Removing Burdens from Providers – What Approaches are Most Effective?
Dr. Andrea Gelzer, Chief Medical Officer, Amerihealth Caritas
Many different approaches to health information sharing have been launched in the past decade, with some having more impact than others. What approaches have had the most impact, and hold the most promise for the future?
Payment Reform is no longer voluntary
MACRA permanently repealed SGR.
Multiple programs combined into MIPS
Alternate Payment Models framework.
Most people are in a Quality bonus mode of Fee For service.
Nobody wants to take down-side risk.
APMs require population-based risk-based payments. condition-specific or comprehensive population based.
What can plans do to help?
understandable and actionable contracts.
tools to help assess performance.
- Proactive Care Management
Target patients that need care
Support across the continuum
use mobile technologies
- Information Exchange
Align with State and Region HIEs
Encourage information flows – No blocking
Leverage actionable analytics
Target who is on the slope to high disease burden. ie. Before it is too late.
Ameritas uses MIRTH to integrate with HIEs ( http://2.healthca.mp/217KP5p )
The challenge is to process ADT messages to identify actionable issues and alert care managers appropriately.
Carebridge Record Exchange – HL7 CCDA
Looking at MiHIN Quality Reporting and Medication Reconciliation
Payers/plans will be critical partners as payment reform takes hold.
Desparate need for Health Informatics staff.
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I am currently HHS Entrepreneur-in-Residence and CMS BlueButton Innovator working on an assignment to update BlueButton for Medicare Beneficiaries.
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