Health information exchange is essential to achieving true interoperability, but solutions are necessary for addressing challenges to information sharing.

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“Hospitals and physicians are now exchanging more electronic health information than ever before,” the Office of the National Coordinator for Health Information Technology told Congress in an annual report from early November.

It is a statement of fact backed up by rather positive statistics.

“In 2008, 41 percent of all hospitals electronically exchanged health information with outside health care providers,” the report continues. “These rates have since doubled. In 2015, more than eight in ten (82 percent) non-federal acute care hospitals electronically exchanged laboratory results, radiology reports, clinical summaries or medication lists.”

Healthcare business intelligence users may have more insight into their operations, but they aren't necessarily using the data for ACO and HIE participation.

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 By Jennifer Bresnick

April 03, 2017 - Healthcare providers who want to wade into the value-based care ecosystem are well aware that they must overcome a number of technical and organizational hurdles before they can reap the rewards of joining an accountable care organization (ACO) or taking on a pay-for-performance contract with a payer.

Not only must they feel comfortable with using their electronic health records for basic documentation and patient management, but they must also master the complex continuum of healthcare business intelligence tools that combine to support risk stratification, revenue cycle management, and care coordination.

The report finds that being part of an ACO allows clinicians to be rated as a group for a key measure to determine Medicare reimbursement.

Published Online: March 30, 2017

Mary Caffrey

Joining an accountable care organization (ACO) could help clinicians raise key Medicare performance scores up to 30%, which boosts their chances of higher reimbursement relative to competitors, according to a new report from Caravan Health.

The report, by Lynn Barr MPH, CEO of Caravan Health, and LeeAnn Hastings, JD, MPH, a compliance officer for 23 ACOs under the Medicare Shared Savings Program (MSSP), compared what payments will look like for clinicians inside and outside ACOs under the Medicare Access and CHIP Reauthorization Act (MACRA, passed in 2015 to push healthcare toward value-based payment.

Under MACRA, performance data reported from 2017 will be used to calculate payments in 2018. CMS has worked to ease the transition to value-based payment, allowing clinicians to select how quickly they want to take on the associated risk. In fact, reporting a small amount of data for 2017 can help clinicians avoid penalties.

Most health plans are missing key socioeconomic data required to develop meaningful population health management programs for vulnerable patients.

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 By Jennifer Bresnick

March 07, 2017 - Managed care policymakers do not have access to enough clean, complete, and accurate socioeconomic and population health data on the millions of patients depending on public insurance programs for care, according to a new article in Health Affairs.

“To reduce disparities, it is critical to first know where they exist,” said the research team from CMS and NCQA.  “Improving documentation of race, ethnicity, and language needs in managed care plan reporting, regardless of data collection method, and clarifying how high-performing health plans achieve their results, will be important.”

EHR technology is one of many health IT systems necessary for success in adopting ACO models, a realization that has led to a new market for developers of end-to-end ACO solutions.

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 By Kate Monica

March 06, 2017 - The lack of standardization in implementing accountable care organizations (ACOs) has created a demand for solution vendors capable of assisting healthcare organizations in seamlessly adopting these value-based care models.

A recent report from Chilmark Research evaluates the 10 leading ACO solution vendors for their capabilities and core competencies in providing a range of services for successful ACO adoption in an effort to help healthcare organizations make informed decisions about which vendor best suits their needs.

The population health management IT market is slated for significant expansion as providers look to improve interoperability and meet patient expectations.

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 By Jennifer Bresnick

March 06, 2017 - Over the next five years, the population health management technology market is predicted to grow into a $42.54 billion opportunity, according to a Research and Markets report, but healthcare providers will need to adopt new care strategies at a similarly rapid pace if they are to make the best possible use of newly available data analytics tools.

As regulatory programs like MACRA and meaningful use, an aging population, and an increasingly complex chronic disease population continue to challenge the status quo of patient care, providers will need to focus on leveraging population health IT tools to optimize coordinated care delivery.

By Stephanie Zaremba  | February 3, 2017

A recap of the past two weeks of health policy news could be boiled down accordingly: ACA, ACA; does anyone have an ACA replacement plan?; ACA; Health and Human Services Secretary confirmation hearings; but seriously, what is happening with the ACA?

So you'd be forgiven if, while following the constant news updates, you forgot that 2017 brought not just a new president but also a new physician performance program: MACRA. In fact, in a live poll conducted during an athenahealth webinar about the ACA last month, a third of the more than 250 participants said they hadn't even heard of MACRA.

For the unacquainted, MACRA is the Medicare Access and CHIP Reauthorization Act of 2015. It is a significant law designed to reform the way Medicare pays physicians (though hospital inpatient payment is not impacted).

It creates a new Quality Payment Program, or QPP, by consolidating existing Medicare pay-for-performance programs: Meaningful Use, the Physician Quality Reporting System, and the Value-Based Modifier program. And it pushes clinicians toward participation in alternative payment models like accountable care organizations.

Population health rates and care quality levels vary significantly across the country, new data from the Commonwealth Fund shows.

 By Jennifer Bresnick

July 15, 2016 - Much of the nation gets a passing grade for care quality, access, and overall population health, according to new data from the Commonwealth Fund, but striking differences in performance, outcomes, and affordability of basic services persist between geographical regions.

Patients who live in the highest-performing areas of the country are up to thirteen times more likely to experience satisfactory care than those at the other end of the spectrum, the report said, and broad variations in insurance coverage rates persist even after the implementation of the Affordable Care Act.

“Many communities are showing signs of getting healthier, and that is encouraging,” said Commonwealth Fund President David Blumenthal, MD.  Nearly all communities included in the survey improved more often than they worsened, indicating overall positive progress towards healthier lives for patients.