Wednesday, June 08, 2016

#CM4H16 Removing Burdens from Providers

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MACRA permanently repealed SGR.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?

  • Transparency

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 ( )

The challenge is to process ADT messages to identify actionable issues and alert care managers appropriately.


Carebridge Record Exchange – HL7 CCDA
ADT Alerts

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.

[category News, Health]
[tag health, cloud, ONC, opendata, hdpalooza, blue button, CM4H16]

Mark Scrimshire
Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Stay up-to-date: Twitter @ekivemark

I am currently HHS Entrepreneur-in-Residence and CMS BlueButton Innovator working on an assignment to update BlueButton for Medicare Beneficiaries.

The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.
Medyear: Less Hassle, Better Care.

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