Meaningful Data Sharing to Enable APMs

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1 Meaningful Data Sharing to Enable APMs MACRA Summit December 1, 2016 Kelly Cronin, MS, MPH, Director, Office of Care Transformation, ONC/HHS

2 Quality Quality Payment Payment Program Program Strategic Strategic Goals Goals Improve beneficiary outcomes Enhance clinician experience Increase adoption of Advanced APMs Maximize participation Improve data and information sharing Ensure operational excellence in program implementation Quick Tip: For additional information on the Quality Payment Program, please visit QPP.CMS.GOV 2

3 CMS Quality Payment Program Final Rule with Comment Merit-Based Incentive Payment System Eligible clinicians and groups are scored based on their performance in 4 categories. Their score is compared across the program to earn a potential positive or negative payment adjustment to Medicare payments. Quality Cost Improvement activities Advancing care information Alternative Payment Models (APMs) An APM is a payment approach that gives added incentive payments to provide highquality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes. 3

4 Merit-based Incentive Payment System (MIPS) Scoring COST 10% IMPROVEMENT ACTIVITIES 15% QUALITY 50% ADVANCING CARE INFORMATION 25% 4

5 MACRA & the CMS Quality Payment Program Final Rule with Comment Health IT in ACI Health IT in Quality Closing the Health IT Referral Loop Bridging the Information Gap across Care Settings Incentivizes Public Health and Population Health Management Streamlining Reporting and Providing Flexibility Seamless Information Exchange through Health IT Flexible Options for Electronic Reporting End-to-End Electronic Reporting Bonus Health IT in Improvement Activities Includes a wide range of options that leverage certified health IT to support eligible clinicians in implementing clinical practice improvements. Certified EHR Technology Bonus for Improvement Activities Health IT In APMs At least 50 percent of the clinicians in an Advanced APM must use certified EHR technology Other payer APMs will align with Medicare APMs using certified EHR technology in future years APM Entities must comply with HIPAA and may also include additional APM specific technology initiatives 5

6 Merit Based Incentive Program Advancing Care Information Category The Advancing Care Information performance category includes measurement of eligible clinicians and groups use of certified EHR technology 6

7 MACRA Rule: The Prevention of Information Blocking & Supporting Providers through the Performance (SPPC) of CEHRT For eligible professionals, eligible hospitals and CAHs, and eligible clinicians using certified EHR technology: Prevention of Information Blocking Attestation CMS finalized the provision implementing Section 106(b)(2) of the MACRA law, which requires eligible providers to demonstrate that they have not knowingly and willfully limited or restricted the interoperability of certified EHR technology. exchange of electronic health information with other health care providers. SPPC Attestation CMS finalized a two part attestation for health care providers using CEHRT in the EHR Incentive Programs and Merit Based Incentive Program (MIPS): As it relates to ONC direct review, the attestation is required. As it relates to ONC-ACB surveillance, the attestation is optional. Also check out ONC s EOA Final Rule and the 2015 Edition Final Rule, which include provisions that support provider use of certified health IT by helping to ensure that products and capabilities continue to perform as expected when they are implemented and used in the field. 7

8 Health IT and Alternative Payment Model Framework APM Health IT and Alternative 12/1/2016

9 HIT Modular Functions for Value Based Payment Providers & Data Sources Reporting Services Payers and Other VBP Stakeholders Health Care Provider Systems Other Non- Health Care Provider Systems EHR Claims Data Clinical Data Information Analytics Services Notification Services Exchange Services Data Extraction Data Quality & Provenance ID Management Data Transport and Load Consumer Tools Provider Portal Patient Attribution Data Aggregation PD/Registry Various Reporting Formats Private Purchasers CMS & Other Federal Agencies Medicaid & Other State Agencies ACOs MCOs - APMs Registries Security Consent Mngt Public Health Other Non- Provider Systems Governance Financing Policy/Legal Business Operations Other 9

10 MACRA Multi-payer APM Requires A More Rational Approach to Data Current State Future State Payer 2 Payer 3 CMS Payer 1 Payer 2 Payer 3 CMS Payer 1 Provider QCDR Shared Services and Third Party Entities (e.g., HIEs, QEs, QCDRs, Vendors, others) Facilitate Provider Reporting and Feedback Leveraging Shared Services (e.g., Provider Directory, ID Management, etc.) Example: A provider receives data feeds on their performance from multiple payers, and reports out to multiple payers Provider