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Archive for the ‘Medicare’ Category

Accountable Care Organizations, Data Federation and CMS’ Updated Final Rule for the Medicare Shared Savings Program

Monday, June 8th, 2015

CMS LogoCMS has published a final rule (http://federalregister.gov/a/2015-14005) focused on changes to the Medicare Shared Savings Program (MSSP) which impacts Accountable Care Organizations (ACO) significantly. There are a variety of interesting changes being made to the program. For this discussion I’m looking at CMS’ continual drive toward data use and integration as a basis for improving quality of care, gaining efficiency and cutting costs in health care. One way this drive is manifested in the new rule regards an ACO’s plans as related to “enabling technologies,” which is an umbrella term for leveraging electronic data.

As background, Subpart B (425.100 to 425.114) of the MSSP describes ACO eligibility requirements. Two of the changes in this section clearly underscore the importance of electronic data and data integration to the fundamental operation of an ACO. Specifically, looking at page 127, the following updates are being made to section 425.112(b)(4) (emphasis mine):

Therefore, we proposed to add a new requirement to the eligibility requirements under § 425.112(b)(4)(ii)(C) which would require an ACO to describe in its application how it will encourage and promote the use of enabling technologies for improving care coordination for beneficiaries. Such enabling technologies and services may include electronic health records and other health IT tools (such as population health management and data aggregation and analytic tools), telehealth services (including remote patient monitoring), health information exchange services, or other electronic tools to engage patients in their care.

It goes on to add:

Finally, we proposed to add a provision under § 425.112(b)(4)(ii)(E) to require that an ACO define and submit major milestones or performance targets it will use in each performance year to assess the progress of its ACO participants in implementing the elements required under § 425.112(b)(4). For instance, providers would be required to submit milestones and targets such as: projected dates for implementation of an electronic quality reporting infrastructure for participants;

It is clear from the first change that an ACO must have a documented plan in place for continually expanding its use of electronic data and providing data visibility and integration between itself and its beneficiaries and providers. This is a tall order. The number of different systems and data formats along with myriad reporting and analytic platforms makes a traditional integration approach tedious at best and a significant business risk at worst.

The second change, keeping CMS apprised of the progress of data-centric projects, is clearly intended to keep the attention on these data publishing and integration projects. It won’t be enough to have a well-articulated plan, the ACO must be able to demonstrate progress on a regular basis.

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Data Unleashed™ Headed to the 2014 Medicaid Managed Care Congress

Thursday, May 15th, 2014

License plate and Data Unleashed license plate frameFor those of you spending time in Baltimore next week (May 19-21, 2014) to attend the Medicaid Managed Care Congress please stop by Blue Slate’s booth. Our MINI road trip begins Sunday as we head for Camden Yards and the beautiful inner harbor area. Our goal in attending? Having the opportunity to speak with you about your data challenges as well as your Medicaid journey.

Data Unleashed(tm) LogoWe will be demonstrating what we mean by lightweight data federation and agile analytics as the drivers behind creating the Data Unleashed™ service platform. Given our extensive healthcare focus, we have deep experience working with companies on Medicaid initiatives, such as those involving dual eligibles, for instance the FIDA program in New York State.

Beyond data integration and analytics, we provide expertise for plans to: implement business process and business rule management solutions; prepare for site reviews and audits; and unify data from a variety of internal and cloud-based systems. More broadly beyond Medicaid, we work extensively in the Medicare and commercial healthcare space, leading transformative change for businesses such as Medicare Administrative Contractors (MACs) and Blues plans.

We look forward to having a chance to learn more about your operational challenges and share with you our organization’s background and focus areas. Let’s get together and explore opportunities to advance your organization’s strategic goals around  improving quality of care and reducing costs.