued commitment to rewarding value and care coordination – rather than volume and care duplication.  We look forward to partnering with providers and stakeholders to continuously refine and improve the Medicare Shared Savings program.”

Through the Affordable Care Act, ACOs encourage doctors, hospitals and other health care providers to work together to better coordinate care when people are sick and keep people healthy, which helps to reduce growth in health care costs and improve outcomes.  ACOs become eligible to share savings with Medicare when they deliver that care more efficiently while meeting or exceeding performance benchmarks for quality of care.

The Shared Savings Program now includes more than 330 ACOs in 47 states, providing care to more than 4.9 million beneficiaries in Medicare fee for service. Recently, CMS announced first year Shared Savings Program (SSP) results:

  • 58 SSP ACOs held spending below their benchmarks by a total of $705 million and earned shared savings payments of more than $315 million.
  • Another 60 ACOs had expenditures below their benchmark, but not by a sufficient amount to earn shared savings.

Other Affordable Care Act initiatives to improve care and reduce costs have helped reduce hospital readmissions in Medicare by nearly 10 percent between 2007 and 2013 – translating into 150,000 fewer readmissions – and quality improvements have resulted in saving 15,000 lives and $4 billion in health spending during 2011 and 2012.

CMS is seeking comment on a number of adjustments to improve the Medicare Shared Savings Program, including:

  • Providing more flexibility for ACOs seeking to renew their participation in the Program. Many ACOs elect to enter the Program under a one-sided risk model, where the organization participates in shared savings with the Medicare program, but does not take on additional performance-based risk. More experienced ACOs that are ready to share in financial losses in return for the opportunity for a higher share of savings may elect to enter a two-sided model. CMS is proposing to give ACOs the option of a longer lead time to transition to a two-sided performance risk model after their first agreement period. ACOs would have the opportunity to renew under the one-sided model for one additional agreement period. ACOs that enter the Shared Savings Program under the two-sided performance risk model would see no change.
  • Encouraging ACOs to take on greater performance-based risk and reward. CMS is proposing to create a new two-sided risk model, called “track 3,” which integrates some elements from the Pioneer ACO model, such as higher rates of shared savings and prospective attribution of beneficiaries – a list of assigned beneficiaries provided at the start of the performance year, and no further beneficiaries will be added to the list during the performance year.
  • We are seeking comments on a number of care coordination tools that would make two-sided performance risk models more attractive to ACOs such as expanded use of telehealth, beneficiary attestation, and more flexibility around post-acute care referrals to help ACOs better coordinate care for beneficiaries using these services. These tools could all help encourage participating providers to improve quality and care coordination for Medicare beneficiaries, which in turn would result in better patient experiences and greater shared savings for both the ACO and the Medicare program.
  • Emphasis on primary care. CMS proposes to refine the way Medicare beneficiaries are assigned to an ACO to place greater emphasis on primary care services delivered by nurse practitioners, physician assistants and clinical nurse specialists and to allow certain specialists not associated with primary care to participate in multiple ACOs.
  • Alternative methodologies for benchmarks. CMS seeks comment on alternative methodologies that would make ACO benchmarks for determining shared savings and losses gradually more independent of the ACO’s past performance and more dependent on the ACO’s success in being more cost efficient relative to its local market. For example, we are considering whether shared savings received by an ACO should be added back to the benchmark in future performance periods.
  • Streamlining data sharing and reducing administrative burden. CMS proposes to streamline the process for ACOs to access beneficiary claims data necessary for health care operations such as quality improvement activities and care coordination while retaining the opportunity for beneficiaries to decline to have their claims data shared with the ACO.

A fact sheet with more information about the proposed rule is available at: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-12-01.html

The proposed rule will be open to a 60-day comment period.

The proposed rule is available for viewing at:  http://www.ofr.gov/(X(1)S(tofvuj12vvyo3oiwkp3jkln3))/inspection.aspx?AspxAutoDetectCookieSupport=1

Comments may be submitted at: http://www.regulations.gov/
This document is scheduled to be published in the Federal Register on 12/08/2014 and available online at http://federalregister.gov/a/2014-28388

December 1, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

New Affordable Care Act Initiative to Support Care Coordination Nationwide

The Centers for Medicare & Medicaid Services (CMS) today announced the availability of a new initiative for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program. Made possible by the Affordable Care Act, ACOs encourage quality improvement and care coordination through the use of health information technology, helping to move our health care system to one that values quality over quantity and preventing illness over treating people after they get sick.

The new ACO Investment Model is designed to bring these efforts to better coordinate care to rural and underserved areas by providing up to $114 million in upfront investments to up to 75 ACOs across the country.

“The ACO Investment Model will give Medicare Accountable Care Organizations more flexibility in setting quality and financial goals, while giving them greater accountability for delivering quality care efficiently,” said CMS Administrator Marilyn Tavenner. “We are working with these organizations to make necessary investments that encourage doctors, hospitals and other health care providers to work together to better coordinate care and keep people healthy.”

Through the CMS Innovation Center, this initiative will provide up front investments in infrastructure and redesigned care process to help eligible ACOs continue to provide higher quality care. This will help increase the number of beneficiaries – regardless of geographic location – that can benefit from lower costs and improved health care through Medicare ACOs. CMS will recover these payments through an offset of an ACO’s earned shared savings.

Eligibility is targeted to ACOs who joined the Shared Savings Program in 2012, 2013, 2014, and to new ACOs joining the Shared Savings Program in 2016. The application deadline for organizations that started in the Shared Savings Program in 2012 or 2013 will be December 1, 2014.  Applications will be available in the Summer of 2015 for ACOs that started in the Shared Savings Program in 2014 or will start in 2016.

Recently, ACOs in the Pioneer ACO Model and the Medicare Shared Savings Program generated over $372 million in total program savings for Medicare ACOs while also improving the quality care delivered to Medicare beneficiaries.

ACOs are one part of the overall effort provided by the Affordable Care Act to help lower costs and improve care and quality. For example, the Affordable Care Act has helped reduce hospital readmissions in Medicare by nearly 10 percent between 2007 and 2013 – translating into 150,000 fewer readmissions – and quality improvements has resulted in saving 15,000 lives and $4 billion in health spending during 2011 and 2012.

For more information on the ACO Investment Model, please visit: http://innovation.cms.gov/initiatives/ACO-Investment-Model/

ACO Investment Model CMS Fact Sheet: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-10-15.html

October 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Why Accountable Care Organizations Are Failing

By Richard Amerling, M.D.

Accountable Care Organizations (ACOs), a key piece of the Affordable Care Act (“ObamaCare”) “reform” plan, are failing because they must fail. ACOs are based on faulty assumptions, poor economics, and junk science. They would not exist in a truly free market, and are best viewed as a product of government central planners and crony capitalism.

I first characterized ACOs about a year ago as little more than HMOs with lipstick in response to a report on the poor performance of the 32 pioneer ACOs. Now comes news that three more of the original groups will jump ship, leaving only 19 of the original 32 still on board. A nearly 50 percent attrition rate should be seen as a death knell for the concept, as these were likely the best of the best, and the inducements most generous. Reasonable people would head back to the drawing board. But we are dealing with government bureaucrats, health policy wonks, and administrators. They will damn the torpedoes and push on at flank speed.

What is wrong with the ACO model? Pretty much everything. The idea that an organization with control over health care dollars will be able to improve actual hard outcomes (as opposed to secondary endpoint numbers) is a collective fantasy. Keeping patients healthy and out of hospitals is already the goal of all physicians I know. The only problems we encounter in collaborating are those imposed by federal regulations (HIPAA). The real problem is that outpatient primary care physicians are not paid enough to devote adequate time to patients with complex problems. The ACO does not solve this problem. Rather, it creates financial disincentives to hospitalize patients or to refer for advanced care (similar to HMOs). This will lead to poor outcomes for the sickest patients, and ultimately, higher costs.

Money saved by rationing care (or by improving care; let’s be optimists), will be consumed largely by the considerable administrative infrastructure required of the ACO. This includes hiring even more administrators to track outcomes and costs, installing and maintaining expense electronic health record systems, and training of staff. EHRs have many problems, do not improve productivity, and impinge on the patient-physician relationship, impairing quality of care.

“Quality” benchmarks are numerical targets for blood pressure, blood sugar, cholesterol, etc., determined by various guideline panels, most of which are dominated by industry-supported physicians. This will lead to inappropriate over-treatment in many individuals, with greater expense and worse outcomes over time. For example, aggressive targeting of low blood sugar has been shown to cause weight gain and higher mortality in patients with type 2 diabetes. It’s not a coincidence that Big Pharma heavily supported ObamaCare.

ACOs are based on the assumption that fee-for-service medical practice is responsible for the high cost of medical care. This is demonstrably false. Direct third party payment, spearheaded by Medicare, is the culprit.

And of course, when Uncle Sam is your partner, there is always risk that rules and payment will be changed, sometimes arbitrarily and without warning. As reported in Modern Healthcare, “as ACOs grow more efficient and Medicare adjusts savings targets accordingly, it may also grow increasingly difficult for ACOs everywhere to earn savings.” Furthermore, “Medicare’s ACO programs so far have produced inconsistent results, some of which policy experts and ACO executives have blamed on how Medicare calculates how much ACOs potentially saved the program. Last week, the CMS announced that the initiatives saved Medicare $817 million through 2013. Dozens of participants shared $445 million of that amount, but three-quarters of ACOs saw nothing after failing to do sufficiently well against the financial benchmarks” [emphasis mine]. So, only a handful saw any real profit, and you can be sure Medicare will alter their formula to not allow whatever they consider to be excessive profit.

It is clear that for ACOs to be profitable, they will need to engage in the old HMO practice of cherry-picking healthy patients. Last week I saw a 65-year-old woman with kidney disease on top of severe lung, liver and heart disease. It took more than an hour just to sort through her records and medications. ACOs will go out of their way to avoid recruiting patients such as this. The only hope for such patients is within the traditional fee-for-service system.

Our hope is that this system is allowed to survive.

###

Richard Amerling, MD is an Associate Professor of Clinical Medicine and a renowned academic nephrologist at the Beth Israel Medical Center in New York City. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is President of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence and is a seasoned speaker and on-air contributor
October 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Boston Medical Center HealthNet Plan Chooses MedeAnalytics to Optimize Medicaid Performance Management

Medicaid health plan in Massachusetts adds robust analytics platform to improve financial, operational and clinical outcomes

Emeryville, Calif. – (March 11, 2014) – MedeAnalytics® today announced that Boston Medical Center HealthNet Plan (BMCHP), a non-profit managed care organization committed to providing the highest quality healthcare coverage to underserved populations, selected MedeAnalytics to implement its cloud-based technology platform to optimize care management activities for over 300,000 members, identifying gaps in care and tracking cost savings opportunities.

MedeAnalytics’ Medicaid Management solution enables payers like BMCHP to solve medical and provider network challenges they face in providing vulnerable populations access to care. By integrating the Medicaid Management solution into their care processes, BMCHP will be able to efficiently identify and stratify care for specific, at-risk patient groups. They will also leverage the solutions’ advanced analytics capabilities to monitor emerging trends, allowing them to proactively adapt and modify procedures to minimize costs.

“We are committed to providing the highest quality healthcare coverage to the traditionally underserved populations of Massachusetts and New Hampshire ” said Lisa Feingold, Vice President of Clinical Informatics at BMCHP. “In the wake of reform and the ever-evolving healthcare landscape, our care management team, as well as our provider partners, need a robust analytics solution that can be quickly implemented to support population health management. MedeAnalytics’ solution is a critical part of our efforts to improve the health of our members, improve the experience of care and reduce the cost of health care.”

Over the coming months, BMCHP will roll out the Medicaid Management solution for all its beneficiaries across Massachusetts and New Hampshire in order to provide a more centralized, robust view of care delivery, costs and quality. The go-live date is slated for May 2014.

“Given the complex healthcare needs of low-income and at-risk patients, Medicaid managed care plans need to run incredibly efficient operations,” said Andrew Hurd, MedeAnalytics Chairman and CEO. “BMCHP will leverage the MedeAnalytics platform to gain clear and actionable insights into cost, quality and risk, improving the way they care for the patients who need it most.”

BMCHP joins a long and prestigious group of Medicaid plans that are working with MedeAnalytics. MedeAnalytics’ robust solutions also empower hospitals and physician practices with the ability to ensure accountability and improve operational, clinical and financial outcomes. Due to its SaaS-based delivery model, time to value is under 90 days. For more details on health plan and provider success stories, please email MedeAnalytics@shiftcomm.com.

# # #

About MedeAnalytics®

MedeAnalytics provides evidence-based insights to solve a real problem that plagues healthcare – how to use the immense amount of patient data collected along the care continuum to deliver cost-effective care and promote a healthier population. Its analytics platform delivers intelligence that helps healthcare organizations detect their greatest areas of risk and identify opportunities to improve their financial health. It empowers providers and payers to collaborate and use data to strengthen their operations and improve the quality of care. MedeAnalytics’ cloud-based tools have been used to analyze more than 21 billion patient encounters in the United States and United Kingdom, providing better care to more than 30 million patients and better business for 900 healthcare organizations. For more information, visit www.medeanalytics.com.

About Boston Medical Center HealthNet Plan

Boston Medical Center founded Boston Medical Center Health Plan, Inc. in 1997 as a non-profit managed care organization doing business in Massachusetts as BMC HealthNet Plan. Outside Massachusetts the business name is Well Sense Health Plan. BMC HealthNet Plan, the managed care organization with the largest number of MassHealth and Commonwealth Care members in Massachusetts, is ranked in the top 10 among Medicaid plans in the nation according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Rankings 2013-2014. BMC HealthNet Plan also continues to maintain Excellent Accreditation from NCQA as a Medicaid health maintenance organization. In addition, BMCHP’s Qualified Health Plan program has been awarded “Accredited” status from NCQA, the highest accreditation level available at this time.

March 11, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Hello Health to Partner with Orange Health Solutions

NEW YORK CITY (Dec. 03, 2013) – Hello Health® and Orange Health Solutions have announced a partnership that will bring Hello Health’s no-cost electronic health record (EHR) and patient portal to Orange Health’s growing national network of accountable care organizations (ACOs). The actionable clinical and financial data from Hello Health’s web-based technology platform, combined with Orange Health’s proactive care coordination and medical cost management solution gives group medical practices and independent primary care physicians a complete set of tools to promote value-based care.

Orange Health Solutions operates an outsourced practice support center that coordinates care for patients by providing health coaches for those with chronic conditions that have a high risk for complications or hospitalization. Patients in the Orange Health network will now have access to Hello Health’s comprehensive portal for an easy, on-demand connection to front-line caregivers. Additionally, the clinical and financial data from Hello Health’s EHR will give those front-line providers and Orange Health’s patient advocate team more ammunition to promote care compliance and improve outcomes along the care continuum.

“This partnership makes sense on a number of levels,” said Hello Health Founder and CEO Nathanial Findlay. “As the industry puts more emphasis on risk-sharing models, providers will need solutions that add an analytic component to clinical care within an integrated network. Hello Health brings the necessary data and technology to this equation, and Orange Health brings the hands-on, service component.”

The partnership will bring the combined solution to more than 2,000 practices around the country.

“We are excited to partner with Hello Health, not only because of the state-of-the art-tools it brings to our physicians but also because of the company’s philosophy about interoperability,” said Nicole Bradberry, president and chief operating officer of Orange Health Solutions. “Hello Health is willing to freely share data amongst all caregivers in the continuum, regardless of the EHR solution the provider is using. Not all EHR vendors are willing to do this.”

For more information, visit www.hellohealth.com, or www.orangehealth.net.

About Hello Health Inc.
New York City-based Hello Health Inc. is dedicated to transforming independent medical practices by connecting patients and physicians through technology. The company’s revenue generating platform and cloud-based technology is available at no cost, and integrates an electronic health record, patient portal and practice management capabilities. The Hello Health patient subscription business model gives medical practices the financial bandwidth to improve care. Hello Health collaborates with leading organizations that offer complementary and strategic solutions that connect patients and physicians. Learn more at hellohealth.com.

About Orange Health Solutions
Orange Health Solutions offers providers the ability to maintain independence and control while helping them deliver higher quality coordinated care, improved population health management, greater practice efficiency and increased operating margins. Providers access our capabilities through an Accountable Care model or by leveraging our administrative services. We allow providers to focus on the patient and improve practice flow while lowering medical costs. Learn more at www.orangehealth.net.

December 4, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Large Pioneer ACO Outlines Role of Clinical & Business Intelligence in Value-Based Care

CHICAGO (November 15, 2012) – As patient care models evolve to value-based care, clinical and business intelligence (C&BI) tools are playing a central role for organizations operating under new payment models. HIMSS Analytics published a new white paper titled “Banner Health Network Pioneer ACO Clinical Intelligence & Business Intelligence Approaches” that looks at how Banner Health Network is designing and implementing C&BI to effectively operate in a value-based care model.

Headquartered in Phoenix, Ariz., Banner Health Network (BHN) is one of 32 organizations selected in 2011 by the Centers for Medicare and Medicaid Services for its Pioneer Accountable Care Organization program. BHN stood out as a Pioneer candidate since it had experience coordinating care across multiple patient care settings. BHN expanded an existing ACO relationship with Aetna to include full technology and analytics support for its ACO patient populations. The report covers the results of in-depth interviews with BHN executive staff to explore the organization’s progress and multi-layered approach to C&BI.

Banner Health Network – the Organization: With the overall mission to provide excellent patient care, BHN followed three key drivers, identified as the “triple aim,” from the Institute for Healthcare Improvement. BHN had an existing infrastructure to support claims payment, medical management, customer service and other health-plan-like activities, which gave it several critical components needed to support the Pioneer ACO model. In addition, senior leadership viewed existing healthcare fee-for-service payment models as unsustainable. As noted in the white paper, “We are moving from an acute care system to a more comprehensive delivery system that is more viable and stable,” says Dr. Tricia Nguyen, Chief Medical Officer.

Clinical & Business Intelligence in Action: Because BHN is transitioning from fee-for-service payment and incentive methodology to a value-based methodology, physicians must receive the right information at the right time to drive more efficient patient care that results in higher quality outcomes.  Adhering to this philosophy, BHN used C&BI to:

  • Implement payment codes that encourage and reward physicians to spend more time reviewing patient risk scores and profiles based on data gathered from BHN information systems that inform physicians about the status of their patients.
  • Manage and refine communication with specialists to help motivate them to follow processes that align and coordinate patient care with BHN standards.
  • Leverage business intelligence to track gaps in care, healthcare risks, communication plan effectiveness, and to benchmark progress toward the desired change in physician and patient engagement.
  • Establish executive level support and leadership through a Business Intelligence Data Governance program, managed by the Executive Steering Committee, with clearly defined roles and responsibilities for each level of data governance to avoid information silos.

“Our research with Banner Health Network provides valuable insights into how this health system leverages clinical and business intelligence in transitioning to a new model of accountable care.  The BHN executive team supports the use of C&BI tools to better understand patient populations and offer patient-level care coordination with high-quality, standardized information,” says James E. Gaston, Senior Director, Clinical and Business Intelligence, HIMSS Analytics.

Collaboration for a Technology Solution:  At Banner Health Network, the distinction between clinical and business intelligence often overlaps, impacting business performance and optimizing patient care.  To better manage C&BI efforts, BHN expanded its existing ACO relationship with Aetna to include technology to better support its value-based care models and patient populations. This support covers population health management and patient services for more than 200,000 Banner Health Network patients, including more than 50,000 Medicare fee-for-service patients who are part of the Pioneer ACO savings program.

The Aetna Accountable Care Solutions (ACS) technology helps physicians see patient data at the individual and population level, and predict risk and opportunities for health and wellness programs. It also enables them to track, monitor, coordinate and report on patient health outcomes.  BHN provides physicians a comprehensive care management model supporting Pioneer ACO efforts so that patient engagement happens in a more meaningful way, including nursing home and palliative care. Using the Aetna ActiveHealth technology care management programs and outreach, BHN is at the early stage, but leading edge, of building and designing true population-based health management tools.

“Value-based care requires physicians to understand and impact the health of individuals and populations of patients, particularly those with chronic disease where intervention and management is key to better health outcomes and cost. The range of technologies from our Aetna companies complements Banner Health Network’s technology to empower full clinical integration and intelligence,” said Charles D. Kennedy, chief executive officer, Accountable Care Solutions from Aetna.

Read “Banner Health Network Pioneer ACO Clinical Intelligence & Business Intelligence Approaches” at www.HIMSSAnalytics.org/research on the HIMSS Analytics website. Contact James E. Gaston at James.Gaston@HIMSSAnalytics.org for more information on this research.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 37.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.

About HIMSS Analytics 

HIMSS Analytics is a wholly owned not-for-profit subsidiary of the Healthcare Information and Management Systems Society (HIMSS).  The company collects and analyzes healthcare information related to IT processes and environments, products, IS department composition and costs, IS department management metrics, healthcare trends and purchase-related decisions.  HIMSS Analytics delivers high quality products, services and analytical expertise to healthcare delivery organizations, healthcare IT companies, state governments, financial companies, pharmaceutical companies, and consulting firms.  Visit www.himssanalytics.org for more information.

November 18, 2012 I Written By

Legacy Health Selects Explorys as its Healthcare Big Data Platform for Value-Based Care Initiatives

Explorys, an innovator of cloud-computing platform solutions for leveraging big data in healthcare, announced today that Legacy Health, one of Oregon’s premier multi-hospital health systems, has selected Explorys to power the healthcare system’s enterprise and community-wide value–based care initiatives, including its flagship patient centered medical home (PCMH) program and to support its participation in the Cigna ACO launched in the region.  This news is great example of how provider organizations are starting to use the kind of powerful big data tools prevalent in other industries to figure out how to make initiatives like PCMH and ACO successful.  In this case, Legacy is using a cloud-based approach – which has a lot of benefits over the more traditional build a giant data warehouse approach – to aggregate and analyze not just their own data, but also data from partners like Cigna.

Explorys’ Cloud-Based Analytics Platform to Enhance Quality and Cost Performance at Legacy Health; Tool Will Combine and Analyze Data from Multiple Sources for Holistic View of Patient and Improved Care Coordination

Cleveland, OH, November 5, 2012 — Explorys, the leader in cloud-based big data solutions for healthcare, announced today that Legacy Health, one of Oregon’s premier multi-hospital health systems, has selected the Explorys Platform and Enterprise Performance Management (EPM) applications to power the healthcare system’s enterprise and community-wide value-based care initiatives, including its flagship patient centered medical home (PCMH) program.  The Explorys solution will also play a key role in helping the organization to better understand quality and cost performance as it joins Cigna’s (NYSE: CI) new collaborative accountable care (ACO) program that was recently expanded into Oregon.

Legacy Health has been on the forefront of implementing new models of care.  Since 2007, Legacy Health has been implementing the PCMH model across their primary care practices.  Legacy Health is shifting to a holistic, coordinated approach to deliver quality care for the patients they serve.  “Taking our patient-centered care model to the next level will require more efficient, holistic visibility to the analytic information that is essential for improving coordinated care for all of the patients we serve,” said Kelley Aurand, DO, Legacy Health Medical Director of the Health Home. “Building on our very successful implementation of an electronic health record, we generate huge volume of clinical data that we can mine for better population health.”

“Legacy Health sought a data solution that would help us take the next steps in health care transformation,” said John Kenagy, PhD, Legacy Health’s senior vice president and CIO. “We need to be able to aggregate, analyze, and explore our clinical and operational data across our delivery system. As we become increasingly accountable for the long-term health of our patients, we will be analyzing data for patient quality and clinical effectiveness.”

The Explorys Platform supports a series of independent software-as-a-service applications for data exploration, population management, performance measurement, and patient outreach. Explorys analytics and informatics services provide prescriptive solutions that combine technology and process to deliver more effective care.  “It is obvious that Legacy Health is committed to the improvement of patient experience, the quality of care that is delivered, and lowering the cost of care to the populations they serve.  We are excited about the opportunity to partner with them as a foundational component of their population health management strategy to meet these needs now and in the future,” stated Sarah Mihalik, VP of Client Services, Explorys.

About Legacy Health

Legacy Health is an Oregon-based, not-for-profit, tax-exempt corporation comprising five full-service hospitals, a children’s hospital, and more than 50 clinics.  Within these award-winning facilities, Legacy offers an integrated network of health care services – acute and critical care, inpatient and outpatient treatment, community health education and a variety of specialty services.
For more information, visit www.legacyhealth.org.

About Explorys

Founded in 2009, Explorys provides the first secure cloud-computing Enterprise Performance Management Platform for Healthcare powered by BIG DATA. The rising costs of healthcare and the need for better outcomes are driving leading healthcare providers to more effectively leverage their data to improve quality, patient satisfaction, and support Patient Centered Medical Home (PCMH) and Accountable Care (ACO) models. Adopted by 13 major integrated healthcare systems 19 million cared-for-lives, 118 hospitals, and thousands of providers and ambulatory venues, Explorys is the leading healthcare BIG DATA platform in the United States.
For more information, visit www.explorys.com.

November 5, 2012 I Written By

Certify Data Systems Introduces the Industry’s Most Advanced HIE Platform

Certify Data Systems, a San Jose based HIE vendor, announced its HealthLogix™ HIE platform. HealthLogix offers real-time query capabilities, true semantic EMR interoperability and an integrated, 360° view of all patient information.

Dave Caldwell, EVP of Certify Data Systems, a leading HIE provider, has vast experience fine tuning HIEs to improve physician workflow. With over 25 years of experience in the healthcare industry, Dave can speak about to why healthcare organizations and providers participating in a Medical Home or an Accountable Care initiative will continue to struggle without access to complete clinical data to care for their patients. 

Certify’s HealthLogix™ HIE platform is the first in the industry to capture clinical information in real-time for every healthcare encounter and deliver an integrated 360° longitudinal view of the patient

San Jose, Calif. — July 25, 2012 — Certify Data Systems, Inc., a pioneer in the Health Information Exchange (HIE)  market, announced today the general availability of its next generation HealthLogix™ HIE platform. HealthLogix is the first HIE solution to deliver on the promise of an aggregated patient view from all healthcare encounters across the community no matter what native EMR/EHR system is in use.  Without this capability, healthcare organizations and providers participating in a Medical Home or an Accountable Care initiative will continue to struggle with incomplete clinical data to care for their patients.

The HealthLogix “networked” architecture provides real-time access to patient specific clinical information across the network in a manner that no other company is doing today. HealthLogix leads the industry in its ability to connect the “last mile” and serve up a complete health record to every member of a patient’s care team.

At the core of the HealthLogix platform are sophisticated HealthDock® edge servers located in physician offices or in the cloud that facilitate the seamless exchange of patient summaries in CCD and CDA formats while aggregating, normalizing and consolidating duplicate clinical information into a unified patient view and introduced into existing EMR workflows. Patient summaries are mined from EMRs across the network, stored in the HealthDock XDS.b repository at every node and made available to any provider on the patient’s care team who the patient has consented to view their data. HealthLogix gives providers a comprehensive medical record for all their patients in a way never offered before.

The HealthLogix networked architecture is the only one of its kind, has been adopted by more of the nation’s leading health systems in the past three years than any other HIE platform, and leads the industry in last mile interoperability to ambulatory EMRs.

“HealthLogix continues to deliver on what many in the HIE industry have promised for years, but are unable to deliver: real-time query capabilities, true semantic EMR interoperability and an integrated, 360° view of all patient information,” said Marc Willard, founder and CEO of Certify Data Systems. “Certify is pleased to deliver on this industry promise and make healthcare more efficient and accountable than ever.”

About Certify Data Systems

Certify Data Systems, Inc., is a pioneer in health information exchange (HIE) technology. The company’s HealthLogix™ Enterprise HIE platform has been adopted by the nation’s leading hospitals, physicians and laboratories. Certify’s HIE platform provides bi-directional semantic interoperability between disparate

Electronic Health Record (EHR) systems, enabling all healthcare providers to exchange essential health information in real-time. In addition to processing electronic orders and results, the HealthLogix HIE platform delivers Continuity of Care Documents and Clinical Document Architecture seamlessly across a healthcare ecosystem. Certify’s industry leading “network approach” is easy to deploy, scale, manage and support.

 

September 24, 2012 I Written By

MedHOK’s 360ACO® Positions ACOs to Reduce Hospital Readmissions, Benefit From Shared Savings

TAMPA, Fla. – Sept. 5, 2012 – Accountable care organizations (ACOs) that deploy 360ACO® from MedHOK, one of the healthcare industry’s fastest-growing software companies, are well-positioned to reduce hospital readmissions and meet quality outcomes as required to benefit from shared savings under the Centers of Medicare and Medicaid (CMS) program.

MedHOK offers fully NCQA–certified software for HEDIS®, pay-for-performance (P4P) and disease-management-performance measures. The company has more than 18 million lives in production and is on track to double this number within the year.

“Hospital readmissions are a major cost driver in Medicare, accounting for a startling $17.5 billion in additional inpatient spending each year. To combat this, CMS is incentivizing ACOs to take steps to reduce readmissions and improve follow-up care for patients with acute myocardial infarction, heart failure and pneumonia,” said Anil Kottoor, president and CEO, MedHOK. “The challenge for many ACOs will be tracking quality outcomes and facilitating the improved coordination of care necessary for timely interventions. MedHOK’s 360ACO overcomes those challenges and positions ACOs to share in the resulting savings.”

MedHOK’s 360ACO integrates patient information in real time and makes it immediately available to hospitals, physicians and other participating providers. The disease and case management modules allow the ACO to better manage care for high-risk patients, reducing unnecessary utilization and encouraging improved patient self-management. Further, 360ACO enables real-time monitoring of quality performance to ensure the ACO is on target to meet the rigorous quality standards that will allow it to share in any reductions in Medicare fee-for-service expenditures.

MedHOK’s integrated care management, quality and compliance platform facilitates improved clinical outcomes and care coordination while enhancing quality measures, compliance and financial performance. It accomplishes this by:

  • Providing real-time access to Star, HEDIS, P4P, and proprietary quality and performance measures, helping plans and providers to accurately monitor in real-time the data they need to achieve and maintain high-quality ratings
  • Triggering interventions when care gaps are identified, in particular for patients with multiple comorbidities and chronic conditions
  • Utilizing predictive analytics models to generate profiles based on clinical, quality and financial data for member, provider and local populations
  • Calculating risk scores for every member, enabling timely predictions of those at the highest risk and more accurate forecasting of care costs and utilization
  • Continuously monitoring for and addressing regulatory changes from CMS and state Medicaid agencies, ensuring clients stay ahead of the compliance curve

“MedHOK’s 360ACO is an end-to-end technology solution that positions ACOs to thrive in this new environment of care, quality and compliance,” said Kottoor. “By utilizing 360ACO, providers will be able to intervene before readmissions are necessary, resulting in increased savings and improved patient care.”

About MedHOK

Tampa, Fla.-based MedHOK has more than 18 million lives in production and expects to double that number in 2012, making it one of the healthcare industry’s fastest-growing software companies. It offers a cloud-based integrated software platform for care management, quality and compliance that enables physicians, ACOs, PCMHs, payers and TPAs to manage and measure care against national quality standards for optimal outcomes. Its innovative modular software helps healthcare organizations meet quality, care and compliance objectives across business lines by facilitating real-time information sharing with all stakeholders to address disease management and care coordination, clinical quality and utilization review, and quality and financial measures. ICD-10 compliant, HIE-ready and securely accessible on any device, the MedHOK platform is user-friendly, rapidly deployed and easily configurable for a low total cost of ownership and rapid return on investment. It holds 2012 HEDIS®, Pay for Performance and Disease Management performance measures certification.

September 9, 2012 I Written By

Health Information Exchange Formation Guide Named HIMSS Book of the Year

Authored by executives from Mosaica Partners, a nationally recognized HIE consulting firm, the award-winning book is considered the essential guide to HIE formation and planning

ST. PETERSBURG, Fla. – March 21, 2012 – The Healthcare Information Management and Systems Society (HIMSS) has named The Health Information Exchange Formation Guide its 2011 Book of the Year.

The book and its co-authors, well-known health information consultants Laura Kolkman, RN, MS, FHIMSS and Bob Brown of Mosaica Partners, were honored on Feb. 23 at the HIMSS Awards Banquet, part of the 2012 Annual HIMSS Conference and Exhibition.

“Each year, the HIMSS Book of the Year award recognizes a book that offers outstanding practical guidance and/or strategic insight for healthcare information and management systems professionals,” said Fran Perveiler, vice president of communications, HIMSS. “Congratulations to authors Laura Kolkman and Bob Brown, winners of the 2011 HIMSS Book of the Year Award for their book, The Health Information Exchange Formation Guide: The Authoritative Guide for Planning and Forming an HIE in Your State, Region, or Community.”

Published by HIMSS in February 2011, The Health Information Exchange Formation Guide has received national acclaim for its practical approach to forming state-, regional- or community-based HIE organizations. The book leverages the insights Kolkman and Brown gleaned from their work with clients, as well as from extensive research and interviews with recognized HIE pioneers.  It provides the knowledge and tools that emerging HIE initiatives need to develop a framework for long-term sustainability.

“HIEs play a significant role in ACOs and new emerging care models and are a catalyst for transforming the nation’s healthcare system,” said Kolkman. “The problem is that many organizations and individuals do not know where to begin when planning an HIE. This book, based on our proven HIE Formation Methodology, gets them on the right path.”

“Over the past decade, we have learned about HIEs through the successes and failures of the front runners in exchange initiatives,” Brown added. “By applying these lessons, emerging HIEs can dramatically increase their odds of success, and establish their role in improving the overall efficiency of the healthcare delivery process, enhancing patient outcomes and significantly lowering costs.”

The HIE Formation Guide has garnered industry-wide praise for its structured approach that incorporates leading practices in the planning, formation and operational stages of HIE initiatives. In addition to a high-level history of HIE and in-depth discussion of its importance and role in transforming healthcare, the book includes a step-by-step guide, numerous case studies, examples, checklists and references.

The Health Information Exchange Formation Guide provides an excellent and diverse grouping of ‘pearls’ from recognized leaders within our industry,” said Dick Thompson, CEO of Grand Junction, Colo.-based Quality Health Network. “I recommend it for nascent as well as more mature organizations, since one never knows where one may find a pearl of wisdom that is applicable to a specific business problem.”

Adds MedVirginia CEO Michael Matthews: “This is an exciting and extremely critical time for health information exchange. The Health Information Exchange Formation Guide provides practical, real-world guidance on important issues facing HIEs today.”

The Health Information Exchange Formation Guide is an excellent resource for professionals and executives that are starting, developing or implementing HIE networks,” said Jeff Blair, director of health informatics at LCF Research, New Mexico Health Information Collaborative. “The Guide is so well-organized that it can be used as a comprehensive textbook, a reference to relevant case studies, or a quick reference guide to specific HIE topics. “

The Health Information Exchange Formation Guide is available for purchase in the HIMSS online store and as a HIMSS eBook. For more information, including the table of contents and chapter summaries, helpful downloadable figures and checklists, visit www.himss.org/hieformationguide.

About Mosaica Partners

Based in the Tampa Bay, Fla. region, Mosaica Partners (www.mosaicapartners.com) is a nationally recognized management consulting firm providing strategy, business planning, development and process optimization services related to health information exchange. Mosaica provides its services to the federal government, states, regions and communities as well as public and private companies with interests in healthcare informatics and health information exchange. In addition, Mosaica provides advisory services to hardware and software firms that are interested, or actively involved, in the health informatics or HIE market space.

March 27, 2012 I Written By