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News & Updates
Hospital CEOs list financial concerns as top worry, point to value-based care, study finds
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American College of Healthcare Executives report says patient safety and quality, governmental mandates rank 2nd and 3rd among the leaders.
Financial challenges once again ranked as the top concern for hospital chief executive officers in 2015, according to a new study by the American College of Healthcare Executives. Patient safety and quality, and governmental mandates came in as the 2nd and 3rd highest concerns.
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Report: Robust data analytics capabilities 'likely several years away'
Challenges include integrating data into workflows, interoperability and vendor maturity
Robust data analysis with be critical for health organizations as the industry moves from volume-based payment to a value-based system, but there's still a long road ahead for hospitals and health systems to get where they need to be, according to a market trends report from Chilmark Research.
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CIO, analyst say cloud computing in healthcare meets HIPAA
​Many fear cloud computing in healthcare. But a long-term care company disputes that stance, instead going 100% into the cloud while firmly believing it complies with HIPAA.​
Creative Solutions in Healthcare may be the only health organization at present that completely operates in the cloud.
"We are the first healthcare company, to my knowledge, that is 100% in the cloud," said Shawn Wiora, CIO at Creative Solutions, based in Fort Worth, Texas.The company was founded in 2000 and currently owns and operates dozens of skilled nursing facilities and assisted living facilities.
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Health data analytics should be a priority for physicians
Though many physicians feel they have more pressing technology concerns, their practices could be enhanced by applying more health data analytics.
The number of small and midsize medical practices that adopted EHR systems surged over the last decade. For the providers that transitioned from paper charts to an EHR, the electronic platform was viewed as way to digitally capture and retrieve clinical data.
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Healthcare providers weigh accountable care vs. Merit-Based Incentive Payment System Providers must be among the top performers to receive benefits, but many still struggle to meet and report quality requirements.
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Many providers are at a crossroads right now: Either join an accountable care organization or be placed into Medicare's Merit-Based Incentive Payment System. Set to begin in 2017, MIPS uses value-based modifiers to rank providers by quality and is expected to fold together with meaningful use, essentially merging the current pay-for-performance models under one umbrella.
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CMS unveils first group of Next Generation ACOs Twenty-one organizations to participate in new accountable care organization model that offers greater financial risk, reward
On Monday, CMS announced that 21 organizations initially will participate in its Next Generation Accountable Care Organization Model, which increases access to telehealth, FierceHealthcare reports (MacDonald, FierceHealthcare, 1/11).
Twenty-one organizations will become the first to join Medicare's new accountable care organization (ACO) model, the Next Generation, taking on greater financial risk but potentially reaping greater financial rewards.
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Stakeholders Question Efficacy of New Cybersecurity Law, HHS Task Force
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by Joe Infantino, iHealthBeat Senior Staff Writer Thursday, January 14, 2016
​A soon-to-be-convened HHS task force and its forthcoming report on cybersecurity mark a step toward strengthening privacy and security in health care, but it might have been the wrong one to take, some experts say.
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Read Andy Slavitt's speech at J.P. Morgan Healthcare Conference; Chief touts ACOs, puts meaningful use on ice
Acting CMS administrator says several programs will change as healthcare industry wades deeper into value-based reimbursement.
Below is the full transcript of his speech, in which, in addition to putting meaningful use on death watch, he touted several new CMS initiatives like the new Next Generation accountable care model:
Thanks for the introduction. Glad to be here and speak about the major policy areas that will affect the health care sector in 2016. I am particularly glad to be here with Jim from AMA, because between us we are working on an incredible amount of change across the health care sector.
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Fueled by health law, 'Concierge Medicine' reaches new markets Primary Care doctors are bringing a service generally considered 'healthcare for billionaires' to other populations.
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A growing number of primary care doctors, spurred by the federal health law and frustrations with insurance requirements, are bringing a service that generally has been considered "health care for billionaires" to middle-income, Medicaid and Medicare populations.
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CMS wants to boost CQM reporting in EHR certification
This article defines the comment period on requiring EHR vendors to annually recertify CQM reporting modules and increase the number of CQM Measures:
Kate Goodrich, M.D., director of the CMS Center for Clinical Standards and Quality, wrote in a blog post accompanying the RFI. "We aim to streamline/reduce provider, hospital and health IT developer burden." That certainly sounds good, but as we know the process will continue to change. At Hexplora we are positioned to stay abreast of these changes and help you to adapt.Kate Goodrich, M.D., director of the CMS Center for Clinical Standards and Quality, wrote in a blog post accompanying the RFI. "We aim to streamline/reduce provider, hospital and health IT developer burden." That certainly sounds good, but as we know the process will continue to change. At Hexplora we are positioned to stay abreast of these changes and help you to adapt.
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ICD-10 dominated 2015 healthcare news, but 2016 could see issues, experts say It seems two-years of preparations paid off, but insiders say it may be too early to celebrate.
ICD-10 came, the public saw, and healthcare providers conquered.
When looking back at the the biggest news in healthcare in 2015, an informal survey of Healthcare Finance readers found no other contender even came close to defeating ICD-10 for the reign of top issue of the year.
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2016 the year of consumerism in healthcare as providers rush to adapt Patients want fast, convenient service in the form of online payments, retail clinics and an improved patient experience.
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Patients are now consumers, and it's changing everything about how healthcare works.
​ On the surface, it makes sense. Patients should take more control over their choice of care if they are paying for more of it. But as healthcare leaders surveyed by Healthcare Finance say consumerism will be the largest driver of change in 2016, many point to challenges that come with the transition.
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Population health, revenue cycle management on CIO's agenda
The following article from SearchHealthIT.com Marc Probst, CIO at Intermountain Healthcare, said his organization is taking strides to make population health happen, is investing heavily in data analytics, and more.
If better understanding and utilization of data analytics and population health management are priorities for your organization in 2016, Hexplora can help. Contact us today for a free demonstration and personalized information session.
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CMS Data Show 44% of EHR Incentive Payments Made in Eight States
The following article from IHealthBeat.org outlines the CMS Data showing that 44% of EHR Incentive Payments were made in Eight States.Contact us today to learn more.
​Nearly half of the meaningful use incentive payments made as of September went to eligible professionals and hospitals in eight states, according to an analysis of CMS data, Health IT Interoperability reports.
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CMS Data Show 44% of EHR Incentive Payments Made in Eight States
The following article from IHealthBeat.org outlines the CMS Data showing that 44% of EHR Incentive Payments were made in Eight States.Contact us today to learn more.
​Nearly half of the meaningful use incentive payments made as of September went to eligible professionals and hospitals in eight states, according to an analysis of CMS data, Health IT Interoperability reports.
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Healthcare top sector for data breaches in first half 2015, Gemalto says Healthcare saw 187 data breaches, making up 21 percent of the total number of breaches across all sectors.
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The following article from HealthCareFinanaceNews.com documents the prevalence of data breaches within the healthcare industry. The experts at Hexplora can help your organization to manage this risk. Contact us today to learn more.
​ Healthcare has outstripped retail as the most breached business sector, according to a new report by digital security giant Gemalto, equalled only by government as the most targeted by hackers.
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CMS lays out strategy, vows to continue to push towards value
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The following article from HealthCareFinanaceNews.com outlines strategy efforts as CMS vows to continue the push towards value. Contact us today to learn more.
​Update noted progress in payment reform initiatives, namely in requirements in the Medicare Access and CHIP Reauthorization Act.
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Better outcomes, lower costs, with value-based models, Humana says Costs 18 percent lower in value-based reimbursement models than those in fee-for-service, report states.
The following article from Healthcarefinancenews.com Humana reports that its 2014 population health shows that costs are 18% lower in their value based reimbursement models. Hexplora can help your organization to analyze and manage population health data to ensure better outcomes and lower costs. Contact us for a free demo today.
​Humana Inc., a Medicare Advantage health plan provider, released its 2014 population health results Wednesday that it says shows its value-based reimbursement models are associated with better outcomes and lower costs.
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All-payer database lawsuit before Supreme Court could hurt HIEs
The following article from FierceEMR.com lawsuit that is currently before the United States Supreme Court about state imposition of all-payer claims databases and the significant adverse effects it could have on health information exchanges (HIEs).Contact us today to learn more.
A lawsuit currently before the United States Supreme Court about state imposition of all-payer claims databases could have significant adverse effects on health information exchanges (HIEs), according to a perspective article in the New England Journal of Medicine.
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Health data analytics should be a priority for physicians
The following article from SearchhealthIT.TechTarget.com discusses the importance of having a Health Data Analytics Vendor who will not only help to analyze and report data, but also provide training and subject matter expertise.Contact us today to learn more.
Hexplora's team of highly knowledgeable professionals possesses outstanding expertise and experience in implementing industry leading solutions that enable ACOs, IPAs, and Payers to leverage Informatics as a strategic asset that can deliver market differentiating capabilities.
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CMS Finalizes Medicare Payment Model With Telehealth Implications
Tuesday, November 17, 2015
The following article from iHealthBeat.org discusses a change in the way CMS is viewing Telehealth. Hexplora can help your organization to utilize data for better outcomes while protecting you from potential security issues and vulnerabilities ,please contact us for a demo.
On Monday, CMS finalized a new Medicare payment model for hip and knee replacements that grants more flexibility in the use of telehealth services, AHA News reports (AHA News, 11/16).
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With population health models, data curbs the risk
The following article from Search Health IT/Tech Target.com explains how data can help to mitigate risk. Hexplora can help you to harness the power of data to protect your healthcare organization.Contact us today to learn more.
As population health models force healthcare organizations to take on more financial risk, the industry will lean on data analysis to mitigate the perils.
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More medical schools teaching about Big Data, healthcare analytics
The following article from HealthcareFinanceNews.com discusses how Big Data and analytics is changing healthcare. At Hexplora we can help your organization to capture and analyze the data to make important decisions and improve outcomes. Medicine, meet Big Data. Contact us today to learn more.
For generations, physicians have been trained in basic science and human anatomy to diagnose and treat the individual patient.
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New ICD-10 Metrics Released
The following article from HealthDataManagement.com outlines the New ICD-10 Metrics showing that rejection rates are now declining. Hexplora can help your organization to analyze and utilize the myriad of information that is being collected to produce meaningful insights. Contact us today to learn more.
Rejection rates for claims increased during the early days of the transition to ICD-10 coding, but a major claims clearinghouse now says rejection rates are now in decline.
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Healthcare industry must discover best ways to weigh, combine disparate datasets
The following article from FierceHealthIT.com talks about the industry's need to figure out how to best utilize the overload of information that is now available. Hexplora can help your organization to analyze and utilize the myriad of information that is being collected to produce meaningful insights. Contact us today to learn more.
As information flows into the healthcare system from myriad technologies--wearables, apps, social media, online portals, electronic records, etc.--the industry needs to figure out how those types of information can be combined and weighed, according to a paper published this week in Nature.
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Report Makes Predictions on Effects of Health Care Trends on IT
This article was reprinted from iHealthBeat.org outlining a report that makes predictions on the effects of Health Care Trends on IT. Hexplora is positioned to keep you ahead of the trends affecting Health Care and the impact on your organization. To learn more about how we are providing Better Insights and Better Outcomes, please contact us for a demo.
The International Data Corporation has released a report that outlines predictions for global health care trends and discusses the effects of health IT, Healthcare IT News reports (Ratchinsky,Healthcare IT News, 11/5).The report lists 10 predictions about trends in health care over the next three years.
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Employer-insured patients spend more on healthcare in 2014, driven by brand-name drugs, report says
New Report Shows Healthcare spending grew by 3.4% in 2014. Learn more in this article reprinted from HealthCareFinanceNews.com, please contact us for a demo.
Per capita prescription spending jumped to $45 in 2014, though the actual use of brand-name prescriptions fell by 16 percent. Healthcare spending grew by 3.4 percent in 2014, a new report by the Health Care Cost Institute found, even though overall utilization declined. According to the HCCI, which runs the popular healthcare price tracking website Guroo.com, said much of the increase can be traced to the rise in prices for brand-name drugs.
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What's the potential of IT and healthcare big data?
The following article is from SearchHealthIT.TechTarget.com To learn more about how Hexplora can help your organization to utilize data for better outcomes while protecting you from potential security issues and vulnerabilities ,please contact us for a demo.
Hexplora can help your organization to utilize data for better outcomes while protecting you from potential security issues and vulnerabilities
Big data in healthcare will open up vast amounts of data to healthcare organizations and providers, allowing them to get a deeper look into the data, extract valuable insights and ultimately enable them to improve patient care. At the same time, opening up that data can possibly create more vulnerabilities that hackers can take advantage of, said Joel Vengco, vice president and chief information officer at Baystate Health in Springfield, Mass. In this Q&A, Vengco discusses the potential security issues healthcare big data brings to the table, what can be done and whether it's all worth it.
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Affordable Care Act initiative builds on success of ACOs
New generation ACO model sets stronger measures and more opportunities for care
The U.S. Department of Health and Human Services today announced a new initiative from the Centers for Medicare & Medicaid Services’ Innovation Center (CMS Innovation Center): the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery. Made possible by the Affordable Care Act, ACOs encourage quality improvement and care coordination, helping to move our health care system to one that achieves the Department’s goals of better care, smarter spending, and healthier people. “The Next Generation ACO Model is one of many innovative payment and care delivery models created under the Affordable Care Act, and is an important step towards advancing models of care that reward value over volume in care delivery,” said HHS Secretary Sylvia M.
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CMS offers pre-paid shared savings for ACOs
By: Mike Miliard
The Centers for Medicare and Medicaid Services says its new ACO Investment Model responds to concerns that some providers lack adequate access to investment capital needed to successfully implement population care management. The model offers pre-paid shared savings to encourage new accountable care organizations to form in rural and underserved areas.
The initiative, announced Wednesday, offers up to $114 million in upfront investments to as many as 75 ACOs nationwide. ACOs must apply to CMS for the funding.
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VA to Pay Non-Contract Providers Using Medicare Payment Models
The Department of Veterans Affairs (VA) has begun issuing notices that inform home health providers of the VA’s revised payment methodology for skilled home health services. Beginning October 1, 2014, the VA will require an Outcome and Assessment Information Set (OASIS) to be completed to generate a health insurance prospective payment system (HIPPS) code in order to reimburse non-contracted home health agencies for skilled home health services using the Medicare home health prospective payment system (HHPPS). For non-contracted hospice providers the VA will continue to pay a per diem rate.
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Obama Administration Announces New Executive Actions to Improve Quality of Care for Medicare Beneficiaries
October 06, 2014
Today, the Obama Administration announced plans to expand and strengthen Medicare’s widely-used Five Star Quality Rating System for Nursing Homes, also known as Nursing Home Compare. The rating system is a consumer service that offers useful information to the public about the quality of care in the 15,800 nursing homes that participate in Medicare or Medicaid. Users may sort through nursing homes in their area through an online tool at CMS’ Nursing Home Compare website.
The Five Star Quality Rating System offers the most comprehensive overview of nursing home quality in the U.S., in an easy to understand format, based on data from onsite inspections conducted by trained, objective surveyors from state public health
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ACO Programs Save Medicare More than $800M, Data Show
Sixty-four of the 243 Medicare accountable care organizations that launched in 2012 have saved enough to earn bonuses, according to financial performance results released by CMS on Tuesday (Rau, "Capsules," Kaiser Health News, 9/16).
The results are from two ACO programs that began in 2012: the Medicare Shared Savings Program and the CMS Innovation Center's Pioneer ACO program (Evans, Modern Healthcare, 9/16). Since 2012, more than 100 additional organizations have become Medicare ACOs (CMS release, 9/16).
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U.S. won't reveal records on HealthCare.gov security
By : Associated Press
After promising not to withhold government information over "speculative or abstract fears," the Obama administration has concluded it will not publicly disclose federal records that could shed light on the security of the government's healthcare website because doing so could "potentially" allow hackers to break in.
The CMS denied a request by The Associated Press under the Freedom of Information Act for documents about the kinds of security software and computer systems behind the federally funded HealthCare.gov. The AP requested the records late last year amid
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PCPs and Hospitals Lobby for Purse Strings in Formation of ACOs
By : LYNNE JETER
Physicians and hospitals are gearing up for a mad dash in the healthcare reform-mandated formation of Accountable Care Organizations (ACOs), with both sides scrambling to hold the purse strings.
“Whoever controls the primary care providers—the point of entry into healthcare—is going to own the show,” said orthopedic surgeon Ed Homan, MD, from Tampa, Fla., and a state legislative leader from 2002-10. Jerry Thompson, MD, 2011 president-elect of the Memphis Medical Society and chairman of the Tennessee Medical Association’s insurance committee, refers to the new model of
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Financial concerns are a top worry for hospital CEO's today as the landscape of healthcare continues to change and evolve. This article from HealthCareFinanceNews.com details the results of a study confirming top worries.
hhttp://www.healthcarefinancenews.com/news/hospital-ceos-list-financial-concerns-top-worry-point-value-based-care-study-finds
Hospital CEOs list financial concerns as top worry, point to value-based care, study finds
American College of Healthcare Executives report says patient safety and quality, governmental mandates rank 2nd and 3rd among the leaders.
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Financial challenges once again ranked as the top concern for hospital chief executive officers in 2015, according to a new study by the American College of Healthcare Executives. Patient safety and quality, and governmental mandates came in as the 2nd and 3rd highest concerns.
Not surprisingly, CEOs cited the transition from volume to value-based reimbursement as a big concern. Medicare is already tying many payments to quality and only plans to shift more away from fee-for-service.
Issues with Medicaid reimbursement like adequacy and timeliness of payment, as well as bad debt, also worry CEOs, the study found.
ACHE found 65 percent of respondents cited volume to value as a top financial challenge, and 62 percent pointed to Medicaid as a top financial concern. More than 57 percent of respondents said bad debt was a noteworthy financial challenge, data showed.
Aside from financial issues, worker shortages ranked as the 4th biggest concern among healthcare execs, which was a big jump from 2014, when staff shortages ranked lower as the 10th most pressing concern. Patient satisfaction as the 5th biggest concern, the study showed.
"The rise in rank of personnel shortages as a top concern for hospital CEOs -- from the 10th-ranked concern last year to the fourth-ranked concern this year -- is noteworthy, indicating organizations are also concerned about recruiting and retaining the right talent," said Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE
For the survey, ACHE said they asked respondents to rank 10 challenges their hospitals face in order of how pressing each was, and then also to find specific areas of concern within each of those broader issues. The survey was sent 1,054 community hospital CEOs. 33.2 percent, or 350 responded.
When it came to patient safety and quality, 66 percent of responding CEOs said engaging physicians in improving the culture of quality and safety was an issue, and 60 percent said engaging physicians in reducing unnecessary tests and procedures was a challenge.
Finally, ICD-10 remains top of mind for healthcare CEOs when it came to governmental challenges, with 71 percent citing it as a top concern with the government-mandate category, the study said.
The American College of Healthcare Executives is an international society made up of 40,000 executives who lead hospitals, healthcare systems and other related organizations.

Report: Robust data analytics capabilities 'likely several years away'
Challenges include integrating data into workflows, interoperability and vendor maturity
Robust data analysis with be critical for health organizations as the industry moves from volume-based payment to a value-based system, but there's still a long road ahead for hospitals and health systems to get where they need to be, according to a market trends report from Chilmark Research.
The report looks at all the challenges providers face when it comes to leveraging analytics to both meet needs of a volume-based payment system and deliver true population health management.
Currently, providers are struggling under all the data, including how to aggregate and store information, as well as how to integrate data into daily workflows, the report finds.
Another reason why health organizations analytics capabilities are not keeping pace with a rapidly evolving industry, the report says, is that vendor product capabilities remain "immature."
To move to more mature analytic capabilities,the report suggests organizations focus on the following areas for improvement:
  • Robust data governance strategies. "Building an over-arching analytics governance framework can uncover potential choke points and identify opportunities to leverage data," the report says.
  • Role of chief information officer. "The new CIO role needs to operate in an [environment] where Web-based tools, open APIs and more complex data analytics capabilities are needed to succeed," the report finds.
  • Cloud technologies. While adoption of the services still lags, the report's authors say they are hopeful it will accelerate in 2016. In fact, 40 percent of providers that responded to a recent IDC Health Insights survey said their budgets are still growing, with many using the funds to expand analytics use in the cloud.
  • Relationships between industry players. So far there has been little coordination between payers, medical associations and other sources of new quality measures.Relationships between industry players. So far there has been little coordination between payers, medical associations and other sources of new quality measures.
"The development of robust data analytics capabilities … are still likely several years away," the report's authors write. "But leading institutions are beginning to meld operational and financial data with clinical to understand the costs and outcomes of care delivered within the community they serve. This will naturally drive a need for more data."
In this article from www.FierceHealthIT.com, outlines a market trends report outlines the following findings: Robust data analysis with be critical for health organizations as the industry moves from volume-based payment to a value-based system, but there's still a long road ahead for hospitals and health systems to get where they need to be. At Hexplora we can help you to have the data analytics capabilities that you need today. Visit our site for a free demo.

CIO, analyst say cloud computing in healthcare meets HIPAA
​Many fear cloud computing in healthcare. But a long-term care company disputes that stance, instead going 100% into the cloud while firmly believing it complies with HIPAA.​
Creative Solutions in Healthcare may be the only health organization at present that completely operates in the cloud.
"We are the first healthcare company, to my knowledge, that is 100% in the cloud," said Shawn Wiora, CIO at Creative Solutions, based in Fort Worth, Texas.
The company was founded in 2000 and currently owns and operates dozens of skilled nursing facilities and assisted living facilities.
Wiora explained that Creative Solutions currently has 43 different applications in the cloud, including its EHR, accounting applications and maintenance software. He said Creative Solutions' HR office system is currently being hosted with Ceridian Dayforce, and its EHR is being hosted with PointClickCare. The company has been 100% in the cloud since the beginning of 2015.
"The challenge that I'm putting out there in the industry is that I'm putting all of my [healthcare] CIO and CISO peers on notice that there's nothing in HIPAA that prevents you from going to the cloud," Wiora said. "I've been very public about the fact that if you're not in the cloud, you're doing a disservice to your patient."
Moving to the cloud, Wiora said, has allowed Creative Solutions' healthcare organizations to focus on their residents rather than focusing on and worrying about things like servers.
"The cloud kind of takes all of that patching and server and mundane activities of IT that has been going on for 30 years and just kind of automates it so we can ratchet up new applications on demand. And we can be very responsive to the business unit when they're implementing all this new technology," Wiora said.
Cloud computing in healthcare allows organizations to get back to focusing on treating patients and residents, said Judy Hanover, research director of provider IT transformation at IDC Health Insights, a research firm in Framingham, Mass. "It really allows them to focus on their core business and to really access best of breed technology," Hanover said.
This approach is becoming increasingly necessary for healthcare organizations due to the shift from fee-for-service models to value-based care. The cloud also helps providers keep up with regulatory changes, Hanover said, which happen every year and require healthcare organizations to adjust quickly.
"It's really changing the way that they operate, and so it's dictating the need for different types of technologies and different types of operations," Hanover said. "Having a cloud-based architecture allows them to access technology as a service and to really put it into use fairly quickly, more so than they would if they had to upgrade their infrastructure on site."
Mood changes on cloud computing in healthcare
IDC has found that more and more health IT leaders -- such as CIOs, CMIOs and IT directors -- are becoming increasingly comfortable with cloud computing in healthcare.
In a recent research survey of IT leaders from hospitals with 200 beds or more, Hanover said IDC found that 41% of respondents were more comfortable with the cloud now than in 2014. Hanover said this is a significant increase from the 31% who said they were more comfortable in 2014.
Furthermore, 46% of respondents said they're using cloud in production today, 10% said they are planning to implement the cloud, 15% said they are planning to use the cloud in 2016 and 10% said they are currently running pilots.
When it comes to cloud security, Hanover said, "We definitely are starting to see a better track record for the cloud, and healthcare CIOs are starting to see that."
"The growing consensus is the cloud can be more secure than an on-premise environment," she added.
HIPAA and the cloud
One common concern among many within health IT is whether the cloud meets HIPAA requirements
To those who believe cloud computing in healthcare is not and will never be HIPAA compliant, Hanover replied: "That's absolutely incorrect."
We are the first healthcare company, to my knowledge, that is 100% in the cloud. Shawn WioraCIO, Creative Solutions in Healthcare
And Wiora agreed.
"When I hear my peers talk about how you can't go to the cloud because of HIPAA, you know what that reminds me of?" Wiora said. "That reminds me of when I was in seventh grade. I remember a teacher told me a story about how in the Middle Ages, people in the villages in Europe wouldn't go into the forest at night because there were fire-breathing dragons. There are no fire breathing dragons in the forest."
​In fact, HIPAA does not refer to or require any specific type of environment, Hanover said.
Rather, "It relates to how you treat designated protected health information, it refers to doing a security audit to understand where that information is, it refers to how you encrypt that data, how you manage that data, and how it's protected," she said.
Hanover also pointed out that the additional HIPAA omnibus rule that was added in 2013 specifically provides regulations for working with service providers, which includes cloud service providers.
Therefore, Hanover said, the "notion that HIPAA doesn't include the cloud is absolutely false."​
The following article from SearchHealthIt.TechTarget.com talks about HIPAA rules as they relate to "cloud based" applications.

Health data analytics should be a priority for physicians
Though many physicians feel they have more pressing technology concerns, their practices could be enhanced by applying more health data analytics.
The number of small and midsize medical practices that adopted EHR systems surged over the last decade. For the providers that transitioned from paper charts to an EHR, the electronic platform was viewed as way to digitally capture and retrieve clinical data.
Moving to an EHR system also satisfied external requirements and pressures such as pay-for-performance reporting, e-prescribing, health information exchange and meaningful use. Early EHR adopters weren't concerned with health data analytics and neither are some of today's providers.
The power of health data analytics
It's easy to get carried away when discussing health data analytics with physicians. Many of them recognize how powerful data and some reporting tools can be when applied correctly. As many clinicians described to me, they have far more important issues to address with their EHRs. In several interviews with physicians across a collection of specialties, they mentioned the need to balance between time spent looking at screens, capturing data and patient interactions as one of their top priorities.
"Analytics tools will be more valuable when first you can show me how I can see all my patients and capture all the data I need without working late hours," an allergist I spoke with said. As reimbursement payments shrink and data requirements increase, organizations don't have enough resources to dedicate to health data analytics projects.
The overall added benefits of analytics shouldn't be ignored for much longer. Soon, more physicians will realize that healthcare analytics systems help organizations run efficiently and can also benefit patient care. While some EHR vendors provide reporting tools as part of their systems, most vendors seem to fall short in delivering adequate training for medical practices looking to incorporate data analytics into their workflows.
Health data analytics applications
The task of applying health data analytics is often left to individuals that have previous analytics experience. Employees that came from organizations where key performance indicators, scorecards and dashboards were commonly used will often be tapped by their current employer to assist in leading an analytics project.
There are some EHR systems that invested in educating their clients on the value of data mining and analytics and have synced up with reporting platforms to offer a comprehensive platform for healthcare organizations. Vendors such as NextGen Healthcare Information Systems LLC, athenaHealth Inc. and eClinicalWorks LLC provide tools and technical training for their clients, as well as educational content that helps organizations understand the potential of analytics.
Here are some objectives that vendors have pitched to clients as possible through deploying their products:
  • Learn how to successfully run a medical practice;
  • Evidence-based decisions that use current data;
  • Reduce denials for claims with daily dashboard views;
  • Manage high-risk patients via dashboards; and
  • Monitor productivity, profitability and performance of the practice.
Analytics must be more than a reporting engine for small and midsize practices. It should also not be limited to a set of basic dashboards and general reports. Medical practices have the opportunity to analyze all their data to improve how they manage patient care and run their businesses. The volume of captured data, combined with any of today's effective products should force a health data analytics initiative higher up on providers' priority lists.

Healthcare providers weigh accountable care vs. Merit-Based Incentive Payment System
Providers must be among the top performers to receive benefits, but many still struggle to meet and report quality requirements.
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Many providers are at a crossroads right now: Either join an accountable care organization or be placed into Medicare's Merit-Based Incentive Payment System. Set to begin in 2017, MIPS uses value-based modifiers to rank providers by quality and is expected to fold together with meaningful use, essentially merging the current pay-for-performance models under one umbrella.
MIPS is part of the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA, which repeals CMS' Medicare Part B Sustainable Growth Rate reimbursement formula and replaces it with a pay-for-performance model. Providers can choose to join an ACO or be part of MIPS.
"People are waiting with bated breath for MIPS rules, just like they were for meaningful use," said Tom Lee, CEO and founder of SA Ignite, which develops analytics tools to help providers keep track of complex government programs. "The biggest thing on the horizon is there are a lot of details on this that will come to light when the rules come out."
"MIPS has higher bonuses, but higher risks," Lee said."Providers don't need to choose a physician group to be a part of the program, but those providers who don't remain on top of the heap lose money."
The rules are due to be finalized by November. Although Acting CMS Administrator Andy Slavitt has hinted draft rules may come out as soon as this spring.
When choosing a program, providers must assess the risk and whether they want the guaranteed 5 percent from ACOs or choose the Merit-Based Incentive Payment System where the value-based swing between the lowest and highest reimbursement could be up to 36 percent when accounting for bonuses.
"ACOs are unproven, and most have been penalized; weigh that against costs to get the ACO up-and-running," Lee said.
The trouble is that many providers are struggling with a lack of resources, which makes it difficult to "poll through the information to meet these requirements," said Darren Barnes, director of quality and performance improvement, Southern Illinois University HealthCare.
"In today's world of quality improvement, you not only have to provide quality care, but prove you can deliver," said Barnes.
Many ambulatory providers in particular are having difficulty transitioning into a quality management system, as "hospital measures are better defined than with multi-specialty ambulatory care organizations," Barnes said. "With data requirements and support, healthcare organizations are being asked to do more with less."
Hospitals have a leg up on quality measure improvements, compared with physician practices. Where hospitals can assess workflows and certain measures on a daily basis, that's more challenging for small ambulatory facilities, posing a special challenge for participating in a physician reimbursement program.
Moreover, data is hard to pull from the EHRs, said Barnes, and providers will continue to struggle "until we can build these systems to look at patient needs and improve the ability for patients to have access to the data for more personalized care."

CMS unveils first group of Next Generation ACOs Twenty-one organizations to participate in new accountable care organization model that offers greater financial risk, reward
On Monday, CMS announced that 21 organizations initially will participate in its Next Generation Accountable Care Organization Model, which increases access to telehealth, FierceHealthcare reports (MacDonald, FierceHealthcare, 1/11).
Twenty-one organizations will become the first to join Medicare's new accountable care organization (ACO) model, the Next Generation, taking on greater financial risk but potentially reaping greater financial rewards.
Unlike other Medicare ACOs, the Next Generation model includes a prospective set benchmark, allows beneficiaries to choose to be aligned to the ACO and tests beneficiary incentives for seeking care at Next Generation providers, including increased availability of telehealth and care coordination services, according to an announcement.
Next Generation ACO participants can take up to 100 percent risk, according to the announcement. But they also have an opportunity to share more savings through better care coordination and case managements. In addition, they can also receive their budgets in advance of a performance year, to plan and manage care around these financial targets. In addition, CMS said they can select from flexible payment options, such as infrastructure payments that support ACO investments in care.
Participants include:
  • Accountable Care Coalition of Southeast Texas Inc.
  • Baroma Accountable Care, LLC
  • Beacon Health, LLC
  • Bellin Health DBA Physician Partners, Ltd. (PPL)
  • Cornerstone Health Enablement Strategic Solutions, LLC (CHESS)
  • Deaconess Care Integration
  • Henry Ford Physician Accountable Care Organization
  • Iowa Health Accountable Care
  • MemorialCare Regional ACO, LLC
  • Optum Accountable Care Organization
  • OSF Healthcare System
  • Park Nicollet Health Services
  • Pioneer Valley Accountable Care, LLC
  • Prospect ACO CA, LLC
  • Regal Medical Group, Inc.
  • River Health ACO, LLC
  • Steward Integrated Care Network, Inc.
  • ThedaCare ACO LLC
  • Triad HealthCare Network, LLC
  • Trinity Health ACO Inc.
  • WakeMed Key Community Care, LLC
In total, the Centers for Medicare & Medicaid Services will have 121 new participants in its ACO models, including the Shared Savings Program, Pioneer ACO model and the Comprehensive ESRD Care Model.

The following article is from IHealthBeat.org
Stakeholders Question Efficacy of New Cybersecurity Law, HHS Task Force
by Joe Infantino, iHealthBeat Senior Staff Writer Thursday, January 14, 2016
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A soon-to-be-convened HHS task force and its forthcoming report on cybersecurity mark a step toward strengthening privacy and security in health care, but it might have been the wrong one to take, some experts say.
"The industry already knows what needs to be done," said David Harlow, a health care attorney, consultant and author of HealthBlawg, citing data encryption and training to avoid human-error breaches as a few best practices. "We don't have to wait for a report in order for those things to happen."
Cybersecurity Measure Included Federal Spending Deal
Last month, Obama signed into law a two-part spending agreement that consists of:
  • A $1.1 trillion omnibus budget measure to fund federal agencies through fiscal year 2016; and
  • A $650 billion tax package that renews for the next 10 years various tax breaks that had ended or were about to expire.
The omnibus measure includes a cybersecurity bill (S 754) that encourages businesses to share information on hackers with the federal government.
In addition, the measure requires HHS to create a cybersecurity task force within 90 days of the law's enactment. The task force will be responsible for:
  • Analyzing challenges private health care entities face in preventing cyberattacks;
  • Examining how other industries handle cybersecurity threats;
  • Giving the HHS secretary information on how to prepare for digital threats and handle information that will be shared with industry stakeholders; and
  • Reviewing challenges covered entities and business associates face in securing medical devices connected to networks and software that connects to electronic health record systems.
In addition, the task force will be charged with creating a report that HHS will deliver to Congress within one year of the law's enactment. The report will detail:
  • The person in charge of cybersecurity prevention in the health care industry; and
  • Plans to combat cybersecurity threats for each relevant division or subdivision within HHS.
Why Wait?
One issue raised about the HHS provision is its timeline.
Waiting up to a year for recommendations on how to counteract cybersecurity threats might be too late, Harlow said.
"By the time the recommendations are surfaced and delivered to Congress and sent back to an agency, the nature of cybersecurity threats will have evolved," Harlow said. "It's a very fast moving area. So trying to deal with it in this way is almost, by definition, doomed to fail."
To address this concern, the task force could release preliminary findings for the industry to consider.
"If the task force is cognizant of the rapid pace of changing [cyber]attacks and threats, there could be some preliminary recommendations that the industry could start on before that 12 months is up," Ann Patterson, senior vice president and program director at the Medical Identity Fraud Alliance, said.
Meanwhile, the cybersecurity law includes other provisions -- not specific to HHS or health care -- that could benefit the sector sooner. Namely, the real-time cybersecurity threat alert system.
Under the provision, companies are encouraged to report cybersecurity information to federal agencies.
"There are people now that are looking at how to create and how to implement that real-time cyber threat environment," Patterson said. "I'm hopeful that with some federal oversight, the [health care industry can work] together in terms of how it can best utilize real-time threat monitoring."
But even this provision has raised some concerns.
"There's the danger of materials -- in this case personally identifiable information that either itself is health information or could be used to retrieve health information -- that have not been sufficiently de-identified being passed up the chain of command," Harlow said.
What's To Come of the HHS Report?
Another concern is about what will happen after HHS' recommendations are delivered to Congress.
The law spells out the topics to be included in the report, but "it's unclear what really happens as a result of that report," Harlow said.
That's because privacy and security regulators already know what they "need to do in terms of impressing upon the industry the need to do what the industry already knows it needs to do," Harlow said, emphasizing the potential for redundancy.
He added, "It should not be a surprise to anyone if this report comes out at the end of a year, and it says health care organizations should focus on" encrypting information with sophisticated technologies and avoiding human errors that lead to breaches -- all things that "already exist."
"There's no reason to believe something good won't come out of [the law], but history has shown these endeavors to be a lot of smoke and not a lot flame."
What the Industry Needs Now
If the industry already knows what needs to be done, why would lawmakers call for a report on the topic?
"It might represent, in a way, a statement from Congress that it is dissatisfied with what agencies have done to date" regarding health care cybersecurity, Harlow said.
Stakeholders told iHealthBeat that Congress, rather than commissioning a report, should encourage the agencies responsible for cybersecurity enforcement, such as HHS' Office for Civil Rights, to:
  • Develop informational materials that can be disseminated immediately;
  • Offer some form of incentives to implement cybersecurity standards;
  • Provide technical assistance to those who need it; and
  • Promote continuing education and cybersecurity retraining for all applicable stakeholders in the health care industry.
Harlow said, "I think the framework for providing those resources is already there. It just needs to be activated, possibly with some additional funding by Congress rather than by commissioning a yearlong report-writing process."
The following article is from IHealthBeat.org

Read Andy Slavitt's speech at J.P. Morgan Healthcare Conference; Chief touts ACOs, puts meaningful use on ice
Acting CMS administrator says several programs will change as healthcare industry wades deeper into value-based reimbursement.
Below is the full transcript of his speech, in which, in addition to putting meaningful use on death watch, he touted several new CMS initiatives like the new Next Generation accountable care model:
Thanks for the introduction. Glad to be here and speak about the major policy areas that will affect the health care sector in 2016. I am particularly glad to be here with Jim from AMA, because between us we are working on an incredible amount of change across the health care sector.
When they put a private sector guy in charge at CMS, I made clear my intention to talk regularly to the health care investor community. From my not-so-distant past, I remember how CMS often felt opaque to me, and I probably said more than once how helpful it would be to know CMS's agenda rather than divining them by poring through an often intricate set of regulations like they were Fed minutes.
I'm a believer in the maxim that it's always 90 percent about implementation, and possibly to the annoyance of my colleagues, it's a constant refrain from me. We only succeed if we bring the ideas behind the big legislation successfully to the kitchen table of the American family and the exam room of their physicians.
I'm blessed to be here now because in many ways the day-to-day work of CMS at this point in time is to start up new consumer and provider-facing capabilities and then scale them, nurture and mature them. It demands we change our culture and execute with clarity, with discipline, and with collaboration. Things we haven't always been known for.
2015 was a meaningful year for execution on a number of fronts. From committing publicly to change how we pay for care, to leading the largest data transparency initiative in health care, releasing tens of millions of lines of data and new consumer websites, to investing in the growth of Medicare Advantage, to seeing record levels of quality, safety and continued low medical trend. To implementing the ICD-10 changeover, the biggest event no one heard about. And of course expanding Medicaid into three new states, and we've now crossed 17 million newly insured since the start of the ACA and have had a strong start to our third open enrollment.
Through the year, I developed a view I will share with you of how CMS operates and a new cultural focus to execute most effectively. CMS works on three important levels.
First, setting policy and acting as a regulator to make sure the laws of Congress and the rules we set advance the interests of consumers and taxpayers. Here our most important job is to listen and learn, policy is often a blunt instrument and in the real-world it takes continual adjusting.
Second, we act as an operator, providing service to our beneficiaries, technical support to health care providers, and partnering with states and commercial health plans to deliver our programs. Our mantra here is to give people the tools they need to thrive in the face of significant change.
And third, we often operate as a market signaler, acting as a catalyst to bring together the disparate pieces of the health care to make improvement more rapidly and more efficiently such as how we pay for care.
So, 2016. Let me start with how we are advancing the agenda on how health care is delivered. To the 130 million Americans in the Medicare, Medicaid and CHIP programs, and by extension how care is paid for across all of health care, 2016 will be an enormous and pivotal year for progress and it's starting off with a bang.
We announced today the participants in the Next Generation ACO model. In Next Gen, provider groups take full financial responsibility for a patient's care and have innovative options like telemedicine, home visits, and direct consumer incentive and engagement options. It's a model driven by all the lessons learned and feedback from previous participants and results. And the news is very good.
With 21 new Next Gen ACOs, there will be over 475 total ACOs with 30,000 physicians participating around the country, including 64 that are 2-sided or full risk, up from 19 just last year and of course zero before the Affordable Care Act. My read of this news is that in 2016, we have not only more ACOs, but better ACOs. In total, 8.9 million Medicare FFS beneficiaries, or greater than 1 in 5, in 49 states and the District of Colombia, will now be a part of an ACO, with 1.6 million in better, more advanced models.
Many have wondered whether ACOs would succeed or would end up in the dustbin of health care's three-letter acronyms. As a recovering entrepreneur, I can certainly tell you that the execution in the first stage is often the hardest part. But today's news is strong evidence that ACO's will be part of ushering in the new wave of alternative payment models. They have demonstrated improvements in quality, patient experience and have been certified to reduce costs.
But it's important to remember where we are. Think of the Next Gen model like the second generation iPhone. There will still be progress and setbacks and we will continually improve.
The implementation of the bipartisan MACRA legislation is a major item squarely on our punch list that has everyone's attention. At its most basic level it is a program that brings pay for value into the mainstream through something called the Merit-based incentive program, which compels us to measure physicians on four categories: quality, cost, the use of technology, and practice improvement.
The stakes are high for this program. As any physician will tell you, physician burden and frustration levels are real. Programs designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that people who build these programs just don't get it. Over the next several months, we will be rolling out details, but for now a couple of themes.
At its core, we need to simplify. We have the opportunity to sunset three old programs and align them together in a single new program. That program needs to be streamlined and simple to use so physicians can focus where they need to – on their patients.
We are designing from the outside-in. We started by working with front-line physicians, tech companies, and practice managers over a four day session and through an RFI to garner direct feedback on the right measures for each specialty and how to implement the program most simply. Jim and the AMA team were of significant help.
We are committed to building a program that is flexible and adapts around the goals of a provider's individual practice and patient population.
I would be remiss if I didn't add that like any good start up, we will start small and leave a lot of tool building opportunities to the private sector.
Let me dive a little deeper on the technology component. Now that we effectively have technology into virtually every place care is provided, we are now in the process of ending Meaningful Use and moving to a new regime culminating with the MACRA implementation.
The Meaningful Use program as it has existed, will now be effectively over and replaced with something better. Since late last year we have been working side by side with physician organizations across many communities -- including with great advocacy from the AMA -- and have listened to the needs and concerns of many. We will be putting out the details on this next stage over the next few months, but I will give you a themes guiding our implementation.
For one, the focus will move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients.
Second, providers will be able to customize their goals so tech companies can build around the individual practice needs, not the needs of the government. Technology must be user-centered and support physicians, not distract them.
Third, one way to aid this is by leveling the technology playing field for start-ups and new entrants. We are requiring open APIs in order to the physician desktop can be opened up and move away from the lock that early EHR decisions placed on physician organizations so that allow apps, analytic tools, and connected technologies to get data in and out of an EHR securely.
And finally, we are deadly serious about interoperability. We will begin initiatives in collaboration with physicians and consumers toward pointing technology to fill critical use cases like closing referral loops and engaging a patient in their care. And technology companies that look for ways to practice "data blocking" in opposition to new regulations will find that it won't be tolerated.
Medicaid is another significant item on our punch list this year. Over the last two plus years, over 13.5 million people have gained the security of Medicaid or CHIP coverage. But even as we are focused on helping interested states expand coverage, we are equally focused on rapidly modernizing Medicaid coverage so that it works as well or better than any insurance program.
This last year, we have released proposed or final rules to modernize how Medicaid managed care works, how states and CMS ensure access to care, and are working state by state on their plans to improve incentives for value-based care with delivery systems. Our priority this year is to attract new innovative companies to invest in the Medicaid IT space. From where I sit, investing in the future of Medicaid is one of the single best opportunities in the health care sector.
First, it's big: Last month CMS permanently extended the 90 percent federal match for investments in Medicaid systems. Overall, CMS' annual investment in state Medicaid IT is more than $5 billion. With over 30 states currently redesigning their Medicaid IT systems, 2016 will the most active year to date for Medicaid IT opportunities.
Second, the opportunity for innovation and differentiation is large and we are making it easier than ever: state investment is geared specifically towards technologies that are modular, reusable, and cloud-based. This opens up opportunities for innovative new entrants to disrupt this market. To assist potential new entrants in entering this solution space, today we are launching a one-stop-shop with a set of resources that will help private sector companies identify opportunities to participate in this important market. I will tweet this URL and a link to a blog with more details after this talk.
The final significant item on the punch list is the health and long term stability of the Health Insurance Marketplaces. Stepping back, the Marketplace is still in the early stages. Consumers are still getting educated and health plans are experimenting with the right product and network designs. Even as the market meets today's needs and signs millions of new consumers up in record numbers, we also pay attention to adjustments that are needed as the Marketplace matures. And today I want to talk about steps we are taking to move from a startup stage to a more mature stage.
We have an experienced team of leaders and actuaries from the private sector and many who come directly from our Medicare Advantage and Part D operations where we have set up and operate very successful large marketplaces already. We study the data and meet regularly with all market participants and take a strategic view to determine what adjustments are warranted. Our focus is simple – Marketplaces must be attractive to health plans to reach and build relationships with desirable consumers; the offerings need to be attractive to consumers so they come and shop; and we need a predictable set of underwriting and other rules that compensate fairly for risk and keep the risk pool stable and balanced.
On the first point, we are seeing the characteristics of an attractive customer base for health plans to serve: A growing market; a younger population; and with high levels of engagement and responsiveness to new offerings. This Open Enrollment period, we've seen a significant influx of new consumers making it clear there is still a large untapped market to serve.
And the tax penalty is bringing more young and healthy consumers into the market. We are using a large portion of our marketing resources to make sure that consumers are aware of the increasing fee for people that go without insurance.
41% of all new consumers this Open Enrollment are under 35, compared to 38% a year ago. And if past patterns continue to hold, the percentage of young people will climb throughout the rest of Open Enrollment.
There are also high levels of consumer engagement– as over 60% of Marketplace consumers have made active decisions about their health insurance choices.
And even at this early stage we are beginning to see health care look and feel like many other retail markets where consumer preferences are creating meaningful consumer improvements. 90% of consumers have an average of three insurance companies to choose from translating into 50 plan options. Consumers can now pick a plan based upon the insurance their doctor accepts or the drug they are looking for. And the vast majority are getting direct services like primary care and generic drugs outside their deductible.
The presence of federal subsidies has exploded the universe of consumers in the individual market. A truly retail market with these type of organic innovations should bring in even more consumers, including higher income individuals who will be attracted to better experiences and better services.
Finally, moving into the third year and beyond, we are focused on continually maintaining and improving a set of marketplace rules that create a healthy, stable and balanced risk pool. These changes will lead directly to a stable rate environment and more affordability for consumers. I want to lay out some of the specific steps we are taking over the next 45 days.
First, we think it is critical to enforce the integrity of the Open Enrollment period. In the first two years of the Marketplace, a number of Special Enrollment Periods or SEPs were created as consumers were learning how to enroll in coverage for the first time. SEPs play an important role for consumers but we are making changes so that as the Marketplace matures, SEPs serve the purpose they are intended.
Last month, we announced the elimination of the tax season special enrollment period; and this week, we will be announcing that we will be eliminating certain other select SEPs and making the language on others clearer to prevent bad actors from signing people up for insurance inappropriately. We have established an enforcement unit and have already terminated coverage for individuals who were improperly enrolled by certain brokers.
But lifting up, most importantly, consumers need to know that Open Enrollment– the next 20 days– is the time to get covered for potential illness and avoid the tax penalty.
Next, we are committed to making sure that risk adjustment works as it is intended to allow coverage of individuals with pre-existing conditions. This year we will be taking a number of steps. First, in response to health plan feedback, we will be providing early estimates of health plan specific risk adjustment calculations. Along with the newly launched backend automation, this will give plans more timely information in order to facilitate informed rate setting.
Second, on March 25, we are hosting a public conference to bring together all market participants to review the risk adjustment methodology so we can build in changes based on the first several years of experience. We have the tools to make certain the proper incentives exist to insure sicker populations.
And outside of risk adjustment, in the next 45 days you will see other announcements and more specificity intended to address the risk pool.
Overall, we're taking steps to move from a start-up period to a more normalized set of operating rules. The start-up stage of anything has unique challenges. The Administration and Congress recognized the challenges that were placed on health plans with building a stable marketplace over the first few years and passed a one-year moratorium on the Health Insurance Tax to assist with that transition.
Just as the reinsurance program, which has paid out $7.9 billion, at a 25% higher level than expected, has been a stabilizing force to date; the one-year tax holiday, of $13.9 billion will help stabilize premiums next year.
The actions we are focused on, while targeting health plans, are aimed at directly benefitting consumers as they enhance predictability and affordability. That is a critical goal as we move to the next stage of Marketplace evolution.
Let me recap the themes in our 2016 agenda.
We maintain our cultural focus on listening and learning that we really launched in earnest this year. We have a number of start-up activities as well as areas where we must move to a more mature stage, which makes that focus even more important.
And we must execute in our role as a market catalyst and signaler– signaling that care delivery payments are changing, and reward people who provide the best care and we are pushing to a tipping point by 2018. Signaling that Medicaid, with the benefit of new innovation, will be a priority area of growth and innovation; and signaling that we have the focus, the tools and the experience to continue to make sure the Marketplace remains healthy.
On a personal note, it is a great honor and very energizing to serve as a leader in CMS at a time when there is such a significant amount to execute on. Taking this assignment on for me after my time in the private sector has been invigorating and inspiring so far, even when all the missiles appear to be pointed directly at us.
Quite simply, it's because of the consumer -- 130 million of them – many on fixed and low incomes who I wake up thinking about every day. When I took this job I decided to keep my email address public and I know now many of them wake up thinking about me.
I quickly realized how many people are just hoping for basic things, to have their family well taken care of when they're sick, to have them home and to lead as productive and healthy life as possible. Whether living with a disability, trying to afford a prescription, or hoping to keep coverage as they look for a better job. Millions more of you are counting on us making smart decisions now so that these programs work for you when you need them. And it's because of the people we serve that our punch list needs to be bold, clear and ultimately successful.
We are committed to continuing to working side-by-side with you to make this happen.

Fueled by health law, 'Concierge Medicine' reaches new markets
Primary Care doctors are bringing a service generally considered 'healthcare for billionaires' to other populations.
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A growing number of primary care doctors, spurred by the federal health law and frustrations with insurance requirements, are bringing a service that generally has been considered "health care for billionaires" to middle-income, Medicaid and Medicare populations.
It's called direct primary care, modeled after "concierge" practices that have gained prominence in the past two decades. Those feature doctors generally bypassing insurance companies to provide personalized health care while charging a flat fee on a monthly or yearly basis. Patients can shell out anywhere from thousands to tens of thousands of dollars annually, getting care with an air of exclusivity.
In direct primary care, patients pay about $100 a month or less directly to the physician for comprehensive primary care, including basic medication, lab tests and follow-up visits in person, over email and by phone. The idea is that doctors, who no longer have to wade through heaps of insurance paperwork, can focus on treating patients. They spend less on overhead, driving costs down. In turn, physicians say they can give care that's more personal and convenient than in traditional practices
The 2010 health law, which requires that most people have insurance, identifies direct primary care as an acceptable option. Because it doesn't cover specialists or emergencies, consumers need a high-deductible health plan as well. Still, the combined cost of the monthly fee and that plan is often still cheaper than traditional insurance.
The health law's language was "sort of [an] 'open-for-business' sign," said Jay Keese, a lobbyist who heads the Direct Primary Care Coalition. Before 2010, between six and 20 direct primary care practices existed across the country. Now, there are more than 400 group practices.
The total number of physicians participating doctors may exceed 1,300. The American Academy of Family Physicians estimates 2 percent of its 68,000 members offer direct care.
"This is a movement -- I would say it's in its early phase," said AAFP President Wanda Filer, a doctor in Pennsylvania. "But when I go out to chapter meetings, I hear a lot more interest."
But questions persist about feasibility. The lower fees could still be a non-starter for people earning minimum wage or on a limited budget, said Robert Berenson, a senior fellow at the Urban Institute. "Can people afford this? Or is it [still] just for well-off people?"
The American College of Physicians advises doctors to consider whether direct primary care can work within their practices, but also urges physicians to recognize how it could affect poorer patients and look for ways to keep care affordable.
Direct primary care doctors say they see patients across incomes. Dr. Stanford Owen, of Gulfport, Mississippi, treats "waitresses and shrimpers, as well as doctors and lawyers." He charges $225 for initial visits, $125 for a follow-up, if needed, and then about $50 per month after.
Owen and other physicians report positive experiences, triggering other efforts to apply direct care more broadly. Although most of these doctors eschew dealing with insurance, some have been trying the model with Medicaid and Medicare patients.
If those experiments work -- and save money and improve health -- they could mitigate concerns about who can afford direct primary care. Berenson pointed out that partnering with insurance or public programs is key to making direct care affordable for lower-income people.
"The idea of setting up stronger primary care services for patients is very exciting and very much needed," said Ann Hwang, director of the Center for Consumer Engagement in Health Innovation, an outpost of the consumer advocacy group Community Catalyst. But, she added, "This is so new that I think the jury is still really out on whether this will be successful."
In Seattle, a company called Qliance, which operates a network of primary care doctors, has been testing how to blend direct primary care with the state's Medicaid program. They started taking Medicaid patients in 2014. So far, about 15,000 have signed up. They get a Qliance doctor and the unlimited visits and virtual access that are hallmarks of the model.
"Medicaid patients are made to feel like they're a burden on the system," said Dr. Erika Bliss, Qliance's CEO. "For them, it was a breath of fresh air to be able to get such personalized care -- to be able to talk to doctors over phone and email."
Qliance has a contract with Centene, an insurance company in the state's Medicaid program. That Medicaid coverage pays for the monthly fee, which covers primary and preventive care, and for other specialty and emergency services. If patients need a specialist, they'll get referred to one who accepts Medicaid. Advocates in other states -- such as North Carolina, Idaho and Texas -- are watching the outcomes and costs while considering rolling out similar programs.
There's little data so far. Bliss estimated participants will cost Washington state between 15 and 20 percent less than traditional Medicaid. Before launching the Medicaid pilot, Qliance contracted with some companies that provide insurance to their employees -- in those cases, employees who opted for Qliance cost about 20 percent less than employees in traditional health insurance. Because patients get better care upfront, the theory goes, they're less likely to develop expensive chronic illnesses.
Still, expanding this approach is tricky. The number of participating physicians is low. There's already a nationwide shortage of primary care doctors. In this model, physicians see fewer patients, potentially exacerbating that shortage's impact. Also, Medicaid negotiates the monthly payment rate, which could be less than what doctors might set independently.
In New Jersey, a pilot program using direct primary care is launching in 2016 for state employees, like firefighters and teachers. It's a hybrid: When consumers pick a primary doctor, they can choose a direct primary care-style practice, which gives around-the-clock access to preventive and primary care services. The monthly fee is undetermined.
Participants will get benefits such as same-day appointments for non-emergency visits. But when they pick this plan -- which will be administered by Aetna and Horizon -- they will have access to specialists that participate in the insurers' plan networks.
In New Jersey, about 800,000 people will be eligible to enroll in the direct primary care program. The state's hoping to attract and accommodate at least 10,000 in the first year.
That's appealing, said Mark Blum, executive director of America's Agenda, an advocacy group that helped develop the project. He cited interest in California, Texas, Pennsylvania and Nebraska. "There are a lot of eyes on New Jersey right now."
Meanwhile, direct primary care is finding traction with Medicare Advantage, the private health plan alternatives to traditional Medicare. Iora Health, a direct primary care system that contracts with unions and employers, a year ago launched clinics in Washington and Arizona catering to Medicare Advantage patients.
Iora's setting up similar clinics in Colorado and Massachusetts.
Despite its potential, the direct care model faces the challenges of integration into existing payment systems and attracting more participating doctors. And navigating Medicare and Medicaid rules can deter physicians.
"It's not for the faint of heart," said Dr. Rushika Fernandopulle, Iora's CEO.
How it evolves from here will vary across the country, said Filer, the AAFP president.
"There are some parts of the country where it is working very well," she said. "But there are other reasons a physician might decide, 'This is not for my patient base.'"

CMS wants to boost CQM reporting in EHR certification
This article defines the comment period on requiring EHR vendors to annually recertify CQM reporting modules and increase the number of CQM Measures:
Kate Goodrich, M.D., director of the CMS Center for Clinical Standards and Quality, wrote in a blog post accompanying the RFI. "We aim to streamline/reduce provider, hospital and health IT developer burden." That certainly sounds good, but as we know the process will continue to change. At Hexplora we are positioned to stay abreast of these changes and help you to adapt.
CMS is giving health IT organizations until Feb. 1 to comment on requiring EHR vendors to annually recertify CQM reporting modules and increase the number of CQM measures.
CMS ended 2015 with a little-noticed request for comment on a proposal to require EHR vendors for the first time to annually recertify clinical quality measures reporting modules, and to boost the number of CQMs to as many as 25.
Interested parties have until Feb. 1 to comment on a series of options to improve CQM reporting. CMS outlined its recommendations in a request for information (RFI) the agency issued Dec. 30.
Clinical quality measures, required under meaningful use, are standards for assessing observations, treatment, processes, patient experience and outcomes of medical care, according to the Office for the National Coordinator for Health IT (ONC), which certifies EHRs for meaningful use incentive eligibility.
"The RFI provides CMS and ONC with an opportunity to assess policy options that could improve the effectiveness of the certification of health IT, and, specifically, the certification and testing of EHR products used for the reporting of quality measures," Kate Goodrich, M.D., director of the CMS Center for Clinical Standards and Quality, wrote in a blog post accompanying the RFI. "We aim to streamline/reduce provider, hospital and health IT developer burden."
CMS officials will use feedback from the RFI in forthcoming proposed rulemaking for CQM reporting and certification.
CQM measures part of value-based reimbursement
The RFI language ties changes in CQM reporting and EHR recertification by ONC to the stage 3 meaningful use rule and criteria that physicians, hospital systems and critical access hospitals must meet to receive incentive payments and to avoid lower Medicare reimbursement payments.
Up to now, meaningful use has generally required that providers -- depending on specialty and whether they work in inpatient or outpatient settings -- track and report on nine quality measures in areas such as pediatric care, patient safety, cardiac surgery and readmission rates for cardiac patients.
That list could increase to 15 for physician practices and 25 for hospitals, according to the RFI.
AMIA is 'guardedly optimistic'
Jeff Smith, vice president for public policy for the American Medical Informatics Association (AMIA), told SearchHealthIT that CMS' CQM reporting initiative is clearly part of the overarching strategy of its parent agency, the Department of Health and Human Services, to move federal healthcare reimbursement to value-based payments.
That approach is embodied in MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which established a framework for moving from fee-for-service to value reimbursement, Smith noted.
We've got to get to the point where everyone is comfortable with how quality measures are reported. Jeff Smith vice president for public policy, AMIA
CQM reporting measures are important in determining value and outcomes. But CQM measures have until now been in disarray because of the lack of agreement among providers, regulators and vendors over care quality measure standards. In turn, that makes it difficult for vendors to incorporate standardized CQM reporting technologies into their EHR systems, Smith said.
Smith said his initial reaction to the RFI -- which he said he expects to be among the first of a salvo of CMS moves in other health IT areas to come this year -- was "guardedly optimistic."
"These are the kind of questions the federal government should have been asking for over the last couple of years," Smith said. "We've got to get to the point where everyone is comfortable with how quality measures are reported."
CHIME says EHR certification focus narrow
While AMIA's view of the CMS move on CQM reporting was somewhat positive, Leslie Krigstein, vice president of congressional affairs for the College of Healthcare Information Management Executives, or CHIME, said healthcare CIOs have reservations.
"We are pleased CMS and ONC have recognized the need to evaluate the capabilities of certified electronic health records to generate electronic clinical quality measures," Krigstein said in an emailed statement. "However, the conversation on electronic clinical quality measurement shouldn't focus solely on the performance and expectations of certified EHRs."
CIOs think quality measurement problems, such as duplicative reporting and capturing outcomes, and the need for better quality measurement guidelines for population health are still being addressed in Congress, Krigstein said.
In the meantime, Krigstein and Smith said their groups are working on submitting commentary by the start of February.
The following article is from SearchHealthIT.com

ICD-10 dominated 2015 healthcare news, but 2016 could see issues, experts say It seems two-years of preparations paid off, but insiders say it may be too early to celebrate.
ICD-10 came, the public saw, and healthcare providers conquered.
When looking back at the the biggest news in healthcare in 2015, an informal survey of Healthcare Finance readers found no other contender even came close to defeating ICD-10 for the reign of top issue of the year.
ICD-10 had already been put off at least twice, but on October 1, 2015, providers flipped to the new coding vocabulary, tossing the 16,000 codes of the previous ICD-9 in favor of the now 70,000 options for documenting a care episode.
Many thought the change spelled disaster, with coding glitches tying up reimbursements and healthcare organizations losing millions in tied-up claims.
But it didn't happen. Denials held pace with pre-ICD-10 numbers, and for the most part the switch hasn't hurt the bottom line at hospitals, physician offices and other healthcare businesses.
It seems two years of preparations paid off, but insiders say it may be too early to celebrate.
"We haven't seen an increase in denials," said Diane Story, director of revenue cycle improvement at Roper St. Francis Healthcare in Charleston, South Carolina. "We are anticipating next year, once we have a few months under our belt, to measure any changes in our yield. It's too soon right now."
Healthcare policy expert Paul Keckley, from Navigant Consulting, said the perception that ICD-10 got off without issue might actually be keeping provides from preparing for the lingering negative effect. In fact, he believes the government will initiate a "re-load" of reimbursement policies, though it won't be calling what it's doing a retreat.
"They'll have to delay without admitting it's a delay," Keckley said. "There's going to be some period of forgiveness for coding error."
Before the roll-out, the Centers for Medicare and Medicaid Services said it would give a year's grace period in the reimbursement of claims as long as they were submitted in the correct family of codes.
Some commercial insurers followed suit in initiating similar policies.
Keckley said providers will need additional relief to keep the issues at bay.
"I think there's a reluctance to admit that even with a year's delay, people weren't ready," Keckley said. "The politics of this, plus meaningful use on the provider side, it's politically a nightmare for the policy folks. I think we're going to see a reload."
There's just way more scrutiny by insurers and government payers of the appropriateness of the new codes, Keckley said.
"I think it's much more complicated than people imagined," he said.
While Keckley looks at the big picture, Story is keeping watch on ICD-10's targeted effect on finances at Roper Saint Francis, which is part of the Carolinas HealthCare System.
Under ICD-10, some service lines will not be as profitable as others, she said. For example, the expected yield for cardiology may be less than medicine, or orthopedics for example she said.
"It's just how the new codes are grouped," Story said. "Financially we are reducing our payments lower because of ICD-10. It could be because of a DRG (diagnostic related group) shift or lower payments because the documentation wasn't specific."
Eventually, she said, they will know whether the issue stems from not capturing the correct code or the nature of ICD-10.
Story is looking at DRGs this year and how they compare to last year. She is comparing in the codes the CCs - the complication or comorbidity -- and the MCCs -- the major complication or comorbidity -- that can drag reimbursements lower.
Also, a vendor the system uses is taking current claims data and "scrubbing" them back to ICD- 9 to compare payment.
"I'm always going to be very cautious," Story said. "I want to see everything proved in numbers before I believe it. I have someone who is analyzing our denials. I think we need at least six months to decide what our final results are going to be."
Another interesting side effect of the ICD-10 rollout was the amount of attention it received in the media, perhaps an effect of the broader consumer interest in healthcare as the financial burden falls more to patients. Of course, much of the media focus pointed to the "weird" codes now part of the ICD-10 vocabulary, which include entries for things such as "struck by an orca" and "problems with in-laws."
Though the buzz has died off, Keckley said ICD-10 will still be a major story for the the CFOs, revenue cycle directors and other administrators who must pay attention.
"It's going to be a big story because it's capital intense, but it's an inside baseball story," Keckley said. "Unless an institution or plan fails to implement completely will it rise to a level of concern at the board level."

2016 the year of consumerism in healthcare as providers rush to adapt
Patients want fast, convenient service in the form of online payments, retail clinics and an improved patient experience.
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Patients are now consumers, and it's changing everything about how healthcare works.
On the surface, it makes sense. Patients should take more control over their choice of care if they are paying for more of it. But as healthcare leaders surveyed by Healthcare Finance say consumerism will be the largest driver of change in 2016, many point to challenges that come with the transition.
For starters, healthcare has changed from being about what's convenient to the provider to what's convenient for the consumer, said a panel of experts speaking about the "Age of Consumerism" during the Revenue Cycle Solutions Summit in Atlanta in December.
"Where we've moved over the past five years, is self-service," said Mark Ehalt, senior director of revenue cycle operations for the University of Pittsburgh Medical Center.
Patients want fast, convenient service in the form of online payments, retail clinics and an improved patient experience. The onus, then, is for health systems to make sure they have those pieces in place.
Hospitals are already facing competition from major pharmacy chains such as CVS and big-box retailers that are building networks of walk-in clinics to make it easier for patients to get convenient care. In response, many hospitals are launching their own clinics, some in partnership with retail chains such as Walgreens, to stay on top of the consumerism trend.
Bills and collections
Perhaps the biggest challenge that comes with consumerism is the pressure it puts on healthcare systems to collect from the patient.
"No question the trend is for larger employers to move to high-deductible or consumer health plans," said Andrew Ziskind, MD, managing director of Huron Healthcare. "That is impacting decision-making and driving consumers to higher quality, lower cost providers."
Lower or not, there is still a cost, and health systems are putting a lot of effort into streaming the billing and collections process so that consumers not only pay what they owe, but more importantly, have good experiences through the process.
Andrew Ray, director of physician revenue cycle operations for Stanford Children's Hospital, said that hospital implemented a single patient statement that has won consumer satisfaction. That's something experts see accelerating in 2016 as consumers lose patience for the confusing multiple bills they receive from providers.
"What we're learning is people don't want to pay the bill until they know what they owe," said Mayo Clinic Revenue Cycle Director Mark Norby.
But even after consumers know what they owe, getting them to pay can be a process.
Chris Kiser, vice president of Patient Financial Services for the Carolinas HealthCare Systems, said the paradigm shift has gone from not asking everybody for money, to asking everyone, to now being more strategically focused.
"We were hounding everybody, treating everybody the same," he said. "If you're paying your bills, we don't need to be hounding you."
Point-of-service collections have more than doubled over the past four years, but providers will need to do better, according to The Advisory Board Company's recent Revenue Cycle Survey.
"This move to collecting payment at or before the point-of-service reflects the industry's experience that as more time passes after care is delivered, a patient's propensity to pay decreases substantially," said Christopher Kerns, managing director of research and insights at The Advisory Board.
Point-of-service collections have increased to a median of 0.57 percent of net patient revenue – and high performers are collecting 1.1 percent of net patient revenue, the report found. They will need to collect 5 percent of net patient revenues at the point of service to remain financially healthy as patient obligation expands, according to The Advisory Board.
That's where analytics comes in, which gives healthcare providers the ability to determine what people can pay, set routines for effective follow-up and create analysis benchmarks on the performance of collections programs.
Jerry Bruno of Deloitte Consulting said providers know very little about patients' financial profiles. He expects that by the end of the decade, 20 percent of payments will come from the consumer. Analyzing the data on consumers is key to managing that.
"We need to create a financial care plan based on where they fall," Bruno said. "If you have means of pay, your account would flow through one revenue cycle process. If you have a bronze plan and high out-of-pocket, and have a $10,000 bill you can't afford, with a profile we should be able to see that. It should result in a higher ROI."
The experience
Hospitals are measured on patient experience, and with insurers planning to tie even more payments to quality in the coming years, the importance of engagement will only heighten in 2016.
Corey Meyer, director of patient access and virtual health at Lancaster General Hospital, said the hospital's goal is to offer a flawless experience around the financial side of care.
"Really our vision is to have a flow where a patient gets a text message from their physician, it's going to say, 'you need a lab test, schedule it,'" he said. "At that point they'll know how much it is, based on their insurance, be able to potentially pre-pay, give a discount for a lab site that is under-utilized, and if they need to check in, do so on the phone."
Studies have shown that a positive financial experience is important to patient satisfaction, with 82 percent of patients recommending a hospital if their experience with the billing was good.
Meyer said Lancaster has already changed its online and paper billing statements, creating one that has the same look and feel for both. Overall, Lancaster has already seen overall growth in net collections of $1.6 million and an increase of $1.7 million for self-service pay, he said.
It's those kinds of results that will keep healthcare busy in 2016 as more of these new consumers react to facilities that focus on more than clinical services and put financial treatment almost on the same plane as care.
"They want us to take care of them when we're not taking care of them as a clinician," said Norby.

Population health, revenue cycle management on CIO's agenda
The following article from SearchHealthIT.com Marc Probst, CIO at Intermountain Healthcare, said his organization is taking strides to make population health happen, is investing heavily in data analytics, and more.
If better understanding and utilization of data analytics and population health management are priorities for your organization in 2016, Hexplora can help. Contact us today for a free demonstration and personalized information session.
ORLANDO, Fla. -- At Intermountain Healthcare in Salt Lake City, Utah, CIO Marc Probst said employees are working on furthering a number of initiatives in health IT including population health, data analytics and revenue cycle management. Probst explained further in this Q&A.
In terms of population health what do you think is going to come next? What tools are Intermountain using to make population health happen and move forward?
Marc Probst: In the area of population health we're really thinking of patient engagement and how do we move from just providing care to helping people with their health. You know it isn't just a nuanced difference, it's big. We [used to] credit ourselves with success by how full the hospitals were [and] how full the clinics were. Now we're looking at, how do we keep them out and how do we keep them healthier? That's completely different technology. And everything we've built was for people when they come in and [for giving] the very best care once they're there.
We're focused very much on portals [and] things that extend out to the consumer, to the patient. Things like portals, mobile platforms, everybody's got [them] on their phones now and none of this is new, a lot of people are talking about it. [We're also working with] extended care through wearables and through other monitoring devices, home monitoring. That whole infrastructure is new for us. It also creates a whole new series of data that we've not had to deal with before. Frankly, today we're not dealing with it well. Because, again, we need to get it into a standard that can then make it useable so that we can do the right analytics and help people stay healthier. We're also not really good at [asking], 'Why would you want to go to our portal? Why would you want to use my mobile technology to be healthier?' I don't think as an industry we're very good at that yet. But we're making strides and at Intermountain we're investing big time around mobile and we're doing a lot around wellness and trying to do more around patient engagement.
Is Intermountain investing in data analytics?
We're focused very much on things that extend out to the consumer. Marc Probst CIO, Intermountain Healthcare
Probst: Massive amounts. We've been involved with data analytics for at least 20 years. We've had an electronic data warehouse because of our focus on standardized data, normalized data. Our successes come through analytics across the organization. We are an analytics driven organization and I think it's been really good for us. That's why our quality is where it is, our costs are as low as they are. So yeah big-time invested in that. As we look at the new world, all these other pieces of big data [are] coming at us, we are invested in Hadoop, we're building a data lake so that we can do better analytics of that data [and be] a little more predictive in our analytics. We will continue to invest there, a lot.
In terms of revenue cycle management, what are you guys doing in that area?
Probst: Our current revenue cycle product is self-developed. We've had it for 30 years probably. It has aged well with us, we've been able to grow it. But because we've made the decision to go off our self-developed medical record and purchase [Cerner's EHR] we also decided to purchase Cerner's revenue cycle product. As we implement Cerner we will be moving to that Cerner revenue cycle.
What's the timeline for that?
Probst: It's begun. We took our first two hospitals up in February. A week from Friday we're going up with two more large hospitals and we'll be rolling it out probably over the next 12 to 18 months.

CMS Data Show 44% of EHR Incentive Payments Made in Eight States
The following article from IHealthBeat.org outlines the CMS Data showing that 44% of EHR Incentive Payments were made in Eight States:
Nearly half of the meaningful use incentive payments made as of September went to eligible professionals and hospitals in eight states, according to an analysis of CMS data, Health IT Interoperability reports.
CMS Data Details
The data show that CMS as of September had paid out a total of about $31 billion to eligible professionals and hospitals participating in the meaningful use program, of which more than 44% was paid to eight states:
  • California
  • Florida
  • Illinois
  • Michigan
  • New York
  • Ohio
  • Pennsylvania
  • Texas
Eligible professionals and hospitals in California and Texas, two of the most populous states, received more than $2 billion in payments as of September. Meanwhile, providers in the remaining six states, each received more than $1 billion.
Among the eight highest-paid states, the data show Illinois, Michigan and Pennsylvania had the highest percentage of office-based physicians who had demonstrated meaningful use under the Medicare program.
Meanwhile, Florida had the highest percentage of hospitals that had demonstrated meaningful use under the Medicare program, with 96% of eligible hospitals demonstrating meaningful use, followed by Michigan, where 95% had done so (Irving, Health IT Interoperability, 12/1).

Healthcare top sector for data breaches in first half 2015, Gemalto says
Healthcare saw 187 data breaches, making up 21 percent of the total number of breaches across all sectors.
The following article from HealthcareFinanceNews.com documents the prevalence of data breaches within the healthcare industry. The experts at Hexplora can help your organization to manage this risk. Contact us today to learn more..
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Healthcare has outstripped retail as the most breached business sector, according to a new report by digital security giant Gemalto, equalled only by government as the most targeted by hackers.
In its 2015 First Half Review, Gemalto said healthcare saw 187 data breaches in just the first half of the year, making up 21 percent of the total number of breaches across all sectors.
Insurance giant Anthem led the pack with its massive cyber attack at the start of February in which nearly 80 million Anthem members had their personal data stolen.
Across all sectors, Gemalto counted 888 data breaches in the first half of 2015, compromising 245.9 million records worldwide.
As for the number of data records lost, healthcare took the lead with 84.4 million records lost – 34 percent of the total.
This represents a dramatic shift from the past few years when both healthcare and government had relatively small numbers of records involved in data breaches, according to Gemalto. For example, in the second half of 2014, healthcare accounted for only 5.2 percent of stolen records and government accounted for only 2.8 percent.
The leading type of data breach in the first half of 2015 was identity theft, accounting for 472 data breaches. That represented more than half of first half of 2015 attacks and nearly three-quarters of compromised data records. Five of the top 10 breaches in the first half of 2015, including the top three, were identity theft breaches.
"It's apparent that a new approach to data security is needed if organizations are to stay ahead of the attackers and more effectively protect against data breaches in the future," Gemalto researchers said in the report. "In today's environment, the core of any security strategy needs to shift from breach prevention to breach acceptance. And, when one approaches security from a breach-acceptance viewpoint, the world becomes a relatively simple place where securing data, not the perimeter, is the top priority."
Network perimeter security technologies offered an added layer of protection, the report said, but cautioned against relying on them as the foundation for information security strategies.
"Unfortunately, there is really no foolproof way to prevent a breach from occurring," the report said. "Alarmingly, market trends show that the lion's share of organizations have no plans to change this approach."
Gemalto cites research firm International Data Corp., which recently reported that of the $32.6 billion enterprises spent on security technology in 2014, 62 percent, or $20.2 billion, was invested in network and perimeter security.
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CMS lays out strategy, vows to continue to push towards value
The following article from HealthCareFinanaceNews.com outlines strategy efforts as CMS vows to continue the push towards value
Update noted progress in payment reform initiatives, namely in requirements in the Medicare Access and CHIP Reauthorization Act.
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The Centers for Medicare and Medicaid Services has released its first comprehensive strategy update in the past two years, touting progress made in its shift to value-based reimbursement and solidifying its goals to continue to push towards quality.
The 2016 Quality Strategy Update noted progress in legislation and payment reform initiatives, namely new requirements stemming from the Medicare Access and CHIP Reauthorization Act of 2015.
"The implementation of MACRA is a major opportunity to put a broad range of health care providers on the path to value through the new Merit-Based Incentive Payment System and incentive payments for participation in certain Alternative Payment Models," said Patrick Conway, acting deputy administrator and chief medical officer at CMS.
The Update aligns with the National Quality Strategy in two major highlighted areas. One, CMS lays out a three-pronged mission for itself including: improving overall quality of care by centering care on the patient, and making it more reliable, accessible and safe; addressing behavioral, social and environmental influences on health and supporting proven solutions to provide better care; and reducing healthcare costs across the board from individuals to businesses to communities and the government.
CMS also laid out six specific goals they hope will drive that mission: Reduce harm caused while delivering care, strengthen personal and family engagement together in care, effective communication and coordination of care, treatment and prevention of chronic disease, promote healthy living in communities and make care affordable.
They said by the end of next year, 85 percent of all traditional Medicare payments to quality or value and 30 percent of traditional Medicare payments should be tied to alternative payment models.

Better outcomes, lower costs, with value-based models, Humana says Costs 18 percent lower in value-based reimbursement models than those in fee-for-service, report states.
The following article from Healthcarefinancenews.com Humana reports that its 2014 population health shows that costs are 18% lower in their value based reimbursement models. Hexplora can help your organization to analyze and manage population health data to ensure better outcomes and lower costs. Contact us for a free demo today..
​Humana Inc., a Medicare Advantage health plan provider, released its 2014 population health results Wednesday that it says shows its value-based reimbursement models are associated with better outcomes and lower costs.
For the 2014 results, Humana compared quality and outcomes for approximately 1 million Medicare Advantage members who were treated by providers in value-based reimbursement models with Humana versus members who were treated by providers in standard Medicare Advantage settings.
Members of Humana's Medicaid Advantage program served by providers in value-based reimbursement models had more screenings and healthier outcomes than their counterparts, according to the Louisville, Kentucky health insurer.
The findings include: costs 18 percent lower in value-based reimbursement models versus fee-for-service Medicare; 7 percent fewer inpatient admissions for Humana Medicare Advantage members; 6 percent fewer emergency room visits; better chronic condition management for diabetes care eye exams, blood sugar control and osteoporosis management for members in value-based reimbursement models; and higher assessment rates for older adults.
Also, Humana providers in value-based reimbursement had 21 percent higher Healthcare Effectiveness Data and Information Set Center for Medicare and Medicaid Services Star scores as compared to providers in standard Medicare Advantage settings, according to to the results.
As the Department of Health and Human Services ties 50 percent of Medicare payments to value by 2018, about 59 percent of Humana's individual Medicare Advantage members have access to primary care physicians who are part of value-based relationships, it said. The goal is to raise that number to 75 percent by the end of 2017, Humana said.
"Putting the physician/patient relationship at the center of care, combined with the transformative power of the value-based reimbursement model, is helping people with Medicare Advantage achieve their best health," said Bruce Broussard, Humana's President and Chief Executive Officer. ​

All-payer database lawsuit before Supreme Court could hurt HIEs
The following article from FierceEMR.com discusses the lawsuit that is currently before the United States Supreme Court about state imposition of all-payer claims databases and the significant adverse effects it could have on health information exchanges (HIEs).
A lawsuit currently before the United States Supreme Court about state imposition of all-payer claims databases could have significant adverse effects on health information exchanges (HIEs), according to a perspective article in the New England Journal of Medicine.
Nicholas Bagley from the University of Michigan Law School and Christopher Koller from the Milbank Memorial Fund warn that the lawsuit, if held in favor of the insurance company fighting a state law requiring all payer claims to be included in a data base to provide claims transparency, could have implications far beyond that particular database. In the lawsuit, Gobeille v. Liberty Mutual, the insurer is arguing that since it's governed by the federal Employee Retirement Income Security Act (ERISA), it does not have to comply with Vermont's state law requiring insurers to submit the claims information. If Liberty Mutual wins, then employers that self-insure would not have to report to state entities--not just to the all-payer data bases, but other public initiatives, such as HIEs.
"These exchanges enable the sharing of clinical information among healthcare providers so that, for instance, emergency department personnel have access to a patient's medical records and claims history when the patient arrives in the department," Bagley and Koller point out. "Although some of these exchanges are private provider-to-provider efforts, others are organized under state auspices. These state-sponsored exchanges depend on the participation of all of the insurers and employers that pay for health care in the state--both to submit information and to help finance them. If self-insured employers can opt out, these new exchanges could founder."
Arguments before the Supreme Court were held Dec. 2, according to the Wall Street Journal.
The lawsuit comes at a time when HIEs, still relatively new, are trying to sustain themselves and meet consumer demand, offering not only interoperability and ways to meet the patient engagement requirements of the Meaningful Use program but also untethered personal health records, care coordination and other services. A win by Liberty Mutual could undermine HIEs' efforts to bring together all of the stakeholders in a state and hamper their data exchange efforts.
  • Learn how to successfully run a medical practice;
  • Evidence-based decisions that use current data;
  • Reduce denials for claims with daily dashboard views;
  • Manage high-risk patients via dashboards; and
  • Monitor productivity, profitability and performance of the practice.

Health data analytics should be a priority for physicians
The following article from SearchhealthIT.TechTarget.com discusses the importance of having a Health Data Analytics Vendor who will not only help to analyze and report data, but also provide training and subject matter expertise.
Hexplora's team of highly knowledgeable professionals possesses outstanding expertise and experience in implementing industry leading solutions that enable ACOs, IPAs, and Payers to leverage Informatics as a strategic asset that can deliver market differentiating capabilities.
Health data analytics should be a priority for physicians Though many physicians feel they have more pressing technology concerns, their practices could be enhanced by applying more health data analytics.
The number of small and midsize medical practices that adopted EHR systems surged over the last decade. For the providers that transitioned from paper charts to an EHR, the electronic platform was viewed as way to digitally capture and retrieve clinical data.
Moving to an EHR system also satisfied external requirements and pressures such as pay-for-performance reporting, e-prescribing, health information exchange and meaningful use. Early EHR adopters weren't concerned with health data analytics and neither are some of today's providers.
The power of health data analytics
It's easy to get carried away when discussing health data analytics with physicians. Many of them recognize how powerful data and some reporting tools can be when applied correctly. As many clinicians described to me, they have far more important issues to address with their EHRs. In several interviews with physicians across a collection of specialties, they mentioned the need to balance between time spent looking at screens, capturing data and patient interactions as one of their top priorities.
"Analytics tools will be more valuable when first you can show me how I can see all my patients and capture all the data I need without working late hours," an allergist I spoke with said. As reimbursement payments shrink and data requirements increase, organizations don't have enough resources to dedicate to health data analytics projects.
The overall added benefits of analytics shouldn't be ignored for much longer. Soon, more physicians will realize that healthcare analytics systems help organizations run efficiently and can also benefit patient care. While some EHR vendors provide reporting tools as part of their systems, most vendors seem to fall short in delivering adequate training for medical practices looking to incorporate data analytics into their workflows.
Health data analytics applications
The task of applying health data analytics is often left to individuals that have previous analytics experience. Employees that came from organizations where key performance indicators, scorecards and dashboards were commonly used will often be tapped by their current employer to assist in leading an analytics project.
There are some EHR systems that invested in educating their clients on the value of data mining and analytics and have synced up with reporting platforms to offer a comprehensive platform for healthcare organizations. Vendors such as NextGen Healthcare Information Systems LLC, athenaHealth Inc. and eClinicalWorks LLC provide tools and technical training for their clients, as well as educational content that helps organizations understand the potential of analytics.
Here are some objectives that vendors have pitched to clients as possible through deploying their products:
  • Learn how to successfully run a medical practice;
  • Evidence-based decisions that use current data;
  • Reduce denials for claims with daily dashboard views;
  • Manage high-risk patients via dashboards; and
  • Monitor productivity, profitability and performance of the practice.
Analytics must be more than a reporting engine for small and midsize practices. It should also not be limited to a set of basic dashboards and general reports. Medical practices have the opportunity to analyze all their data to improve how they manage patient care and run their businesses. The volume of captured data, combined with any of today's effective products should force a health data analytics initiative higher up on providers' priority lists.
About the author:
Reda Chouffani is vice president of development at Biz Technology Solutions Inc., which provides software design, development and deployment services for the healthcare industry. Let us know what you think about the story; email editor@searchhealthit.com or contact @SearchHealthIT on Twitter.

CMS Finalizes Medicare Payment Model With Telehealth Implications
Tuesday, November 17, 2015
The following article from iHealthBeat.org discusses a change in the way CMS is viewing Telehealth:
On Monday, CMS finalized a new Medicare payment model for hip and knee replacements that grants more flexibility in the use of telehealth services, AHA News reports (AHA News, 11/16).
Background
Medicare will only reimburse for telehealth services under certain conditions. For example:
  • Office visits and consultations must be provided using an interactive, two-way telecommunications system with real-time audio and video;
  • The originating site (where the patient is) must be in a Health Professional Shortage Area or in a county that is outside of any Metropolitan Statistical Area; and
  • The originating site must be a medical facility, not the patient's home (Infantino, iHealthBeat, 9/21).
Details of Final Rule
In the final rule, CMS waives the geographic and originating site requirements that limit telehealth payments (AHA News, 11/16).
CMS wrote, "Any service on the list of Medicare approved telehealth services and reported on a claim" using an accurate ICD-10 code "could be furnished to a [joint replacement] beneficiary, regardless of the beneficiary's geographic location."
CMS wrote that waiving the requirements will "allow the greatest degree of efficiency and communication between providers and suppliers and beneficiaries by allowing beneficiaries to receive telehealth services at their home or place of residence" (CMS final rule, 11/16).
Overall, the final rule aims to encourage hospitals to improve quality and lower costs. Under the rule providers will receive one flat fee for the procedures instead of multiple payments for each individual service they provide related to the replacements.
Hospitals that meet certain benchmarks for quality and cost measures will receive a bonus payment. Starting in year two of the program, hospitals can be penalized for a portion of their spending above a set target (CMS fact sheet, 11/16).

With population health models, data curbs the risk
The following article from Search Health IT/Tech Target.com explains how data can help to mitigate risk. Hexplora can help you to harness the power of data to protect your healthcare organization.For more information on how we can help, click here:
As population health models force healthcare organizations to take on more financial risk, the industry will lean on data analysis to mitigate the perils.
ORLANDO -- Compensation for healthcare providers in America is moving away from a fee-for-service model to one based on value measured by quality, affordability, efficiency and satisfaction of the patient. The former model is based on volume of services provided, while the new population health models focus on improving the overall well-being of a defined group of patients.
Providers now need to organize the healthcare system based on understanding population, said Charles Saunders, M.D., CEO of Healthagen Population Health Solutions in New York (Aetna's population health company), speaking in June at the Healthcare Financial Management Association (HFMA) annual conference in Orlando. This change is inevitable, he said, because payers are moving to value-based compensation.
Medicare has pledged that next year, 30% of its payments will be made to accountable care organizations, (ACOs) and 85% of all payments will be value-based. By 2018, one out of every two payment will be to ACOs and nine out of 10 to value-based programs.
Every session covering population health was well attended at the HFMA conference, and speaker after speaker touched on the challenges. Almost every case came down to the same raw conclusion: To analyze population health, healthcare organizations need data and technology, not just one or the other.
Population health = population risk
Healthcare providers who embark on a population health initiative agree to assume greater risk. In all the various population health models, the provider assumes responsibility for providing care for a group of patients for a negotiated amount. If the cost of care exceeds that amount, the provider loses money
"Healthcare in the past has been rewarded not for risk, but for avoiding risk," said Roger Jansen, senior vice president and chief human resources officer at Spectrum Health, a hospital and health plan system based in Grand Rapids, Mich. But with population health initiatives, a provider is knowingly and willingly taking on risk.
"We need to understand risk," said Robert Broadway, vice president of corporate strategy at Bethesda Health, a hospital system in Boynton Beach, Fla. But the real truth is that providers under the fee-for-service model already assume "exorbitant risk" from treating self-pays to insuring themselves against malpractice, said Broadway, who is also former chairman of the HFMA board of directors.
Population health models require a "completely new set of skill sets running a risky, narrow-margin business that consumes an enormous amount of capital, and if you are wrong on pricing, you can have massive losses," Saunders said. He encouraged providers to look at payers, which have been managing risk for decades.
The risk is measurable. "The first thing is to aggregate and analyze data that is available to understand the population and understand the risk," Saunders said. To do that, use analytics to focus on "highest-risk individuals," as in his experience, 45% of the cost of any health system is consumed by 5% of its population. "No one is in a better position than a health system" to understand those at highest risk and highest cost, he said.
All kinds of data are relevant to assessing risk, Saunders said. Examine electronic health records, claims, patient registration information, patient self-reported health risk appraisals, laboratory and prescriptive information, and even external sources such as credit card and other sociodemographic data that will enable you to break down populations and predict behavior and risk.
While providers might be daunted by what appears to be the sheer volume of data, especially in a field that lags behind other data-driven industries, according to one provider, what seems massive is actually not.
Dignity Health runs on data
One of the nation's largest healthcare providers has jumped into a data-rich environment with both feet.
Dignity Health, which is based in San Francisco, exports all its data from repositories into a Hadoop data lake, in which the information can be culled and analyzed. The data lake sits in the cloud alongside more traditional databases, rather than replacing them, said Sunil Kakade, Dignity Health's director of information and application architecture. He spoke in June at the Hadoop Summit North America.
"Healthcare data is not going to be high volume," he said. "It's not like Facebook," with billions of transactions. "Big data doesn't mean a lot of data," Kakade explained.
Generally, data lakes store information using the open source Hadoop framework for future use in analytics applications. Proponents believe data lake architecture offers a cheaper alternative to traditional data warehouses. Others, however, say data lakes bring hidden complications.
Dignity has structured its data lake around the patient. Even if Dignity treated every person in the U.S., that would mean at most 400 million rows in the database, he said. Thanks to Hadoop, the database contains structured and unstructured data, and the horsepower behind the system comes from the analytic engines.
"We use big data to find the small data and do smart analytics on that," he said. Much of what Dignity's analysts do is identify risk, carving large patient databases into smaller pieces for forecasting. As an example, he said if his company wanted to identify the risk around patients with congestive heart failure, it represents a relatively small subset of the entire patient population.
"We want to start focusing on the use case and not focus on the data," Kakade said. By employing the data lake approach, the emphasis shifts to the analysis. "Doctors can analyze the data better than the IT guy, so we should take the IT guy out of the equation," he said.
"We use big data to find the small data and do smart analytics on that," he said. Much of what Dignity's analysts do is identify risk, carving large patient databases into smaller pieces for forecasting. As an example, he said if his company wanted to identify the risk around patients with congestive heart failure, it represents a relatively small subset of the entire patient population.

More medical schools teaching about Big Data, healthcare analytics
The following article from HealthcareFinanceNews.com HealthcareFinanceNews.com discusses how Big Data and analytics is changing healthcare. At Hexplora we can help your organization to capture and analyze the data to make important decisions and improve outcomes. Medicine,meet Big Data. For more information on how we can help, click here:
For generations, physicians have been trained in basic science and human anatomy to diagnose and treat the individual patient.
But now, massive stores of data about what works for which patients are literally changing the way medicine is practiced. "That's how we make decisions; we make them based on the truth and the evidence that are present in those data," says Marc Triola, an associate dean at New York University School of Medicine.
Figuring out how to access and interpret all that data is not a skill that most physicians learned in medical school. In fact, it's not even been taught in medical school, but that's changing.
"If you don't have these skills, you could really be at a disadvantage," says Triola, "in terms of the way you understand the quality and the efficiency of the care you're delivering."
That's why every first and second year student at NYU Medical School is required to do what's called a "health care by the numbers" project. Students are given access to a database with more than 5 million anonymous records -- information on every hospital patient in the state for the past two years. "Their age, their race and ethnicity, what zip code they came from," Triola lists, as well as their diagnosis, procedures and the bills paid on their behalf.
The project, funded in part by an effort of the American Medical Association to update what and how medical students are taught, also includes a companion database for roughly 50,000 outpatients. It's called the Lacidem Care Group. (Lacidem? That's "medical," backwards). It contains data from NYU's own faculty practices -- scrubbed to ensure that neither the patients nor the doctors can be identified. Students can use tools provided by the project to "look at quality measures for things like heart failure, diabetes, smoking, and high blood pressure," says Triola. "And drill down and look at the performance of the practice as a whole and individual doctors."
Some students have taken to the assignment with relish. Second-year student Micah Timen is one. Timen likes numbers. A lot. A former accountant before applying to med school, he keeps a spreadsheet to track his study hours before a test. An upcoming test is on the digestive system. "So I know I have 18 hours and 40 minutes left to make sure I feel comfortable walking into my exam," he says.
For his project, Timen wanted to know if the cost to patients of hip replacement surgery around the state vary as much as the cost of a fast-food hamburger. Timen says they tried comparing hip replacement costs using The Economist magazine's famous Big Mac Index, which measures purchasing power between currencies. "But when you call McDonald's, they don't give you prices over the phone," he said. So he tried Plan B: "Burger King gave it to me."
Using his "Whopper Index" instead, Timen found, not surprisingly, that the price of a giant burger sandwich is higher in New York City than, say, Albany. So, too was the amount patients paid for their hip replacements. But the margin was much wider for health care than for hamburgers, meaning patients are paying more in some places than simple geography would suggest. Timen says he'd like to explore why that might be, "but unfortunately med school is a little bit time-consuming," so that may have to wait.
Still, it turns out the classes appeal not just to data "junkies," like Timen, but also to those who were not already steeped in crunching data.
"I really have no statistical background," says Justin Feit, also a second year student. "I don't even know how to use Excel well."
So Feit was partnered with Jessica Lynch, who already has a PhD -- in physics. She says that if medicine wasn't moving in the direction of more data interpretation, "I don't know if I would have gone into medicine."
Together Feit and Lynch looked at the rates of cesarean births around the state – and, like the cost of hip replacements, found that C-section rates varied widely. But their project will get more than just a grade. A faculty member at NYU is using it as part of a bigger research project headed for publication.
Triola says he hopes that will happen more and more.
"With literally millions of records, these in-class student projects often involved more patients than the published literature. It's incredible," he said.
And the concept of having students learn to use health data is catching on quickly. Triola says NYU is offering its database and program to other medical schools; seven are already incorporating it into their curriculum.
Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

New ICD-10 Metrics Released
The following article from HealthDataManagement.com outlines the New ICD-10 Metrics showing that rejection rates are now declining. For more information on how we can help, click here:
Rejection rates for claims increased during the early days of the transition to ICD-10 coding, but a major claims clearinghouse now says rejection rates are now in decline.
There were spikes of rejections throughout October, but as the month ended, the payer rejection rate actually was lower than the year-to-date baseline measure, says Mike Denison, senior director of regulatory compliance programs at Emdeon. And clearinghouse rejection rates were only slightly above baseline.
At the end of October, 99.9 percent of claims that should be coded in ICD-10 came in with the new codes, and now in early November, both payer and clearinghouse rejection rates are at the baseline. Claims coded in ICD-9 for services before October are still coming in, but 86 percent of claims now being received at Emdeon are ICD-10.
Importantly, early remittance advice being sent by insurers back to providers shows little changes in reimbursement rates. However, the flood of remittance has not yet started but soon will as October claims work their way through the payment process in November.
For commercial insurers, the average paid amount so far is slightly lower but less than 1 percent, compared with remittance under ICD-9, Denison says. The average paid amount for Blues plans is a little over 1 percent less. Medicare payments on average are 7 percent less, but that is due to October payment policy changes, the Centers for Medicare and Medicaid Services told Emdeon, so there is no change in reimbursement simply because of ICD-10.
Medicaid is a different and confusing story. The average paid amount is 12 percent higher but denied payments—for several reasons that include a claim not meeting contractual policy or a subscriber is not recognized, among others—are down 9.6 percent. Medicaid is often the payer with the highest denial rates, and Denison isn’t yet sure why that isn’t the case so far.
While cautioning that the industry should have a good indication of denial and payment rates by the end of November, Denison believes that in general, the transition to ICD-10 has been very successful. “The readiness of providers was better than expected.”
Further, he sees early indications that coder productivity is better than expected, ranging from less than a 10 percent change to no change at all.

Healthcare industry must discover best ways to weigh, combine disparate datasets
The following article from FierceHealthIT.com talks about the industry's need to figure out how to best utilize the overload of information that is now available. Hexplora can help your organization to analyze and utilize the myriad of information that is being collected to produce meaningful insights. For more information on how we can help, click here:
As information flows into the healthcare system from myriad technologies--wearables, apps, social media, online portals, electronic records, etc.--the industry needs to figure out how those types of information can be combined and weighed, according to a paper published this week in Nature.
Not all data can be created equal, say the authors, from medical institutions across the U.S., Canada and Australia; they point out that healthcare data increasingly is coming in from different domains, is generated in many different ways and is store in many different places.
Because of that, "scientists need to work out why, when and how to combine diverse data--for instance, should physical-activity data from clinical records, online questionnaires and wearable devices be combined?" they write
In the case of patient-generated data, the Office of the National Coordinator for Health IT recently announced that it plans to create a policy framework to identify best practices, gaps and opportunities for the use of such information in research and care delivery through 2024.
However, bias of health data also must be considered, according to the Naturepaper's authors. It must be analyzed using methods like the Cochrane Risk of Bias approach, and those methods must be used in analytical systems that guide healthcare decision-making.
Being able to easily blend such disparate datasets will be important for major initiatives now underway in healthcare because of easier access to information--like President Obama's Precision Medicine Initiative.
Achieving success, though, requires "understanding the effects of myriad genomic, behavioral and environmental factors and their interactions," the authors say. "The value of the initiative will be enhanced if data from these very different domains can be combined appropriately and easily."
One of the challenges to population health initiatives is trying to deal with so much data.
"We're data rich and information poor," UPMC's Chief Innovation Office Rasu Shrestha previously told FierceHealthIT. "We've done a great job of aggregating the data, harmonizing the data, having control of the data--but there's still a lot to do in the industry at large in terms of data transformation."

Report Makes Predictions on Effects of Health Care Trends on IT
This article was reprinted from iHealthBeat.org outlining a report that makes predictions on the effects of Health Care Trends on IT. Hexplora is positioned to keep you ahead of the trends affecting Health Care and the impact on your organization. To learn more about how we are providing Better Insights and Better Outcomes, please contact us for a demo.
The International Data Corporation has released a report that outlines predictions for global health care trends and discusses the effects of health IT, Healthcare IT News reports (Ratchinsky,Healthcare IT News, 11/5).The report lists 10 predictions about trends in health care over the next three years.
Details of Report
The report lists 10 predictions about trends in health care over the next three years. Each prediction includes:
  • Guidance for action; and
  • The effect of health IT.
The report also:
  • Identifies areas of health care business that will be affected by the trends;
  • Prioritizes investments; and
  • Shares each initiative's relative cost and complexity.
According to IDC, "major themes" among the predictions are:
  • Demand for advanced analytics and new data sources;
  • Movement in the direction of personalized medicine;
  • Security and the effect of breaches in health care;
  • The availability of third platform technology -- which includes mobile, social, big data and cloud computing -- and innovation accelerators to enable digital transformation; and
  • Ubiquitous access to mobile technology (Burghard et al., IDC report, November 2015).
IDC Predictions
IDC predicts that in 2016:
  • Cyberattacks will compromise information on one-third of individuals; and
  • Third platform acute health information systems and electronic health records will start to come to market, with early adopters beginning transformation efforts in 2017-2019.
Meanwhile, by 2017, IDC predicts:
  • Risk-based contracting will comprise half of payments because of downward pressure in the health care economy, increasing premiums 2% to 3%;
  • Surgeons will use computer-assisted or robotic surgery techniques for planning, performing and simulating half of the most complex surgeries; and
  • Health care IT service buyers will consolidate IT services spending among the five to 10 largest service providers for each sub-vertical at twice industry growth rates
By 2018, the report predicts:
  • 30% of worldwide health care systems will use real-time cognitive analysis for personalized care that leverages patient clinical data, supported directly by clinical outcomes and real-world evidence;
  • 80% of customer/patient service interaction will use the Internet of Things and big data to boost quality, timeliness and value, and virtual care will become routine;
  • Industry cloud creation will be tech providers' and industrial companies' top market entry strategy, while IT and industry domain leaders will unite to eliminate traditional entry barriers;
  • The pharmaceutical industry's adoption of global launch sequence optimization solutions will grow by 50% because of an increase in the frequency of drug launches, which will save the industry billions in potential lost revenue; and
  • Physicians will use cognitive solutions to identify the most effective treatment for half of complex cancer patients, which will reduce mortality and cost by 10% each (Healthcare IT News, 11/5).

Employer-insured patients spend more on healthcare in 2014, driven by brand-name drugs, report says
New Report Shows Healthcare spending grew by 3.4% in 2014. Learn more in this article reprinted from HealthCareFinanceNews.com, please contact us for a demo
Per capita prescription spending jumped to $45 in 2014, though the actual use of brand-name prescriptions fell by 16 percent. Healthcare spending grew by 3.4 percent in 2014, a new report by the Health Care Cost Institute found, even though overall utilization declined. According to the HCCI, which runs the popular healthcare price tracking website Guroo.com, said much of the increase can be traced to the rise in prices for brand-name drugs.
The institute found per capita prescription spending jumped to $45 in 2014, though the actual use of brand-name prescriptions fell by 16 percent. Much of the rise is tied to pricey Hepatitis drugs such as Olysio, Sovaldi, and Harvoni, which hit the market in 2013.
The report tracked spending for Americans under 65 who are covered by employer-sponsored private insurance.
According to the report, average medical spending per person was $4,967, up 3.4 percent compared to the previous year. Of that, $810 per person came out-of-pocket, a 2 percent jump.
While pharmaceutical accounted for the biggest rise, prices for medical services rose across the board, the report said, with acute patient admission prices jumping more than 4 percent, or $831 per admission.
In the other hand, acute admissions actually declined by nearly 3 percent.
The report also supported the trend that more patients are seeking outpatient treatment. Spending on outpatient services rose $16 per capita and professional services rose by $15 per capita.
The institute also found the spending gap between men and women continues to grow, with women spending per capita more than $237 than men in 2014.

What's the potential of IT and healthcare big data?
The following article is from SearchHealthIT.TechTarget.com To learn more about how Hexplora can help your organization to utilize data for better outcomes while protecting you from potential security issues and vulnerabilities, please contact us for a demo.
Hexplora can help your organization to utilize data for better outcomes while protecting you from potential security issues and vulnerabilities
Big data in healthcare will open up vast amounts of data to healthcare organizations and providers, allowing them to get a deeper look into the data, extract valuable insights and ultimately enable them to improve patient care. At the same time, opening up that data can possibly create more vulnerabilities that hackers can take advantage of, said Joel Vengco, vice president and chief information officer at Baystate Health in Springfield, Mass. In this Q&A, Vengco discusses the potential security issues healthcare big data brings to the table, what can be done and whether it's all worth it.
By: Joel Vengco
There's a lot of value to having that data exchanged more liberally but then it's a double-edged sword … A lot of things stem off of big data as we discussed -- privacy and particularly security -- and as we start to really go down this path of true big data and Internet of Things, security, particularly cybersecurity and information security, become cornerstones of any IT organization. And so in the past we've had security teams and we've had structures in place that we rely on to ensure that we're compliant withHITRUST [Alliance] standards or HIPAA standards, but now that we're really creating more gateways and more access to this data, I think we're going to find information security [and] cybersecurity to be really the focus of IT outside of the applications that we service on a day-to-day basis. And that's going to be a big challenge because as you know, healthcare data on the black market is worth much, much more now than even credit information. So that kind of accessibility of the data that we're providing today is really going to push more of us to focus on how to create strategies for information cybersecurity going forward.
So opening up the data is good for people within healthcare but it also means you're making yourself vulnerable to attackers?
Vengco: Exactly. Exactly right
That's a tough place to be.
Vengco: It is a tough place to be … I certainly hate to say it as a CIO, but that's what keeps me up at night. And when you think about these big companies like Sony and Home Depot and Target and even large insurers who, let's just say, have bigger IT budgets and yet they can't seem to stop some of these attacks, it's pretty scary for a lot of health systems, you know?
What do you think healthcare organizations can do in order to better protect themselves? Is it about constant vigilance? Is it about developing better security tools?
Vengco: It's a little bit of a lot of those things. A lot of these infiltrations happen because your employees internally aren't being as careful as they should be and you're not training them well enough, perhaps. It's not necessarily just their fault. It's a team game, this is like a team effort. So you have to make sure that they're well trained but that they're also vigilant on their own. Because as soon as they put an app [out there] that has a gap in it or a hole in it, and that's what the bot was waiting for or that's what the hacker was waiting for, now they're in with one user and they can sort of crawl through everything else. That's what happened at Sony, really. They actually accessed one user or a couple users and it proceeded from there. That's really the Trojan horse issue. How do you stop someone from coming in through another gateway even if it's not a front end? Maybe somebody clicked on a link through an email that they thought came through an internal division and all of sudden folks are in. So that's a part of it. And, of course,security tools are huge too. The maturity of those is continuing to evolve, and healthcare is certainly behind in terms of those tools that they've either purchased or implemented … We need to continue to strengthen our security posture. So policy, technology and the people are really important in fighting against that kind of cybersecurity issue.
Do you think the benefits of healthcare big data outweigh the privacy and security concerns and risks?
Vengco: I think they do … When we think about the different things we can discover with the availability of big data, it's limitless. I think healthcare struggles still today with having access to that kind of data and it struggles with true discovery of perhaps new ways to treat patients, of new processes or methods to keep patients well because we don't have all of that empirical data in a single place. We've got pockets of it and we've got sample data, and that's good, but I think when you have petabytes and petabytes of data, that really significantly changes the game of medicine and the way we care for people. So I do think there's a lot of benefit there. It's still scary nonetheless
Let us know what you think about the story and the effect of big data in healthcare organizations; email Kristen Lee, news writer, or find her on Twitter @Kristen_Lee_34.

Affordable Care Act initiative builds on success of ACOs
New generation ACO model sets stronger measures and more opportunities for care
The U.S. Department of Health and Human Services today announced a new initiative from the Centers for Medicare & Medicaid Services’ Innovation Center (CMS Innovation Center): the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery. Made possible by the Affordable Care Act, ACOs encourage quality improvement and care coordination, helping to move our health care system to one that achieves the Department’s goals of better care, smarter spending, and healthier people. “The Next Generation ACO Model is one of many innovative payment and care delivery models created under the Affordable Care Act, and is an important step towards advancing models of care that reward value over volume in care delivery,” said HHS Secretary Sylvia M. Burwell. “This model is part of our larger effort to set clear, measurable goals and a timeline to move the Medicare program -- and the health care system at large -- toward paying providers based on the quality, rather than the quantity of care they give patients.” Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program (Shared Savings Program), the Next Generation ACO Model offers a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care. The ACOs in the Next Generation ACO Model will take on greater performance risk than ACOs in current models, while also potentially sharing in a greater portion of savings. To support increased risk sharing, ACOs will have a stable, predictable benchmark and flexible payment options that support ACO investments in care improvement infrastructure that provides high quality care to patients. The new ACO model encourages greater coordination and closer care relationships between ACO providers and beneficiaries. ACOs will have a number of tools available to enhance the management of care for their beneficiaries. These tools include rewards to beneficiaries for receiving their care from physicians and professionals participating in their ACOs, coverage of skilled nursing care without prior hospitalization, and modifications to expand the coverage of telehealth and post-discharge home services to support coordinated care at home. The Next Generation ACO Model also supports patient-centered care by providing the opportunity for beneficiaries to confirm a care relationship with ACO providers and to communicate directly with their providers about their care preferences. “This ACO model responds to stakeholder requests for the next stage of the ACO model that enables greater engagement of beneficiaries, a more predictable, prospective financial model, and the flexibility to utilize additional tools to coordinate care for beneficiaries,” said Patrick Conway, deputy administrator for Innovation and Quality and chief medical officer for CMS. The Next Generation ACO Model is part of the Department’s efforts to create opportunities for providers to enter into alternative payment models and meet the Secretary’s new goals announced on Jan. 26 to move an increasing percentage of Medicare payments into models that pay providers based on the quality rather than the quantity of care they provide patients. CMS will accept ACOs into the Next Generation ACO Model through two rounds of applications in 2015 and 2016, with participation expected to last up to five years. Organizations interested in applying in 2015 must submit a Letter of Intent by May 1, 2015, and an application by June 1, 2015. Second round Letters of Intent and applications will be available in spring 2016. For more information on the Next Generation ACO Model, please visit the Next Generation ACO Model web page. The Center for Medicare and Medicaid Innovation (CMS Innovation Center) was created by the Affordable Care Act to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. The CMS Innovation Center is committed to transforming Medicare, Medicaid and CHIP and is expected to help deliver better care for individuals, better health for populations, and lower growth in expenditures for Medicare, Medicaid and CHIP beneficiaries.

CMS offers pre-paid shared savings for ACOs
By: Mike Miliard
The Centers for Medicare and Medicaid Services says its new ACO Investment Model responds to concerns that some providers lack adequate access to investment capital needed to successfully implement population care management. The model offers pre-paid shared savings to encourage new accountable care organizations to form in rural and underserved areas.
The initiative, announced Wednesday, offers up to $114 million in upfront investments to as many as 75 ACOs nationwide. ACOs must apply to CMS for the funding.
"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, in a press statement." We are working with these organizations to make necessary investments that encourage doctors, hospitals and other healthcare providers to work together to better coordinate care and keep people healthy."
The initiative, directed through the CMS Innovation Center, will offer up-front investments for infrastructure and redesigned care processes to help eligible ACOs in delivering higher-quality care. CMS said the payments are structured to address both fixed and variable costs ACOs must cover to improve care coordination.
The goal, say CMS officials, is to help more people, irrespective of where they live, benefit from Medicare ACOs.
CMS will recover these payments through an offset of an ACO’s earned shared savings, officials say.
Eligibility is targeted to ACOs that joined the Medicare Shared Savings Program in 2012, 2013 or 2014, and to new ACOs joining in 2016.
The application deadline for organizations that started in the Shared Savings Program in 2012 or 2013 will be Dec.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.
This article originally appeared on Healthcare IT News.

VA to Pay Non-Contract Providers Using Medicare Payment Models
The Department of Veterans Affairs (VA) has begun issuing notices that inform home health providers of the VA’s revised payment methodology for skilled home health services. Beginning October 1, 2014, the VA will require an Outcome and Assessment Information Set (OASIS) to be completed to generate a health insurance prospective payment system (HIPPS) code in order to reimburse non-contracted home health agencies for skilled home health services using the Medicare home health prospective payment system (HHPPS). For non-contracted hospice providers the VA will continue to pay a per diem rate.
On February 18, 2010, the VA issued a proposed rule to implement certain payment methodologies for all non-contracted inpatient and outpatient health care professionals and providers, which included paying according to Medicare fee schedules and prospective payment systems, as applicable. When the final rule was published on December 17, 2010 the regulation included an exception for implementing the payment methodologies for home health and hospice services. The VA cited administrative and systems problems that prevented their ability to implement the Medicare payment system for home health and hospice services on such short notice. Since the final rule, the VA had delayed the effective date for the payment changes several times.
The effective date was finally set for June 1, 2014 with an implementation date of October 1, 2014.
The following was recently issued by the VA:
“The Chief Business Office Purchased Care (CBOPC) has announced the Veterans Health Administration (VHA) has revised the payment regulation related to non-VA medical care claims for home health and hospice services.
As part of a revision to Title 38 Code of Federal Regulations (CFR) § 17.56, the change in the payment regulation, also known as AN98, will impact non-VA medical care providers for home health and hospice services that do not have an existing contract or provider agreement in place. If VA does not have a contract, provider agreement, or negotiated rate in place, VA will pay non-VA home health and hospice claims utilizing the Centers for Medicare and Medicaid Services’ (CMS’) Home Health Prospective Payment System and hospice payment methodology, when possible. The effective date for the new payment methodology was June 1, 2014, however, the implementation date was on October 1, 2014.
Services included in the AN98 regulatory revision include:
  • Skilled home health care
  • Home health aides
  • Homemaker services
  • Home respite care services
  • Home hospice care
Services not included in the regulation revision for home health care include:
  • Bowel and bladder care
  • Adult day care
  • Home respiratory care
  • Home dialysis care
  • Veteran-Directed and Community Based Services
  • Home infusion therapy
Adopting CMS pricing methodology for these home health and hospice schedules and services will allow VA Medical Centers to use their resources more efficiently to meet Veterans’ needs. The adoption of Medicare rates will also help ensure consistent, predictable medical costs, while also helping to control costs and expenditures. The AN98 implementation team has ensured the home health claims process, field procedure guide and associated training are updated to reflect this implementation.”
Agencies that do not have a contract or negotiated rate for their VA patients will be reimbursed by the HHPPS. According to the VA, any home health contract or negotiated agreement must be executed through a VA contracting office. The VA also clarified that for episodes beginning on or after October 1, 2014, the VA will require an OASIS and HIPPS code on claims. Initially, claims will not be rejected if the HIPPS code is not present, and will be paid at the current VA fee amount.
Home health agencies may bill the same as with Fee for Services Medicare including submitting a RAP with type of bill (TOB) 322, final claim TOB 329, 60/40 split percentage paid on initial claims, and 50/50 for subsequent claims, and LUPAs. The Central VA office will continue to issue guidance to the local VAs over the next several weeks.

Obama Administration Announces New Executive Actions to Improve Quality of Care for Medicare Beneficiaries
October 06, 2014
Today, the Obama Administration announced plans to expand and strengthen Medicare’s widely-used Five Star Quality Rating System for Nursing Homes, also known as Nursing Home Compare. The rating system is a consumer service that offers useful information to the public about the quality of care in the 15,800 nursing homes that participate in Medicare or Medicaid. Users may sort through nursing homes in their area through an online tool at CMS’ Nursing Home Compare website.
The Five Star Quality Rating System offers the most comprehensive overview of nursing home quality in the U.S., in an easy to understand format, based on data from onsite inspections conducted by trained, objective surveyors from state public health departments and CMS; Quality Measures submitted by the nursing homes is used to calculate certain quality measures, such as the prevalence of pressure ulcers, use of restraints, and the extent of injurious falls; and information about the staffing levels in nursing homes.
While the onsite inspections form the core of the rating system, CMS has been concerned that the quality measures and information about staffing levels rely on self-reported data from nursing homes that have been difficult to verify.
Beginning in January 2015 CMS will initiate the following steps to improve the reliability and utility of data displayed on Nursing Home Compare as well as to help nursing homes improve:
  • Nationwide Focused Survey Inspections :   In FY 2014 CMS piloted special surveys of nursing homes that focused on verifying performance on resident assessments and the data set that is used in the quality measures. Effective January 2015, CMS and states will implement these focused survey inspections nationwide for a sample of nursing homes nationwide. Expansion of these inspections will enable better verification of both the staffing and quality measure information that is part of the Five-Star Quality Rating System.
  • Payroll-Based Staffing Reporting :   Using new funding provided by the IMPACT Act of 2014, signed by the President today, CMS will implement a system of quarterly electronic reporting that is auditable back to payrolls to verify staffing information. This new system will increase accuracy, improve the timeliness of the data, and allow for the calculation of quality measures for staff turnover, retention, types of staffing, and levels of different types of staffing. This data will not only allow for better information available to the public, but may equip nursing homes with better data by which to improve staffing and quality of care. CMS expects that pilot testing will occur in fiscal year (FY) 2015, with nationwide reporting by all nursing homes by the end of FY2016.
  • Improved Scoring Methodology :   CMS will revise the scoring methodology by which we calculate each facility’s Five Star rating. The revised scoring methods will place more emphasis on data that is verified by independent sources rather than data that is self-reported by nursing homes.
  • Timely and Complete Inspection Data:   CMS will also strengthen requirements to ensure that states complete inspections of nursing homes in a timely and accurate manner, and maintain a user-friendly website for public viewing.
  • Additional Quality Measures:   CMS will increase both the number and type of quality measures used in Nursing Home Compare. The first additional measure starting January 2015 in the ratings system will be the extent to which anti-psychotic medications are in use. More measures will be added later, including data on re-hospitalization and rates of returning beneficiaries to home that use Medicare claims as the source of information.
Actions to Improve Quality Home Health Care Received by Medicare Beneficiaries
In conjunction with today’s efforts to improve the quality of care received by Medicare beneficiaries in nursing homes, the Centers for Medicare & Medicaid Services today issued a proposed rule that strengthens patient rights, improves communication, and focuses on patient well-being. These rules are designed to improve the quality of home health services for Medicare beneficiaries.
These updates to home health agency conditions of participation (CoPs) make substantial revisions to the existing CoPs. They focus on the care needs of patients and will clarify the operational and quality expectations for the approximately 12,500 home health agencies participating in Medicare. There are more than five million people with Medicare and Medicaid benefits who receive home health care services each year.
The proposed regulation, will include these proposed updates:
  • A clear explanation of patient rights, including a requirement to communicate with patients in a language and manner that they understand, and a requirement that home health agencies must take measures to assure and protect those rights.
  • An expanded comprehensive patient assessment requirement that focuses on all aspects of patient well-being.
  • An integrated communication system, increasingly enabled by health information technology, that ensures that patient needs are identified and addressed, care is coordinated among all disciplines, and that there is active, timely, needs-based communication between the home health agency and the physician.
  • A data-driven, agency-wide quality assessment and performance improvement program that continually evaluates and improves agency care for patients.
  • An expanded patient care coordination requirement that makes a licensed clinician responsible for all patient care services, such as coordinating referrals and assuring that plans of care meet each patient’s needs at all times.

ACO Programs Save Medicare More than $800M, Data Show
Sixty-four of the 243 Medicare accountable care organizations that launched in 2012 have saved enough to earn bonuses, according to financial performance results released by CMS on Tuesday (Rau, "Capsules," Kaiser Health News, 9/16).
The results are from two ACO programs that began in 2012: the Medicare Shared Savings Program and the CMS Innovation Center's Pioneer ACO program (Evans, Modern Healthcare, 9/16). Since 2012, more than 100 additional organizations have become Medicare ACOs (CMS release, 9/16).
ACOs Largely Achieve Savings Goals
Altogether, the ACOs have reduced Medicare spending by $817 million (Modern Healthcare, 9/16). The 64 ACOs received a combined $445 million in bonuses, while Medicare saved the remaining $372 million.
Meanwhile, four ACOs significantly overspent and now owe money to Medicare ("Capsules," Kaiser Health News, 9/16).
Pioneer ACOs
During their second performance year, the 23 Pioneer ACOs saved Medicare an estimated $96 million, and 11 of them qualified for shared savings payments of $68 million. The organizations reported lower per capita spending growth than Medicare fee-for-service.
Three Pioneer ACOs generated shared losses, and three chose to defer reconciliation until the end of the third performance year.
Meanwhile, the mean quality score for Pioneer ACOs also improved by 19%, increasing from a mean quality score of 71.8% in 2012 to 85.2% in 2013.
Meanwhile, four ACOs significantly overspent and now owe money to Medicare ("Capsules," Kaiser Health News, 9/16).
The results come amid questions about the viability of the Pioneer ACO program, which has lost 10 of its 32 original participants (Viebeck, The Hill, 9/16).
MSSP ACOs
The new report covers two cohorts of MSSP ACOs: the first announced in April and the second in July. There were 204 MSSP ACOs with available data (Modern Healthcare, 9/16).
During their first year, 53 MSSP ACOs with available data held spending $652 million below their targets and earned performance bonuses of more than $300 million (CMS release, 9/16).
Meanwhile, 41 MSSP ACOs overspent. One MSSP participant will have to repay Medicare $4 million because it cost the agency $10 million more than estimated ("Capsules," Kaiser Health News, 9/16).
As part of its data release on Tuesday, CMS published the specific financial results of each of the MSSP ACOs (Modern Healthcare, 9/16).
In addition, the report found that MSSP ACOs improved on 30 of 33 quality measures, including measures like ratings of physician communication and screening for tobacco use. They also scored higher average performance rates on 17 of 22 Group Practice Reporting Option Web Interface measures (CMS release, 9/16).

U.S. won't reveal records on HealthCare.gov security
By : Associated Press
After promising not to withhold government information over "speculative or abstract fears," the Obama administration has concluded it will not publicly disclose federal records that could shed light on the security of the government's healthcare website because doing so could "potentially" allow hackers to break in.
The CMS denied a request by The Associated Press under the Freedom of Information Act for documents about the kinds of security software and computer systems behind the federally funded HealthCare.gov. The AP requested the records late last year amid concerns that Republicans raised about the security of the website, which had technical glitches that prevented millions of people from signing up for insurance under President Barack Obama's healthcare law.
In denying access to the documents, including what's known as a site security plan, Medicare told the AP that disclosing them could violate health-privacy laws because it might give hackers enough information to break into the service.
"We concluded that releasing this information would potentially cause an unwarranted risk to consumers' private information," CMS spokesman Aaron Albright said in a statement.
The AP is asking the government to reconsider. Obama instructed federal agencies in 2009 to not keep information confidential "merely because public officials might be embarrassed by disclosure, because errors and failures might be revealed, or because of speculative or abstract fears." Yet the government, in its denial of the AP request, speculates that disclosing the records could possibly, but not assuredly or even probably, give hackers the keys they need to intrude.
Even when the government concludes that records can't be fully released, Attorney General Eric Holder has directed agencies to consider whether parts of the files can be revealed with sensitive passages censored. CMS told the AP it will not release any parts of any of the records.
The government's decision highlights problems as it grapples with a 2011 Supreme Court decision that significantly narrowed a provision under open records law that protected an agency's internal practices. Federal agencies have tried to use other, more creative routes to keep information censored.
In addition to citing potential health-privacy violations, the government cited exemptions intended to protect personal privacy and law-enforcement records, although the agency did not explain what files about the healthcare website had been compiled for law-enforcement purposes. Some open-government advocates were skeptical.
"Here you have an example of an agency resorting to a far-fetched privacy claim in an unprecedented attempt to bridge this legal gap and, in the process, making it even worse by going overboard in withholding such records in their entireties," said Dan Metcalfe, a former director of the Justice Department's office of information and privacy who's now at American University's law school.
Keeping details about lockdown practices confidential is generally derided by information technology experts as "security through obscurity." Disclosing some types of information could help hackers formulate break-in strategies, but other facts, such as numbers of break-ins or descriptions of how systems store personal data, are commonly shared in the private sector. "Security practices aren't private information," said David Kennedy, an industry consultant who testified before Congress last year about HealthCare.gov's security.
Last year, the AP found that CMS Administrator Marilyn Tavenner took the unusual step of signing the operational security certificate for HealthCare.gov herself, even as her agency's security professionals balked. That memo said incomplete testing created uncertainties that posed a potentially high security risk for the website. It called for a six-month "mitigation" program, including ongoing monitoring and testing. The site has since passed a full security test.
Government cyber-security experts were also worried that state computers linking to a federal system that verifies the personal information of insurance applicants were vulnerable to attack. About a week before the launch of HealthCare.gov, a federal review found significant differences in states' readiness. The administration says the concerns about state systems have been addressed.

PCPs and Hospitals Lobby for Purse Strings in Formation of ACOs
By : LYNNE JETER
Physicians and hospitals are gearing up for a mad dash in the healthcare reform-mandated formation of Accountable Care Organizations (ACOs), with both sides scrambling to hold the purse strings.
“Whoever controls the primary care providers—the point of entry into healthcare—is going to own the show,” said orthopedic surgeon Ed Homan, MD, from Tampa, Fla., and a state legislative leader from 2002-10. Jerry Thompson, MD, 2011 president-elect of the Memphis Medical Society and chairman of the Tennessee Medical Association’s insurance committee, refers to the new model of healthcare delivery as “The List.” “If you’re not on the list of preferred providers for ACOs, you may not have patients coming in your door,” he said. “That’s why it’s so important for a collaborative effort on the part of medical societies and doctors in their communities to be proactive as ACOs are being organized.”
Recently, hospitals like Orlando, Fla.-based Florida Hospital have been snapping up primary care practices to better position themselves in the ACO landscape. The acquisitions have seemed on the surface like a good exchange, and arguably many of them represent win-win scenarios. Selling their practice has been attractive to physicians tired of dealing with administrative headaches, declining reimbursement rates, and lower profit margins. “After all,” said Homan, “doctors have been taking it on the chin.” The lure of upfront cash—$200,000, for example—combined with a salary and benefits that include medical malpractice insurance coverage, along with having the hospital retain and pay for the clinical staff, seems reasonable in exchange for admitting all practice patients to that hospital. “They’ll have the money, the patients, and the medical records and birddog Medicare patients to be sure that when they get their total hip replaced, they get the $1,000 prosthesis, not the $7,000 one,” he said. “And if there’s a choice between a stent and open heart surgery and the results are about the same, it’s not going to be a decision made between the patient and doctor regarding the treatment. It’s going to be made in favor of the cheapest treatment going, as long as no one can deny that we’re providing care. We can turn this around and save money.” But some primary care physicians who sold their practices to hospitals in 2008 with a 3-year salary guarantee on a 5-year contract, are finding themselves in an unpleasant predicament in 2011. This summer, physicians in a small Florida city are looking at a 40 percent reduction in salary. Because their contract included a non-compete clause limiting the physicians from practicing medicine within 30 miles of the hospital, their choices in this poker game are limited: either try to negotiate a smaller pay cut without bargaining power, stand together as a group to generate bargaining power, accept the terms being offered, retire, or move outside the 30-mile radius and start again. “This scenario is more common than many physicians think,” said Thompson. “That’s even more reason to collaborate and be proactive.”
Some state medical associations such as Florida and Texas are looking for ways to give doctors more control over patient care through ACOs. If doctors or medical societies form an ACO, then they hire the hospital. “The problem is, there aren’t enough doctors who are businessmen or leaders to do the sort of thing that’s like herding cats,” said Homan. “They’re independent businessmen who don’t work for large companies like GM, RCA or Xerox. They’re not organized in the sense of how other industries are organized. Even hospitals are organized with a leadership ladder and are growing in size like Adventist in Orlando or BayCare in Tampa or HCA. That’s a handicap for doctors as a group.”
Thompson said the Memphis Medical Society would love to form an ACO, but “it takes a lot of time and money to do it.”
The timing of the move to ACOs coincides with the anticipated push by Florida lawmakers this year to expand mandated managed-care enrollment in other areas of the state beyond the five pilot counties. The playing field would tilt if state legislators allowed ACOs as an alternative to traditional managed care. “Basically, our position is that we still oppose the move to managed care,” Jeff Scott, director of governmental affairs for the Florida Medical Association, told Health News Florida, “and we will fight that.” Bruce Rueben, president of the Florida Hospital Association, said conversations are underway at hospital systems statewide to determine how they might establish and maintain ACOs without violating antitrust laws. But questions linger about many details until federal rules are in place.
“There are a lot of ifs,” said Homan. Tennessee Medical Association spokesperson Russ Miller pointed out that mergers with hospitals for all specialties have been growing statewide, not only primary care practices. “One thing we’ve been acutely focused on recently is the ACO,” he said, quickly adding there are multiple reasons for the mergers. “Some are hospitals wanting to be better positioned. Some are medical practices that are being threatened or have had the rug yanked out from under them. Then others are purely collaborative efforts. There are a lot of reasons why that’s happening.”
Noting trends that are developing as a result of the ACO model, Thompson said that Medicare has severely reduced reimbursements for imaging services at cardiology practices, adding that hospitals have not been affected. “That sent a very strong signal over where future cuts are going to be,” he said. While healthcare systems, hospitals and physician practices are weighing the options until solid information is accessible, they should be cautious about making a move too quickly, said Thomas E. Bartrum, a Nashville attorney with Baker, Donelson, Bearman, Caldwell & Berkowitz, and co-chair of the American Health Lawyers Association’s new ACO Task Force.
“If you move too quickly, increase your efficiency and increase your cost accountability for care, what you’re going to see is a decrease in revenue without any corresponding savings to share with anybody,” he explained. “I don’t want to say there’s a fair amount of gamesmanship here, but I don’t think you want to get too far in front of the curve, either.” He cautioned healthcare providers to be cognizant of consultants who appear quite knowledgeable about ACOs. Instead, he suggested, initiate a self-evaluation to identify opportunities to save money and improve care for patients.
When ACOs are finally in place, Bartrum believes the Shared Savings Program might be “an opportunity for real money.”

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