Administration announces $1 billion initiative to provide better health care and lower costs

By Rick Gilfillan, Director, CMS Innovation Center

Bringing down health care costs is a top priority. That’s why the Affordable Care Act contained an historic set of reforms designed to reward higher quality and lower the cost of care.  And we know that the best way to do that is the same way leading health care organizations do it: by making care better and more efficient.

We also know there are great ideas out there that can help push this work forward and that the kinds of innovative practices that make our health care system work better for everybody can come from any corner of the country. That’s why today we’re launching a $1 billion initiative through a second round of Health Care Innovation Awards.

These Innovation Awards will be given to organizations whose creative solutions to our most pressing health care challenges have the potential to serve as models for improving care and lowering costs across the country.

In November of 2011, we launched our first round of Health Care Innovation Awards by issuing a challenge to America’s health care providers, businesses, universities, and community groups.  We asked them to submit their proposals for how to get the most out of our health care dollars by delivering better care. That challenge resulted in more than 3,000 applications, from which a team of independent experts and HHS officials selected 107 promising innovations with the strongest likelihood of creating larger-scale, sustainable results.

And as we kick off round two of the Innovation Awards today, we’re already seeing encouraging results from a number of our round one recipients. The University of Miami, for example, is transforming school-based health clinics into medical homes to serve vulnerable children. These medical homes are connected to community health care providers and these children are already receiving tele-health consults for dermatology, psychiatry, and nutrition along with dental care.

Another recipient, Christiana Care Health Services, has used advanced data analytics to improve preventive care for patients with heart disease. Their comprehensive electronic registry allows providers to more quickly and accurately assess patients’ symptoms and needs based on similar occurrences in the past. This smarter preventive care doesn’t just prevent tragedies before they happen—it also saves money on hospital visits.

As with last year’s awards, we’re seeking out innovative practices that have a high likelihood of delivering better care and lower costs on a national scale.  The last few years have seen us make tremendous strides towards keeping health care spending in check, and a lot of that is thanks to innovations that have helped improve the quality and efficiency of care delivery and payment systems.

Across the country, private and public sector innovators are developing even more great ideas to improve our health care system.  And today’s announcement will allow us to take some of the most promising innovations and put them into action for the benefit of all Americans.  That’s good news for patients, for providers, for our economy, and for the future of American health care.

More information is available at: http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/Round-2.

Learn more about the key features of the Affordable Care Act.

Continuing to work with states to build new systems of health coverage

By Cindy Mann CMS Deputy Administrator and Director, Center for Medicaid and CHIP Services

CMS is committed to working in partnership with states in administering their Medicaid and Children’s Health Insurance Programs (CHIP) and to providing flexibility in pursuit of our shared goals.

Premium assistance has been a longstanding option in both Medicaid and CHIP and is one way to accomplish those shared goals.  CMS provided guidance in December of last year on how states might use these options to develop state-based solutions that meet both the state’s unique needs and requirements of the programs

In response to some questions that have been raised by states, today we are issuing some clarifying guidance.   Today’s Frequently Asked Questions explain the basic requirements that apply when a state chooses the premium assistance option and the guidelines we would apply when a state requests a waiver to implement premium assistance.  Under both approaches, individuals remain Medicaid beneficiaries and continue to be eligible for benefits and cost-sharing protections established by law.

As we review waiver proposals, HHS will consider factors that will impact cost effectiveness, such as those introduced by the creation of Health Insurance Marketplaces.

We remain committed to working with states and providing them with the flexibility and resources they need to build new systems of health coverage.  Premium assistance is simply one option, and we will continue to work with states on solutions that work best to meet shared goals.  We encourage states to come to us with their delivery system ideas, and look forward to continuing to work with states on these and other innovative approaches.

Premium Assistance FAQ

eHealth: Aligning Quality Measurement at CMS

By Patrick Conway, MD, MSc

Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs

The next step on the path of meaningful adoption of health information technology (HIT) for providers—will launch later this year for hospitals and next year for eligible professionals. How will this next phase improve health care and reduce the burden on providers?

Achieves Electronic Data Reporting

With the increase in adoption of EHRs, we are moving away from technology as an end goal and towards the use of technology as a key tool in health care quality improvement. The next phase of the EHR Incentive Programs will encourage the adoption of broad scale electronic reporting of quality data.

Aligns of Quality Measurement

One of the foremost goals of Stage 2 is the alignment of quality measure reporting across CMS programs. CMS has worked with partners and representatives from industry to identify and finalize a set of unified quality measures which meet the requirements of multiple programs, such as the Physician Quality Reporting System (PQRS) and Physician Value-Based Modifier, in addition to meeting EHR Incentive Programs requirements.  Accountable Care Organizations can also report quality measures from their EHRs to meet reporting requirements for participating eligible professionals.

The quality measure set—released by CMS last October—includes only measures that have been field tested, meet validation standards, and align with the National Quality Strategy, which outlines improvement goals for health care.

How Providers Benefit

For providers, program alignment means:

•  Using a single submission method to report on a unified set of quality measures
•  Choosing the submission method most suited to their unique needs

For example, eligible professionals may submit through a data-submission vendor or submit reports generated from their certified EHR technology directly to CMS.

As we look toward full implementation of meaningful use Stage 2 in 2014, CMS is committed to continuing to improve processes, support program alignment, facilitate interoperability and feedback to providers, and focus on the strategic use of health IT to drive quality improvement in our health care system and better outcomes for patients.

Learn more at HIMSS

We encourage you to learn more about CMS’ efforts during the CMS Quality Measurement Session at HIMSS13 today.

Administrative Simplification and ICD-10: Streamlining Health Care Operations

By: Christine Stahlecker, Director, Administrative Simplification Group, Office of E-Health Standards and Services, Centers for Medicare & Medicaid Services

Did you know that the United States spends more than $150 billion annually on health care administration, and for the average physician, two-thirds of a full time employee is needed to carry out billing and insurance related tasks?

To ease these financial and administrative burdens, the Health Insurance Portability and Accountability Act (HIPAA) and the Patient Protection and Affordable Care Act (Affordable Care Act) established administrative simplification requirements. These requirements are in place to lower costs, create uniform electronic standards, and streamline exchanges between health care providers and payers.

We at the Centers for Medicare & Medicaid Services (CMS) are charged with carrying out and enforcing the administrative simplification requirements for HIPAA-covered entities, which include health care providers that conduct certain transactions in electronic form, health care clearinghouses, and health plans.

The administrative simplification mandates require the adoption of operating rules for each of the HIPAA Administrative transactions; a unique, standard Health Plan Identifier (HPID); and standards and operating rules for electronic funds transfers (EFT) and claims attachments.

Two key components of administrative simplification are Version 5010 and ICD-10. Version 5010 modified standards for electronic transactions and created the platform to support the expanded ICD-10 code sets. The ICD-10 code sets convey clinical advances in health care and current medical protocols in the administrative transactions.

If you are attending the HIMSS13 conference and would like to hear more about these initiatives, be sure to catch our ICD-10 and Administrative Simplification session (Education Session 131) on March 6, 2013, 8:30 – 9:30 am. And please stop by our booth (#2868) in the exhibit hall.

We also have helpful resources to help you stay up to date on ICD-10 and other administrative simplification initiatives.

Visit our ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. And be sure to check out the ACA website and sign up for Administrative Simplification Updates.

Lastly, follow us on Twitter @CMSGov using #ICD10 and #CMSeHealth. You can also use the official HIMSS hashtag #HIMSS13 to join in on all conference related topics.

Building the Future through CMS eHealth

By Robert Tagalicod, Director, Office of E-Health Standards and Services

Transforming Health Care

What is the most important electronic initiative in health care today? Is it the switch to ICD-10 that will enable us to capture information more accurately? The widespread adoption and use of electronic health records (EHRs) to provide an infrastructure for electronic data exchange? The establishment of clinical standards that allow physicians, hospitals, and patients to communicate with each other, regardless of their chosen electronic platform? Or is it the introduction of new payment models that focus on quality of care and patient improvement in order to reduce the overall cost of health care?

The truth is that each of these initiatives will have a significant impact on the practice of medicine, but taken together they have the potential to dramatically transform the delivery of health care.

We are living in a time of rapid and unprecedented change for health IT. Initiatives like the Medicare and Medicaid EHR Incentive Programs are driving hundreds of thousands of hospitals, physicians, nurse practitioners, and many others to not only adopt an electronic framework for patient information but also use the tools of health IT to better coordinate care, improve public health, and reduce health disparities across different populations. The adoption of ICD-10, operating rules, and clinical standards will facilitate electronic data exchange and put information in the hands of patients and their caregivers in a way that has never been seen before. Accountable Care Organizations and Patient Centered Medical Homes are introducing new ways for us to provide better care not only for individuals but for entire populations.

Yet each of these initiatives introduces new challenges for all of us. Physicians, hospitals, and health care providers across the country are rushing to adopt new hardware, new software, and new workflow processes that make all of these initiatives possible. Health IT vendors are working hard to build the kind of technology that will realize true electronic interoperability. CMS itself is introducing new systems, aligning programs, and introducing new ways to electronically measure quality. The process can sometimes seem chaotic, even to those of us who are intimately involved in effecting the outcome.

CMS Launches eHealth

Today, the Office of E-Health Standards and Services is launching a new eHealth initiative that specifically aims to help providers, health IT developers, and other industry partners overcome the challenges of collectively implementing this new electronic infrastructure. As part of this eHealth initiative, we are launching a dedicated CMS eHealth website (www.cms.gov/eHealth) and listserv to act as a central hub of information on implementation, guidance, milestones, and critical steps so that providers and other stakeholders have a “single source” of information on coordinating efforts toward implementing ICD-10, EHRs and meaningful use, operating standards, electronic quality measurement, and payment models.

This is only the first of many steps we plan to take to help providers. Over the next several months, the Office of E-Health Standards and Services will take an active role in engaging physicians, provider associations, payors, and technology developers to identify ways to meet the challenges they face. As we more closely integrate our many efforts using the infrastructure of EHRs, we will be looking at some of the challenges presented in areas such as information exchange and coding. We will also be convening stakeholder groups and working closely with health IT organizations to establish a “roadmap” for successful integration of EHRs, operating standards, and quality measurement.

Learn More at HIMSS and Online

There is a lot of work to be done by all of us—and your voice needs to be heard. I hope that you will take advantage of the opportunities we will present to engage with CMS about how we all can build a health IT framework for the future together. If you are at the HIMSS conference in New Orleans today, I hope you will stop by our CMS Town Hall (Session 81, 1:00-2:00 pm, New Orleans Theater C) to hear more about our eHealth initiatives. And if you are not able to join us in person, I hope that all of you will watch our eHealth website for more information on ways to engage with us.

Privacy and Security’s Role in the eHealth Transformation

By Maribel Franey

Improving the delivery of health care is the focus of the eHealth initiative. But eHealth also involves promoting standards and processes that will enable patient information to be shared in a more efficient and timely manner, while ensuring the data is kept private and secure. This brings me to the topic of privacy and security. What is the big deal about privacy and security, anyway?

Importance of Privacy & Security

The goal of privacy and security is to ensure that the technologies and information that are generated as part of the eHealth initiative are only used for their intended purposes. Privacy and security of patient information is just one part of eHealth, but it is arguably one of the most important components.

HIMSS Highlights

At this year’s HIMSS conference, my presentation will focus on making the patient the central focus in discussions about eHealth, privacy, and security. How do we assure a patient that his or her information is secure, and that it will only be used and disclosed for its intended purposes? What are the security, privacy, and governance questions that we need to work through to make information security happen? Are the current privacy and security rules enough, or does more need to be done to ensure necessary governance and oversight of patient information? I will explore these topics more in my HIMSS presentation.

Keeping Privacy & Security as the Focus

No matter what your business interest, whether it is developing new software or other technology to advance electronic health records, improving interoperability through standards or other means, or if it’s bringing new health care products to market, the bottom-line is that privacy and security are foundational pieces of the eHealth initiative. I am confident that we can work together to make sure that the patient’s privacy and security interests are central in our eHealth discussions. I hope you will attend my session at the conference.

EHR Incentive Programs: Moving into the Next Stage

By Elizabeth Holland

This week, industry leaders from all over the country gather for the Healthcare Information and Management Systems Society conference and discuss the future of health information technology implementation, and we at CMS are pleased to report updates on our efforts to promote and support the meaningful use of electronic health record (EHR) technology in health care.

Growing EHR Adoption and Meaningful Use

In January, we passed the 210,000 mark for the total number of providers, including nearly 200,000 eligible professionals, who received a Medicaid or Medicare incentive payment for successfully adopting, implementing, or upgrading or meeting meaningful use of EHR technology.

Nearly 73% of all eligible hospitals in the country have received an EHR incentive payment for either meeting MU, or fulfilling the requirements for AIU of a certified system.

Meanwhile, about 1 of every 4 Medicare eligible professionals are meaningful users; and many more have begun the process.  As of the end of 2012, 1 out of every 3 Medicare and Medicaid eligible professionals has made a financial commitment to EHR systems either through meaningful use or adopting, implementing, or upgrading.

Moving into Stage 2

The meaningful use objectives in Stage 2 are the first step towards utilizing technology as a tool to improve quality and efficiency in our health care system, and in each category the program greatly exceeded our expectations for participation and successful implementation of EHR systems.

The changes we have made moving into Stage 2 of meaningful use build on the foundational data capture and sharing outlined in Stage 1.  Stage 2 moves the bar higher, focusing on advanced clinical procedures, including: measures focused on more rigorous health information exchange (HIE); increased requirements for e-prescribing and incorporating lab results; electronic transmission of patient care summaries across multiple settings; and more patient and family engagement.

In addition, Stage 2 lays the groundwork for alignment across CMS programs to reduce provider burden and support effective quality measurement.

Just as Stage 1 presented a challenge to CMS, to agency partners, to system vendors, and to our providers, Stage 2 will require hard work and collaboration with a wide range of stakeholders to ensure its success.  We look forward to continuing to work with our partners in the public and private sector to meet new milestones and continue to improve the quality and efficiency of our health care system.

Welcome to the CMS eHealth Blog

By Robert Tagalicod, Director, Office of E-Health Standards and Services

Welcome to the CMS eHealth blog. Here you can find information about the eHealth initiative that CMS is launching at the annual HIMSS conference in New Orleans. Upcoming blogs will highlight HIMSS sessions about eHealth and its programs, and we look forward to continuing the conversation as our eHealth programs reach key milestones over the coming months.

What is eHealth?

eHealth aligns several CMS programs:

• Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs
• Quality Measurement
  • Physician Quality Reporting System (PQRS)
  • Hospital Inpatient Quality Reporting (Hospital IQR) Program
• eRx Incentive Program
• Administrative Simplification
  • ICD-10
  • Health Plan Identifier (HPID)
  • Electronic Funds Transfer (EFT)
  • Electronic Remittance Advice (RA)

Each program is part of an overarching eHealth infrastructure that will transform our health care system by capturing and tracking health information electronically. CMS is committed to helping health care providers deliver better patient care by simplifying the use of electronic standards and encouraging the adoption of health information technology.

eHealth Website

Visit the eHealth website to find helpful information on electronic standards and health information technology implementation, guidance, and milestones.

Follow CMS on Twitter

CMS is tweeting about eHealth and its programs. Join the conversation by using #CMSeHealthand the CMS handle, @CMSGov.

Join CMS at HIMSS

If you are attending the annual HIMSS conference, we encourage you to learn more about eHealth by attending the CMS sessions, and visit the CMS booth #2868.

We look forward to a successful conference and to the launch of the eHealth initiative!

Promoting Greater Value for Enrollees in Medicare Advantage and Drug Plans

By Jonathan Blum, Acting Principal Deputy Administrator and Director, Center for Medicare

Posted February 15, 2013

New limits on overhead and profits for health plans in Medicare Advantage and Medicare drug plans will increase value for the over 14 million seniors and persons with disabilities enrolled in Medicare Advantage and over 35 million Medicare beneficiaries in drug plans offered by private insurance companies.  This step is part of the Affordable Care Act’s efforts to ensure that consumers get the most health care for their dollars.  Last year, we issued a rule to make sure that insurance companies generally spend at least 80 percent of the premiums paid by consumers in private health plans on health care or activities that improve health care quality, instead of paying for administrative costs or overhead.  Today’s proposal for people with Medicare is similar to last year’s rule benefiting consumers in the private health insurance market.

Seniors and individuals with disabilities will get more value and be more likely to stay healthy as plans invest more in their health care.  Specifically, beginning in 2014, Medicare health and drug plans will be required to meet a minimum medical loss ratio; they must spend at least 85 percent of revenue on clinical services, prescription drugs, quality improvements, and/or direct benefits to beneficiaries in the form of reduced Medicare premiums.  The higher the medical loss ratio, the more a health plan is spending on health care services and quality improvement activities and less the health plan is spending on non-health related items.

The medical loss ratio policy will spur Medicare plans to become more efficient in their operations.  Medicare plans not already meeting the medical loss ratio can either reduce administrative costs, profits, or increase benefits to meet the minimum medical loss ratio.

The Affordable Care Act requires that if a Medicare plan’s medical loss ratio is below 85 percent, the plan must return the amount by which the plan’s medical loss ratio is below this minimum.

The proposal will also enhance transparence for prospective enrollees.  When comparing their options and making choices, people with Medicare and their caregivers will be able to consider information about a plan’s medical loss ratio, along with quality ratings, coverage, premiums and other factors that influence their health care decisions.

With careful use of taxpayers’ dollars on health care services and improvements, the Affordable Care Act will create greater value for seniors and persons with disabilities enrolled in Medicare plans by helping them stay healthy.  And with additional information about health plan spending and quality, people with Medicare are better equipped than ever before to make informed health care choices.

Bundled payments, DMEPOS, regulatory reform, and ESRD

By Jonathan Blum, Acting Principal Deputy Administrator and Director, Center for Medicare 

In the past few days, the Centers for Medicare and Medicaid (CMS) announced four critical initiatives that are designed to enhance health care delivery for millions of Medicare beneficiaries by improving care or lowering costs, or both.  Taken together the announcements illustrate the breadth and diversity of efforts underway to ensure a better, stronger, more patient-centered Medicare program.

Last week, we announced a new health care delivery system reform, made possible by the Affordable Care Act, to test how bundling of payments for episodes of care, for example a heart attack or stroke, instead of paying for each test or procedure or physician’s visit, can result in more coordinated, higher quality care for beneficiaries.  By bundling payments for services that beneficiaries receive during an episode of care, CMS hopes to encourage doctors, hospitals, and others  to work together to improve care and health outcomes, while also lowering Medicare costs.  Over 500 organizations, nationwide, have already signed-on to participate.

We also announced a major expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  In its first year of operation, competitive bidding, where prices are based on suppliers’ bids, saved the Medicare program, and taxpayers, over $202 million, while maintaining access to quality products for Medicare beneficiaries in the nine areas of the country where the program launched.   It’s a great example of the Administration’s determination to put the brakes on runaway healthcare costs.  With this expansion in the program, Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent on certain DMEPOS items beginning in July.  Between 2013 and 2022, we estimate that the expansion of the DMEPOS program will save Medicare $25.7 billion, while saving beneficiaries, who pay a percentage for medical equipment and supplies, $17.1 billion through lower prices.

This week, we issued a proposed rule which will help health care providers and hospitals to operate more efficiently by getting rid of regulations that are outdated, obsolete, or excessively burdensome.  Many of the rule’s provisions streamline requirements that health care providers must meet in order to participate in the Medicare and Medicaid programs, without jeopardizing patient safety, and they will save providers nearly $676 million annually.  Just as important, by eliminating burdensome requirements, health care providers can improve the quality of health care delivery for Medicare beneficiaries by spending more time focusing on patient care and less time filling out forms.

Finally this week, we announced the Comprehensive End-Stage Renal Disease (ESRD) Care Initiative.  It will help identify, test and evaluate new ways to improve care for Medicare beneficiaries living with ESRD.  We’ll be working with the health care provider community to care for a population that significant and complex health care needs.  Through better care coordination, beneficiaries can more easily navigate the multiple providers involved in their care, ultimately improving their health outcomes.

These four initiatives demonstrate that CMS is employing new and novel tools and programs, thinking outside the box and beyond the usual way of doing things, in order to improve health care delivery for people with Medicare and, in the process, strengthen the Medicare program for current and future beneficiaries.