Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

Health Information Technology Allows Payers to Share Data

CMS partnered with private payers to improve primary care delivery using health information technology and data exchange.

Health information exchange

Source: Thinkstock

- The Centers for Medicare & Medicaid Services (CMS) strive to create programs meant to bring “better care, smarter spending, and healthier people.” CMS partnered with healthcare payers across seven regions to improve primary care through the Comprehensive Primary Care initiative (CPC), according to The CMS Blog. Through the use of health information technology and multi-insurer payment reform, the program was created to support primary care practices in advancing the quality of care.

Payers across three regions including Colorado, Ohio, and Oklahoma and CMS partnered to create reports with private patient data to provide quality information directly to primary care offices. Payers worked closely with primary care practices while CMS continually transformed the format and wording of the reports.

Utilizing health information technology and sharing key patient data has become a vital aspect of improving patient care inside and outside of primary care physician offices. By ensuring primary care doctors have access to a patient’s overall medical data outside of their office, physicians will be able to reach out to their patients and offer services before a patient seeks more costly emergency care.

Prior to the Comprehensive Primary Care initiative, primary care doctors often had multiple reports from different healthcare payers with various quality measures and formats. Such diverse reports made it more difficult for providers to target what data mattered and how they could act on the given data.

However, CMS programs like the Comprehensive Primary Care initiative provide aggregated data reports, which offer doctors with a stronger understanding of their patient populations and enable them to identify gaps in care. Physicians can then focus on areas where population health management could be improved.

“This was a much anticipated solution to the complexities posed by not having access to consistent claims data, and a continuous desire to improve our approach to meeting CPC Milestones [program requirements],” said Dr. Austin Bailey, Medical Director of University of Colorado Health (UCHealth).

“Our practices will continue to leverage the use of aggregated claims data using Stratus [the tool for practices in Colorado] to identify the cost patterns of high risk patients — for example, among our patients with diabetes, is the greatest cost associated with specialists, emergency department utilization, or medications?  Having this information across multiple payers makes it more relevant and helps to build our confidence in selecting the appropriate interventions, identifying trends, and effectively assigning care management resources,” Bailey concluded.

The Comprehensive Primary Care Plus program is an advanced version of the former initiative and began operating on January 1, 2017. More than 50 private healthcare payers have partnered with state Medicaid agencies and CMS across 14 regions to participate in the Comprehensive Primary Care Plus program.

CMS is looking to continue working with payers to expand the implementation of aggregated data reports and health information technology to share medical information that enables physicians to identify gaps in care. Private and public healthcare payers are encouraged to work with primary care physicians and the patient population to deliver medical data meant to improve the quality of care.

The sharing or exchange of data through health information technology enables doctors to strengthen care coordination, fill in gaps in care, and focus on increasing preventive care use, said Dan Paoletti, CEO of Ohio Health Information Partnership at CliniSync.

In the past, hospitals, clinics, and payers had a fragmented system of healthcare delivery with inadequate communication and coordination. Since then, health information technology and the sharing of data enabled payers and providers to improve coordination and the use of preventive care.

“Having access to information really goes back to managing coordination of care,” Paoletti said. “One of the most important things related to that is preventative care because, ultimately, this is about trying to keep people healthy. That’s how we’re going to manage risk by making that pool of healthy people bigger and reducing overall costs of care through that.”

“It really is critical to get the information where it needs to be in order to fill in the gaps that exist today,” Paoletti added. “That’s what we’re trying to do and that’s where we’re headed on a larger scale.”

Additionally, the results from health information exchange shows that duplicative testing is reduced and wasteful spending is also decreased, said Paoletti.

“I think what will result [from health information exchange] will be a reduction in spending both because ultimately, it will increase preventive care but also realistically we will have a reduction in tests and duplicative services because the information will be available,” Paoletti asserted.

Private and public payers are advancing their work with primary care doctors to share patient data more quickly to fill in gaps in care and improve coordination.

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