Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
Since the passage of the Patient Protection and Affordable Care Act, most of the health reform activity in the Medicaid arena has primarily been about expansion of coverage. According to the Centers for Medicare and Medicaid Services (CMS), as of February 2015, 70.5 million people—more than one in every five Americans—were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), which represents an increase of almost 40 percent from the number enrolled at the end of 2009.
However, on May 26, CMS aimed its sights on improving the quality of care delivered by Medicaid, issuing a 653-page proposed rule to “modernize the Medicaid managed care regulations,” which have not been revised in a decade. The proposed rule faces a public comment period that will continue thru July 27.
The changes presented in the proposed rule would align the regulations governing Medicaid managed care with those of other major sources of coverage, including Medicare Advantage (MA) plans and Qualified Health Plans (QHPs), which are offered thru health insurance exchanges (marketplaces). CMS has said that the proposed Medicaid measures will emphasize evaluating health outcomes and the patient experience enrollees have with private plans. In addition, the proposed rule mandates public reporting of information on quality of care, as well as the use of financial incentives to reward Medicaid managed care plans that meet quality measures, a la Medicare Advantage Star Ratings.
CMS’s announcement has been met with mostly favorable responses. “It was about time for the changes” has been a common refrain, with the revisions viewed as a natural, logical progression.
How big is the market that will be impacted by the changes? Per CMS, Medicaid managed care organizations (MCOs) have grown from handling 8 percent of Medicaid beneficiaries in 1992 to about 70 percent of the 70 million Medicaid enrollees today—almost 50 million people. That figure compares with 17.3 million MA enrollees as of January 2015.
Guest post by Chris Boone, CEO, Health Data Consortium.
Consumers are receiving more health data than ever, as evidenced by the myriad mobile apps (WeightWatchers, Mindshift, Nike+ Training Club, etc.) and wearables (FitBit, iWatch, Jawbone, etc.) now available. With health data so pervasive, health literacy has become a commonly discussed issue as it pertains to consumers’ ability to obtain and process healthcare information to make better healthcare decisions. But, with the advent of so much data, there must be a national emphasis on the importance of health data literacy, as well, to empower patients to leverage available data in a meaningful way that can improve their and their loved ones’ health outcomes.
The Health Data Literacy Landscape
There remain challenges to the health data movement – such as privacy concerns – and as a result, questions around how to improve health data literacy remain largely unexplored. The road to health data literacy starts with digital access to health information, and new technologies that seamlessly augment consumers’ daily health practices to enable better health decision-making. Interestingly enough, however, the rate at which health data entrepreneurs and innovators are producing incredible technologies may be exceeding the rate at which consumers are able to digest and use the information.
So, how do we leverage the opportunities provided by greater access to health data without overwhelming the consumer?
Data Visualization and the User Experience
Once data becomes accessible to consumers, data visualization is a key component to ensuring it is understandable and actionable. Consumers must be able to comprehend and digest data to put it to work.
In addition – and like in any other industry – the user experience must be a top priority when building new technologies. We need developers to build mobile apps, wearables, websites, etc. that are simple in design with an emphasis on providing useful and easily actionable data for consumers.
On May 28, HIMSS submitted comments to the Department of Health and Human Services on the meaningful use Stage 3 proposed rule and the 2015 Edition Health IT Certification Criteria. The two letters, sent to Acting CMS administrator, Andrew Slavitt, and National Coordinator for Health IT, Dr. Karen DeSalvo, respectively, strongly urge CMS and ONC to:
Decrease the prescriptive nature of the EHR Incentive program,
Increase focus on the substantial capabilities established earlier in the program, and
Reduce complexity in the 2015 Certification Criteria.
HIMSS voiced its continued support for the meaningful use program as a tool to positively transform health and healthcare in the United States. Identifying meaningful use as a “critical tool for enabling healthcare transformation,” the response cites HIMSS Analytics data – collected annually on all non-federal US hospitals, and more than 30,000 tethered US ambulatory facilities – that “70 percent of hospitals have made a positive progression in the advancement of their EHR capabilities over the last five years, with more than 60 percent of ambulatory facilities showing similar progress in the last three years.”
HIMSS reiterated its long-standing commitment to interoperability: “HIMSS is committed to a culture in which IT is fundamental to transforming healthcare; improving quality of care, enhancing the patient experience, containing cost, improving access to care, and optimizing effectiveness of public payment.”
HIMSS remains strongly committed to making the Electronic Health Record Incentive program less prescriptive and more focused on encouraging and assisting providers to take advantage of the substantial capabilities established in Meaningful Use Stages 1 and 2, including interoperability.
HIMSS applauds a proposal in the NPRM for a single definition of Meaningful Use starting in calendar year 2018, no matter when a provider began to participate in the EHR Incentive Program.
HIMSS supports the work being done by CMS to align the EHR Incentive Program with other CMS quality reporting programs that also use certified health IT. HIMSS believes such efforts will lessen the burden on providers.
HIMSS is committed to ensuring patient safety remains paramount to the development, implementation, and wide-spread use of health IT systems.
HIMSS reiterates its long-standing assertion that 18 months is the minimum length of time needed between the final rules on Meaningful Use, certification, and standards, and the start of any stage of Meaningful Use. An 18-month timeline allows stakeholders to help educate and prepare providers on the upcoming new stage. The current timeline for transitioning to Meaningful Use, Stage 3 in 2017 and 2018 does not include 18 months.
At Health Datapalooza, the acting Centers for Medicare & Medicaid Services (CMS) Administrator, Andy Slavitt, announced a new policy that for the first time will allow innovators and entrepreneurs to access CMS data, such as Medicare claims. As part of the Administration’s commitment to use of data and information to drive transformation of the healthcare delivery system, CMS will allow innovators and entrepreneurs to conduct approved research that will ultimately improve care and provide better tools that should benefit healthcare consumers through a greater understanding of what the data says works best in health care. The data will not allow the patient’s identity to be determined, but will provide the identity of the providers of care.
CMS will begin accepting innovator research requests in September 2015.
“Data is the essential ingredient to building a better, smarter, healthier system. The announcement is aimed directly at shaking up health care innovation and setting a new standard for data transparency,” said acting CMS Administrator Andy Slavitt. “We expect a stream of new tools for beneficiaries and care providers that improve care and personalize decision-making.”
Innovators and entrepreneurs will access data via the CMS Virtual Research Data Center (VRDC), which provides access to granular CMS program data, including Medicare fee-for-service claims data, in an efficient and cost effective manner. Researchers working in the CMS VRDC have direct access to approved privacy-protected data files and are able to conduct their analysis within a secure CMS environment.
“Historically, CMS has prohibited researchers from accessing detailed CMS data if they intended to use it to develop products or tools to sell,” said Niall Brennan, CMS chief data officer and director of the Office of Enterprise and Data Analytics. “However, as the delivery system transforms from rewarding volume to value, data will play a key role. We hope that this new policy will lead to additional innovation and insights from the CMS data.”
Guest post by Donald M. Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University; and Thanh Tran, CEO, Zoeticx, Inc.
The ECRI Institute released in May a survey outlining the top 10 safety concerns for healthcare organizations in 2015. The second highest concern is incorrect or missing data in EHRs and other health IT systems.
HIEs? The latest Black Book survey in the U.S. finds that 90 percent of hospitals and 94 percent of independent physicians don’t trust the business model of public HIEs and have concerns over how much of the cost payers will be fronting, causing a contraction in the HIE market. Even the ONC and medical industry are at odds on how to address the interoperability issue. The ONC does not even mention middleware in any of its plans.
Even HL7 does not provide the seamless connection of middleware and is only capable of connecting one medical facility to another, requiring specific end point interfaces to even do that. For every additional facility, a customized interface must be built. At the end of the day, HL7 is really a point-to-point customized interface requiring extra steps. A middleware platform does not tie developers to specific hospitals or EMRs and allows universal access.
Meanwhile, yet another survey cites the tragedy of a lack of interoperability. A new survey of nurses nationwide, taken by the Gary and Mary West Health Institute, find that some 60 percent of registered nurses say medical errors could significantly decrease if hospital medical devices were coordinated and interoperable. Also, 74 percent of these nurses agreed that it is burdensome to coordinate the data collected by medical devices and 93 percent agreed that medical devices should be able to seamlessly share data with one another automatically.
Half of them claim they actually witness medical mistakes because of lack of interoperability of these devices. Some 46 percent of RN respondents also noted that when it comes to manual transcription from one device to another, an error is “extremely” or “very likely to occur.”
From a cost perspective, West Health Institute officials estimate that a connected, fully interoperable health system could save a potential $30 billion each year by reducing transcription errors, manual data entry and redundant tests. Meanwhile physicians and surgeons struggle with interoperability on a daily basis.
According to data published on HealthIT.gov, 173 health IT vendors are supplying certified EHR products to more than 4,500 hospitals. Despite wide penetration of EHR’s in hospitals, clinics and physician offices, access to patient information between systems continues to plaque our healthcare system.
Mobile health technologies have been on the rise for quite some time, with the number of health and fitness apps doubling over the last two years, these tools are becoming a part of our daily lives. Health apps can do everything from monitoring sleep patterns to diagnosing diseases, while other evolving technologies are paving the way for a seamless patient care experience via online patient records. An expansive infographic by the Adelphi Healthcare Informatics Master’s Degree program that follows details these important technologies.
In the beginnings of 2014, almost 50 million Americans were using health and fitness apps to monitor their behaviors. Among their most important reasons for doing so are keeping track of personal goals, staying on top of health issues, and gaining motivation. The ability to track and improve eating and exercise habits has only scratched the surface; as more and more people hop on board, the technologies will continue to get better and better.
Beyond the health and wellness applications of mobile health technologies are the value of mobile diagnoses. There are mobile technologies for diagnosing issues with the eyes, for diagnosing malaria and thyroid conditions and screening for oral lesions. These and other technologies have a wide range of applications and will only become more useful as remote areas and countries gain more access to them.
Reviewing test results online, scheduling appointments and requesting medication refills are just some of the capabilities that come along with the evolution of online patient records. Being able to interact with records and doctors in real time from miles away has the potential to revolutionize the way that the healthcare industry functions. Not only does this improve communication, but it also saves time and removes barriers that can crop up along a patient’s medical journey.
The possibilities for keeping track of health and wellness, improving the ability to make diagnoses around the world, and accessing patient records from anywhere are what make mobile health technologies exciting.
Guest post by Sergio Galindo, general manager, GFI Software.
With stolen medical data selling on the black market at a rate anywhere between 10 to 50 times that of stolen credit card numbers, hackers have a new favorite target – the healthcare industry.
The industry is a sitting duck, and hackers have declared open season. Indeed, we have seen several extremely high-profile penetrations of healthcare companies in the past months, and more are likely in the coming months. Anyone with medical insurance should pay attention to the increasing number of data security breaches.
Consider the three most high-profile security incidents that have recently struck the healthcare industry. Community Health Systems claims that no medical information was exposed when the insurer was hacked, but the breach affected some 4.5 million records within their systems. In February of this year, Anthem reported that a breach resulted in 80 million records stolen, and recently data attackers broke into Premera Blue Cross and obtained medical and financial data of 11 million of their customers, stealing both electronic health records (EHR) and protected health information (PHI).
While stolen credit card data may fetch between $1 and $2 per record, EHRs are far more lucrative for hackers, often going for $20 to $50 per entry. This value stems from several reasons:
EHRs can contain data that enables identity theft;
Stolen EHRs can be used to commit insurance fraud;
Users can use EHRs to obtain medical services and prescription medications; and
EHRs can also be used for extortion.
It’s worth noting that the value of stolen data increases relative to its longevity as a source of revenue. Credit card numbers are often replaced in 30 to 90 days (a new number issued); business information remains valid for up to three years (price lists, customer database), for example, while medical information can remain valid for more than 10 years. Social Security numbers have the longest ROI for cybercriminals because they last until the individual passes away (and even then they are still used).
As the comment period has come and gone (ended May 29, 2015) for meaningful use Stage 3, and as multiple organizations, like CHIME, and countless other individuals have taken the time to comment on the final rule, I thought it was a good time to ask the question: Does the meaningful use Stage 3 rule sail or sink?
Procuring responses to this question from a number of health IT insiders helps to identify some of the most pressing issues with the final stage of meaningful use, a topic that is almost second to none in regard to generating support or opposition from those in the sector.
The College of Healthcare Information Management Executives, in its comments on the rule, called federal plans for the third stage of meaningful use too ambitious and in need of several important changes, but still offered their support for a corresponding CMS proposal that would shorten meaningful use reporting in 2015 from a full year to any continuous 90-day period. In total, CHIME said meaningful use Stage 3 is “unworkable.”
“Were all requirements finalized as proposed, we doubt many providers could participate in 2018 successfully,” CHIME said. “And with so few providers having demonstrated Stage 2 capabilities, we question the underlying feasibility of many requirements and question the logic of building on deficient measures.”
Bennett Lauber
Bennett Lauber, chief experience officer, at The Usability People offered a slightly different take: “The MU3 program contains some well-needed enhancements to the Safety-enhanced design portion of the 2015 certification criteria. They have also proposed significant changes to the Safety-enhanced Design (aka usability) testing requirements. These new requirements might seem burdensome to some of the smaller EHR vendors, as they require 17 and not seven items to be usability tested and finally set a minimum number of participants for these studies and more. With everyone complaining about the (lack of) usability of healthcare software these additional requirements should be welcome as they force the vendors to perform real summative usability tests and as a result it eventually might actually save lives.
David Muntz
David Muntz, former principal deputy director of the ONC and current CIO of GetWellNetwork adds, “Getting to a common stage is a good thing, but there is still some concern expressed by those who are struggling with the move from Stage 1 and Stage 2 to the future state. The limit on adding new elements is a positive, though some of the thresholds that need to be met will be a concern to many, particularly those that require a provider to affect behaviors in the patients. Standardizing quality measures and adjusting the reporting period are good moves, but the possibility of requiring all vendors to have a complete set will delay release dates.
“The encouragement to add APIs for data exchange is a positive. More thought, however, is needed to the areas where open APIs can prove beneficial. Secure messaging is great, but the threshold for usage is really based on patient preference and may be a bit aggressive. The greatest disappointment was the continued use of specific features and functions without an alternative to deem features and functions based on a combination of appropriate process and outcome measures. A deeming approach would have given the users a great deal of latitude in how to implement features and functions that would have produced favorable outcome.”
At Health Datapalooza, the acting Centers for Medicare & Medicaid Services (CMS) Administrator, Andy Slavitt, announced a new policy that for the first time will allow innovators and entrepreneurs to access CMS data, such as Medicare claims. As part of the Administration’s commitment to use of data and information to drive transformation of the healthcare delivery system, CMS will allow innovators and entrepreneurs to conduct approved research that will ultimately improve care and provide better tools that should benefit healthcare consumers through a greater understanding of what the data says works best in health care. The data will not allow the patient’s identity to be determined, but will provide the identity of the providers of care.
