CMS

1
CMSs Health Information Technology Initiatives
in Massachusetts

• Craig D. Schneider, Ph.D.
• Boston Regional Office
• Quality Colloquium
• Cambridge, MA
• August 23, 2005

2
Outline

• CMSs Quality Roadmap
• Pay-for-Performance Initiatives
• DOQ-IT
• MCMP
• Bridges to Excellence
• VistA Office EHR
• E-Health Collaborative

3
Quality Roadmap

• Based on IOMs STEEEP principles
• 5 major system strategies for improving care
• 1. Work through partnerships with providers and
  other government agencies
• 2. Publish quality measurements and information,
  both for providers/purchasers and for
  beneficiaries and their families
• 3. Pay in a way that supports providers for
  doing the right thing improving quality and
  avoiding unnecessary costs
• 4. Assist providers to use effective electronic
  health systems to make care more effective and
  less costly
• 5. Become active partner in driving creation and
  use of information about effectiveness of health
  care technologies

4
Pay-for-Performance

• Planning for P4P in the following 5 settings
  physicians, hospitals, NH, HHA, and dialysis
  facilities/ESRD care.
• Plan is to begin with pay-for-reporting prior to
  pay-for-performance
• Abt Associates in Cambridge is the contractor for
  proposing design and implementation of NH P4P.
• Premier hospital P4P demo at 270 facilities shows
  significant improvement during first year -- 34
  measures in 5 clinical conditions

5
Doctors Office Quality Information Technology
Project

• MA is one of 4 states that did DOQ-IT pilot (AR,
  CA, and UT).
• In MA, 470 practices representing over 1500
  physicians
• Developing educational materials for national QIO
  EHR program
• Participating in MA-SHARE and MA E-health
  collaborative for EHR rollout
• Working with MA Health Data Consortium for
  e-prescribing rollout

6
Medicare Care Management Performance Demonstration

• MA DOQ-IT is pilot for MCMP (MMA Section 649)
• Three-year demonstration program where physicians
  will be paid to adopt and use health information
  technology and evidence-based outcome measures to
  promote continuity of care, stabilize medical
  conditions, prevent or minimize acute
  exacerbations of chronic conditions, and reduce
  adverse health outcomes.
• Four sites meeting eligibility criteria. Payment
  can vary based on performance, however total
  payments must be budget neutral. QIOs could help
  enroll physicians, evaluate their performance,
  and provide technical assistance.
• Based on Bridges to Excellence model.

7
Bridges to Excellence

• 3 BTE programs Diabetes Care Link, Cardiac Care
  Link, Physician Office Link.
• POL 3 categories of care across 3 levels - not
  just IT. 1st category is IT though Clinical
  Information Systems/Evidence-based Medicine, with
  incentives to move from index cards in a shoe
  box to EHRs. Other 2 categories are Patient
  Education and Support, and Care Management
• Launched 2/04. About 80 practices participating,
  representing 550 physicians, who have received
  over 1m in rewards.
• BTE Physician Practice Portal allows practices to
  add, edit, or update profile information and view
  performance recognitions. Launching this week.
• MassPRO working with BTE to develop nationwide
  rollout of DOQ-IT based BTE sign-up and payouts,
  and to automatically recognize physicians
  eligible for MCMP awards.
• Creating a wide door for physician recognition
  to broaden participation in BTE

8
VistA Office EHR

• CMS working with Veterans Health Administration
  to configure VistA -- VHAs EHR -- to private
  physician office setting.
• Currently used in 1300 sites of care and serves 5
  million veterans
• Will rely on vendor community -- CMS not becoming
  a software vendor.
• CMS to provide limited technical support for
  initial installation and technical problem
  resolution, and will encourage vendors to provide
  training and TA, along with Iowa and WorldVistA
  as vendor support org.
• VistA Office EHR will offer automated disease
  management functionality based on DOQ-IT
  measures. Patients who meet DOQ-IT qualifications
  will be placed on Disease Management Registry.
  Fully functional interfaced designed to meet QIO
  clinical warehouse specs.
• CMS active in E-Health Collaborative

9
Summary

• CMS embarking on wide-ranging health IT and P4P
  efforts
• Mass. is leading the nation on many of these
  initiatives, such as DOQ-IT, MCMP, and BTE
• Contact information
• Craig D. Schneider, Ph.D.
• Manager, Provider Reimbursement Branch
• CMS Boston Regional Office
• Craig.schneider_at_cms.hhs.gov