Health Information Technology (HIT) Permits Payers to Share Data

The Centers for Medicare & Medicaid Services (CMS) strive to develop programs meant to bring “better care, smarter spending, and healthier people.” CMS joined hands with healthcare payers across 7 regions to make better primary care through the Comprehensive Primary Care initiative (CPC), in accordance to The CMS Blog. Through the utilization of health information technology (HIT) and multi-insurer payment reform, the program was established to support primary care practices in advancing the quality of care.

Payers across 3 regions involving Ohio, Colorado, and Oklahoma and CMS partnered to establish reports with private patient information to give quality information straightly to primary care offices. Payers worked closely with primary care practices while CMS constantly transformed the format and wording of the reports.

Utilizing health information technology (HIT) and sharing significant patient data has become a major aspect of making better patient care inside and outside of primary care physician offices. By ensuring primary care doctors have access to a sufferer’s overall medical information outside of their office, physicians will be capable to reach out to their sufferers and offer services before a patient seeks more expensive emergency care.

Prior to the Comprehensive Primary Care initiative, primary care doctors mostly had numerous reports from different healthcare payers with several quality measures and formats. Such diverse reports made it more complex for providers to target what data mattered and how they could act on the given information.

Although, CMS programs like the Comprehensive Primary Care initiative give aggregated data reports, which provide doctors with a stronger understanding of their patient populations and enable them to recognize gaps in care. Physicians can then concentrate on areas where population health management could be improved.

“This was a much anticipated solution to the complications posed by not having access to consistent claims information, and a continuous desire to make better our approach to meeting CPC Milestones [program requirements],” stated Dr. Austin Bailey, Medical Director of University of Colorado Health (UCHealth).

“Our practices will sustain to leverage the utilization of aggregated claims data using Stratus [the tool for practices in Colorado] to recognize the cost patterns of high risk patients — for instance, among our sufferers with diabetes, is the greatest cost linked with specialists, emergency department utilization, or medications?  Having this data across several payers makes it more relevant and assists to build our confidence in choosing the suitable interventions, recognizing trends, and effectively assigning care management resources,” Bailey summarized.

The Comprehensive Primary Care Plus program is a modern version of the former initiative and began operating on the day of January 1, 2017. More than fifty private healthcare payers have partnered with state Medicaid agencies and CMS across fourteen regions to participate in the Comprehensive Primary Care Plus program.

CMS is searching to continue working with payers to expand the execution of aggregated data reports and health information technology to share medical information that enables physicians to recognize gaps in care. Private and public healthcare payers are motivated to work with primary care physicians and the sufferer population to deliver medical data meant to make better the quality of care.

The sharing or exchange of information through health information technology enables doctors to reinforce care coordination, fill in gaps in care, and concentrate on increasing preventive care use, stated Dan Paoletti, CEO of Ohio Health Information Partnership at CliniSync.

In the previous days, hospitals, clinics, and payers had a fragmented system of healthcare delivery with inadequate communication and coordination. Since then, health information technology and the sharing of data enabled payers and providers to make better the coordination and the use of preventive care.

“Having access to data actually goes back to handling coordination of care,” Paoletti stated. “One of the most significant things related to that is preventative care because, finally, this is about trying to keep people healthy. That is how we are going to handle risk by making that pool of healthy individuals bigger and decreasing overall costs of care through that.”

“It actually is critical to get the data where it requires being in case to fill in the gaps that exist today,” Paoletti added. “That is what we are attempting to do and that is where we are headed on a larger scale.”

Furthermore, the results from health information exchange indicate that duplicative testing is decreased and wasteful spending is also decreased, stated Paoletti.

“I consider what will result [from health information exchange] will be a reduction in spending both because ultimately, it’ll increase preventive care but also realistically we’ll have a reduction in tests and duplicative services because the data will be available,” Paoletti contended.

Private and public payers are advancing their work with primary care doctors to share patient information more rapidly to fill in gaps in care and make better coordination.