Welcome to TIM Talks: Business Acumen

“Health IT Interoperability and the 

Community Based Organization (CBO)”

January 31 , 2017
Health IT and the CBO

Timothy P. McNeill, RN, MPH

Healthcare Consultant
Role of Health IT in Reform

Opportunities for CBOs to participate

Application of Health IT with CBO 

Next Steps 4

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Health Information Technology Investment

• Office of the National Coordinator (ONC)

– Authorized by the American Recovery and Reinvestment Act of 

2009 (ARRA) -- also known as the Stimulus Bill

• HITECH Act (Health Information Technology for Economic 

and Clinical Health Act)

– Administers the provider/hospital electronic health record (E.H.R 

incentive program

• Provides direct financial payment to physicians and hospitals 

that adopt qualified electronic health records and use the 

products in a meaningful way – ”Meaningful Use Standards”

• State and Regional Health Information Exchanges

– Financial assistance to State and localities that develop health 

information exchanges
Role of Health IT Policy in Payment Reform

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• The Patient Protection and Affordable Care Act

– Health Reform. Commonly called the Affordable Care Act or ACA

– Signed into law by President Obama on March 23, 2010

– On June 28, 2012, the Supreme Court rendered a final decision to 

uphold the law

• MACRA – Medicare Access and CHIP Reauthorization 

Act

– Increased emphasis on Physician participation in “Alternative 

Payment Models (APMs)”

– APMs – ACOs and Bundled Payment
MACRA and Health IT requirements

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• The shift towards value-based payments requires an analysis 

of the quality and cost of services rendered.

• Assessment of quality and cost is done primarily through the 

submission of electronic quality measures

• Certified E.H.Rs have components to track and report 

mandatory electronic quality measures

• Inability to report electronic quality measures is a failure on 

the measure
eCQMs or eMeasures

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• electronic Clinical Quality Measures – eCQMs

• Specific clinical quality measures that must be reported by 

physicians, providers, and hospitals that are eligible for 

incentive payments

• MACRA regulations begin to link provider performance on 

eCQMs to payment
Provider Merit Incentive Payment System

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Provider MIPS Categories

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• Quality

• Advancing Care Information

• Improvement Activities

• Cost
MIPS Quality Category

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• Must report up to 6 quality measures, including an outcome 

measure

• Most measures are clinical in nature

– All-cause hospital readmission

– Diabetes management

– Depression Screening 

– Falls

• Plan of Care

• Risk Assessment

• Screening for Future Fall Risk
Potential Role of CBO in supporting MIPS 

Quality Measures

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• Identify which measures the provider is going to report

• Align CBO programs with the planned reporting measures

• Examples:

– Fall Risk – Matter of Balance, Stepping On, Etc.

– Diabetes Management – DSMT

– Depression Screening/Mgmt – PEARLS

– Readmissions – Care Transitions and chronic care mgmt
MIPS – Advancing Care Information

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• In 2017, providers must report on two measures.

• Focus in on how the E.H.R is utilized to coordinate care

• Examples:

– E-Prescribing

– Request/Accept Summary of Care

– Send a Summary of Care

– Secure Messaging
MIPS – Improvement Activities

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• New Category

• Physicians are rewarded for care focused on care 

coordination, beneficiary engagement, and patient safety

• Examples:

– Care transition documentation practice improvements

– Chronic care and preventative care management

– Engagement of community for health status improvement

– Evidence-based techniques to promote self-management

– Collection and follow-up on patient experience and satisfaction data 

on beneficiary engagement
MIPS – Cost Measure

• Not included in the 2017 measurement – delayed until 

2018

• No data submission required

• Performance is based on adjudicated claims

– What was the total cost of care for the population of 

patients under your care
MIPS and Provider Payment

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• Providers will earn a performance-based payment 

adjustment to their Medicare payments

• Payment adjustments are directly tied to their performance 

and practice-specific quality data

• 2017 is the based performance year

• Payment adjustments will begin based how well provider 

perform on measures in 2017
CBO role in supporting MIPS

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• MIPS requires providers to report on specific e-Measures

• e-Measures originate from the electronic health record

• Many e-Measures can be influenced by partnering with 

CBOs

• Compatible systems are required to track, share, and report 

performance on required e-Measures
Application of the Concept - Depression

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• Preventive Care and Screening: Screening for Clinical 

Depression and Follow-up Plan

– Provider screens for clinical depression

• Any beneficiary identified with mild to moderate depression 

referred to a CBO PEARLS program

– PEARLS program has the capacity to receive referrals, document 

services rendered, and report outcomes

– PEARLS program submits electronic reports back to the provider

– Provider submits eMeasure showing the following outcomes

• Depression Screening

• Send and Receive care plans

• Intervention provided and outcomes documented in physician 

E.H.R
What type of system is required?

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• Your ability to support the change to value-based payment is 

dependent upon your ability to support eMeasure

performance

• Questions to Ask:

– Provide documentation showing system is Meaningful Use Certified

• If certified, it can communicate with ANY other system –

EPIC, Cerner, Athena, etc.

– Integration with Billing and Revenue Cycle Mgmt Services

– Secure Messaging capability

– Ability to use on mobile platforms (Tablets, Laptops, Etc.)

– Willingness to customize workflows to align with CBO programs
Funding Opportunity to Support CBO 

Participation

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CMS Notice Excerpts

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• ...State costs of facilitating connections between 

Eligible Providers and other Medicaid providers (for 

example, through an HIE or other interoperable 

systems), or costs of other activities to promote other 

Medicaid provider’ use of E.H.R and HIE, can also be 

matched at the 90 percent HITECH matching rate.
CMS Notice Excerpt #2

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• States may thus be able to claim 90 percent HITECH 

match for expenditures related to connecting Eligible 

Provider to other Medicaid providers,...including 

community-based Medicaid providers.
Draft eMeasure Impacting Nutrition Programs

• Proposed hospital eMeasure for screening and identifying 

malnutrition in hospitalized patients

• Research shows that up to 1 in 4 hospitalized older adults 

have malnutrition.

• eMeasure requires screening, diagnosing, and establishing 

an intervention to address malnutrition

• Diagnosis of malnutrition requires a community 

intervention and follow-up
Next Steps

• Identify Programs that align with required eMeasures

– eMeasures can be found at the following website:

– https://qpp.cms.gov/learn/qpp

• Determine if you have a meaningful use certified system 

or access to one through partnership

– Certified Systems can be found at the following website:

– https://chpl.healthit.gov/#/search
Next Steps (Cont.)

• Develop your pitch and analyze the market

• Finalize your strategy and enter the market

• New rules are spurring new entrants to the market which 

also open opportunities for teaming or public-private 

partnerships

– MSOs: 

– General Electric (GE), 

– United Healthcare/Optum, 

– Centene/Envolve
Questions?

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