The Centers for Medicare and Medicaid Services has set up two healthcare test pilots " one in North Carolina and one in Indiana " to show how healthcare quality is affected by the exchange of electronic heath records across multiple payers and providers in the two regions.
The pilots are part of CMS' Medicare "Health Care Quality Demonstration" program, a five-year effort required by the Medicare Modernization Act that aims to test approaches to improving patient safety and efficiency and eliminating variation in medical practices.
In the Indiana demo, the Indiana Health Information Exchange (IHIE) will launch a regional, multi-payer, pay-for-performance program based on a common set of quality measures, CMS said.
IHIE's project is unusual among recent Medicare projects because it is using Medicare data, as well as clinical and claims data from other payers, to provide physicians information on the status of patients they are treating.
IHIE will test whether quality improvement and pay-for-performance initiatives are more effective in a multi-payer environment, which will include private insurers, employer-sponsored group health plans, Medicare, and Medicaid.
The tests are expected to yield empirical data on the effectiveness of pay-for-performance, health IT, and multi-payer initiatives in improving the quality of care provided to Medicare beneficiaries.
"Under the current health care system, patient data is often inconsistent and housed in different systems making it less useful to physicians," said Charlene Frizzera, CMS's acting administrator.
The North Carolina demo, to be conducted with North Carolina Community Care Networks (NC-CCN), will extend a "medical home," or provider-team approach, to low-income patients eligible for both Medicaid and Medicare benefits. The project consists of eight regional health care networks in several North Carolina counties.
Currently, NC-CCN serves North Carolina's Medicaid-only, low-income, and uninsured populations. Under the Medicare demo, the same coordination of care efforts will expand to the dual eligible and Medicare-only population.
Healthcare for beneficiaries who are dually eligible for Medicare and Medicaid can be fragmented, Frizzera said. To address that, each network uses clinical care coordinators who work with practices to plan and coordinate care for all of the patients in the medical home.
Both CMS demonstrations allow organizations to share in a portion of Medicare savings achieved once quality of care and cost objectives are met. The demonstrations are described in documents available on the CMS Web site.
The Centers for Medicare and Medicaid Services has set up two healthcare test pilots " one in North Carolina and one in Indiana " to show how healthcare quality is affected by the exchange of electronic heath records among multiple payers and providers in the tw0 regions.
The pilots are part of CMS' Medicare "Health Care Quality Demonstration" program, a five-year effort required by the Medicare Modernization Act that aims to test approaches to improving patient safety and efficiency and eliminating variation in medical practices.
In the Indiana demo, the Indiana Health Information Exchange (IHIE) will launch a regional, multi-payer, pay-for-performance program based on a common set of quality measures, CMS said.
IHIE's project is unusual among recent Medicare projects because it is using Medicare data, as well as clinical and claims data from other payers, to provide physicians information on the status of patients they are treating.
IHIE will test whether quality improvement and pay-for-performance initiatives are more effective in a multi-payer environment, which will include private insurers, employer-sponsored group health plans, Medicare, and Medicaid.
The tests are expected to yield empirical data on the effectiveness of pay-for-performance, health IT, and multi-payer initiatives in improving the quality of care provided to Medicare beneficiaries.
"Under the current health care system, patient data is often inconsistent and housed in different systems making it less useful to physicians," said Charlene Frizzera, CMS's acting administrator.
The North Carolina demo, to be conducted with North Carolina Community Care Networks (NC-CCN), will extend a "medical home," or provider-team approach, to low-income patients eligible for both Medicaid and Medicare benefits. The project consists of eight regional health care networks in several North Carolina counties.
Currently, NC-CCN serves North Carolina's Medicaid-only, low-income, and uninsured populations. Under the Medicare demo, the same coordination of care efforts will expand to the dual eligible and Medicare-only population.
Healthcare for beneficiaries who are dually eligible for Medicare and Medicaid can be fragmented, Frizzera said. To address that, each network uses clinical care coordinators who work with practices to plan and coordinate care for all of the patients in the medical home.
Both CMS demonstrations allow organizations to share in a portion of Medicare savings achieved once quality of care and cost objectives are met. The demonstrations are described at the following CMS Web site: http://www.cms.hhs.gov/demoprojectsevalrpts/md/itemdetail.asp?filterType=none&filterByDID=-9&sortByDID=3&sortOrder=descending&itemID=CMS023618&intNumPerPage=10
