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HIEs play crucial role in change to value-based reimbursement, HHS analyst says

Providers range from linking some payments to the effective management of a population to full population-based management.
By Susan Morse
05:37 PM

LAS VEGAS - Health information exchange is an essential tool to support the transition to value-based payment models, according to Alex Baker of the U.S. Department of Health and Human Services, who gave an overview of federal initiatives and how states, hospitals and physicians can benefit from the innovations, during HIMSS16 in Las Vegas.

Baker is a public health analyst, Office of Care Transformation, a relatively new office at the Office of the National Coordinator for Health Information Technology.

“I think a good framing point is the way the ONC and Health and Human Services think about interoperability and delivery, is they  see delivery system reform as providing the business case for health information exchange.”

Health and Human Services is getting stakeholders and states involved in supporting delivery system reform through such efforts as a nationwide interoperability roadmap released in January 2015. The roadmap is to guide towards meeting the goal of shared information.

It sets such high-level goals as having, by the end of 2017, providers using a common set of clinical information at the nationwide level, Baker said.

The roadmap was announced at the same time as Health and Human Services Secretary Sylvia Burwell announced the goal of tying 30 percent of Medicare fee-for-service payments to quality or value through alternative payment models by 2016, and 50 percent by 2018.

Providers can be ready through various models, from linking some payments to the effective management of a population, to full population-based management.

Through Medicare, alternative payment models include bundled payments, accountable care organizations, Medicare Shared Savings, Pioneer and the new Next Generation model.

A total of 477 ACOs have been established. Of 121 new ACOs in 2016, 64 are risk-bearing, which is an important increase, Baker said.

“But the department is very interested in making sure this is not just Medicare, but that we engage stakeholders in the private sector as well as states,” Baker said. “We want to shift momentum from CMS to the private payer and state communities.”

Currently six states are in a testing phase for an innovation model  for alternative payment models: Maine, Vermont, Oregon, Arkansas, Massachusetts and Minnesota. That number is expected to increase to 11 in round two and and another 21 states are involved in a design phase before moving to testing phase, Baker said.

The Office of the National Coordinator for Information Technology is supporting the state innovation model by providing technical assistance, Baker said.

“The philosophy is states can make real strides in efficiency and savings by investing in shared services across providers for data quality,” he said.

Twitter: @SusanJMorse


This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.