Draft discussion

only

Advanced Health
Models and
Meaningful Use
Workgroup
Paul Tang, chair
Joe Kimura, co-chair
October 17, 2014

Agenda
I. Welcome and Introductions
II. HITPC Overview
III. Workgroup Charge and Context
IV. Vision and Scope
V. Short Term Goals
VI. Next Steps
VII.Public Comment

WELCOME AND INTRODUCTIONS

Advanced Health Models and MU

Workgroup Members
Paul Tang, Palo Alto Medical Foundation
(Chair)
Joe Kimura, Atrius Health (co-chair)

Shaun Alfreds, HealthInfoNet

Cheryl Damberg, Rand Corp.

Michael H. Zaroukian, Sparrow Health

System

Amy Zimmerman, Rhode Island Office of

Health & Human Services

Ex Officio Members

Arthur Davidson, Denver Public Health

Department

Jessica Kahn, Centers for Medicare and

Medicaid Services

Marty Fattig, Nemaha County Hospital

(NCHNET)

Robert Fleming, Center for Medicare and

Medicaid Innovation

John Pilotte/Terri Postma, Centers for

Medicare and Medicaid Services

Frederick Isasi, National Governors

Association

Marty Rice, Health Resources and Services

Administration

Lisa Marsch, Center for Technology

and Behavioral Health

Stephan Fihn, Veterans Health Administration

Shaun Terrell, Administration for Community

Living

Norma Lang, University of Wisconsin

Lisa Patton, Substance Abuse and Mental

Health Administration

Devin Mann, Boston University

Ginny Meadows, McKesson

Corporation

Terrence OMalley, Partners

ONC Staff
Samantha Meklir, Office of Policy (Lead WG
Staff)
Alex Baker, Office of Care Transformation
(Lead WG Staff)

Neal Patterson, Cerner

HITPC OVERVIEW

Member Responsibilities

Thanks for volunteering to serve on the Advanced Health Models and MU

Workgroup! Our best work happens when we have full participation.
Accordingly, ONC has set up some guidelines for your participation.
Workgroup members are expected to be actively engaged in their workgroup
Membership of the workgroups will be reviewed on a quarterly basis to
ensure active participation
Members missing more than 5 meetings in a year will be removed from
membership (unless extenuating circumstances)
Differing opinions are welcome and encouraged but should be done in a
respectful manner
Participants should be prompt and do their best to minimize personal
interruptions (e.g., mute phones)
Meeting materials are due at least 24 hours in advance of meetings
Members are expected to review materials in advance and be actively
engaged in the discussion with questions prepared in advance
When commenting be as concise as possible and use examples to explain
your point of view
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HITPC Workgroups and Chairs

HIT Strategy and Innovation
Chair: David Lansky
Co-chair: Jennifer Covich

Health Information
Technology Policy
Committee
Chair: Karen DeSalvo
Vice Chair: Paul Tang

Advanced Health Models and

Meaningful Use
Chair: Paul Tang
Co-chair: Joe Kimura
HIT Implementation, Usability &
Safety
Chair: David Bates
Co-chair: Larry Wolf
Interoperability & Health
Information Exchange
Chair: Micky Tripathi
Co-chair: Chris Lehmann
Privacy and Security
Chair: Deven McGraw
Co-chair: Stanley Crosley
Consumer Perspective and
Engagement
Chair: Christine Bechtel
Co-chair: Neil Calman

HIT Policy and HIT Standards

Committees Information Flow

WORKGROUP CHARGE AND CONTEXT

Workgroup Charge

The purpose of the Advanced Health

Models and Meaningful Use Workgroup
is to provide recommendations to the
HITPC on policy issues that facilitate
the effective use of HIT to support
outcomes-focused advanced models
for healthcare delivery and valuebased payment.
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Efforts Informing WG Agenda

To accomplish this purpose, the workgroup will leverage

recommendations from prior work efforts including:
Meaningful Use Workgroup Recommendations
Quality Measures Workgroup Recommendations
Accountable Care Workgroup Recommendations
Data Intermediaries Tiger Team
Institute of Medicine Work on Social Determinants of Health

The work group will coordinate with parallel activities around:

Interoperability
Privacy and Security
Consumer Perspective and Engagement
S&I Initiatives Structured Data Capture, Data Access
Framework, Clinical Quality Framework
Governance
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Previous MU Recommendation Efforts

The HIT Policy Committee approved Meaningful Use Stage 3

recommendations from the Meaningful Use Workgroup on March
11, 2014 meeting.
Key recommendations supporting advanced health models
included:
Better care coordination through transitions of care measures
Electronic notifications from hospitals to treating professionals
Improved patient engagement through view, download,
transmit requirements for summary care record
Increasing adherence to evidence based guidelines through
more robust CDS functionality
Process for developing recommendations included:
Over 125 public meetings to discuss Meaningful Use Stage 3.
Hearings on topics including: patient generated health data,
clinical documentation, implementation and usability, care
planning/ advanced directives, lessons learned from
accountable care organizations, and stage 2 experiences from12
providers and vendors.

Previous ACWG Final Recommendation

Highlights
Focus Area

Selected Recommendations

I. Exchanging
Information across the
Healthcare Community

II. Data Portability for

Accountable Care

Requiring sharing of ADT feeds for

participants in VBP programs
Update survey and certification
guidance for Medicare hospitals to
require electronic sharing of patient
information at discharge
Provide additional shared savings
incentives to ACO partners not eligible
for EHR incentives

Data residing in EHRs needs to be

seamlessly available to multiple types
of HIT applications to support
population health management

ONC should focus additional attention

on discrete data standards, in addition
to further constraining document
based data standards.

ONC can increase vendor

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Previous ACWG Final Recommendation

Highlights
Focus Area

Recommendation Highlights

III. Clinician Use of

Data and Information
to Improve Care

Establish more pilots to drive

adoption of electronic shared care
planning standards-based approaches

Accelerate clinical consensus around

standards-based electronic shared
care planning across the continuum of
care

Pursue research around effectiveness

of clinical decision support

Advance a federated, scalable data

infrastructure model to meet the data
and reporting needs of accountable
care

Expand support for the development

of state-level all-payer claims
databases (APCDs)

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Drive progress on standardization and

IV. Leveraging Existing

Sources of Information
to Support Data
Infrastructure for
Value-Based Programs

OVERALL
MEASURES

Previous QM Recommendation Highlights

Measurement Framework

Intermediate
Outcomes

Expenditures
Healthcare Expenditures
PublicHealth Expenditures
Patient Expenditures
EnablingService Expenditures

Experience
Patient Activation
Accessto Care and Information
Communication with Healthcare
Shared Decision-making
Accessto EnablingServices

Outcomes
Functional Health
Health Risk
Disease/condition
Site of Care

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Previous QM Recommendation Highlights

Domain Framework

Desire
d
future
state

Curren
t state
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Previous QM Recommendation Highlights

Summary of Key Recommendations

Key measure concepts. Recommended key measurement concepts

to be included in MU3 (functional status and well-being, shared
decision making, coordination of care, efficiency, safety, prevention
and population health).
Next stages of measures. Recommended development of
functional status measures and assessment, patient goal
setting/individual goal achievement, and measures that allow
evaluation of delta over time for providers.
Updated Innovation Pathway. Recommended promoting innovative
measurement and infrastructure building, building HIT infrastructure
for advanced care models, and multi-source measures.
Continued use of the established measure criteria to
evaluate/develop measures. 8 criteria including: enabling patientfocused and patient-centered view of longitudinal care and
measurement is beneficial and meaningful to multiple stakeholders.
Additional need for health IT infrastructure. Highlighted need for
interoperable systems, cohort identification and usage, and display/
integration of transactional and analytical data at the point of care.
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Guiding Principles
AHM recommendations should:
1.

Enable success for a wide range of advanced health models while

recognizing that different tools may be particularly relevant in specific
contexts. (Relevant models include but are not limited to: ACOs,
Accountable Communities, Medicaid Health Homes, Bundled payments,
P4P, multipayer models, etc.)

2.

Recognize patients and families as partners in healthcare delivery

transformation as they experience care across the continuum.

3.

Recognize that health is determined by a variety of interrelated factors

and social determinants and address the role of non-clinical settings.

4.

Address coordinating mechanisms (e.g. accountable care communities

and care organizations, integrator agencies) that exist at the state,
community, and provider level.

5.

Reflect how provider needs in the accountable care environment may

evolve over time (the HIT glide path) and consider both near-term and
long-term goals for providers.

6.

Align with a clear policy lever that the government can act on.

7.

Consider policy levers across HHS to address cross-cutting needs of

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VISION AND SCOPE

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Vision
The AHM workgroup can take many different directions. To
keep discussions focused, we propose focusing our work
around a common visionthe Accountable Care Community of
the future:
Optimal patient/consumer and community health
Aligned accountability for patient and community health
that bridges employers, health plans, hospitals, providers,
communities, and patients
Aligned financial incentives that encourage market
competition to optimize patient and community health
Seamless integration of required clinical, financial,
administrative, and operational information across the
entire continuum of care to eliminate information gaps as a
root cause of inefficient and ineffective patient care.
Promotion of innovations and improvements to continuously
discover, test, and evaluate better ways to achieve health 20

Key areas of focus

I. Data Sharing across the Healthcare Community
Recognize, prioritize, and address barriers to data sharing that
are identified as inhibitors of clinical and financial
performance improvement within advanced
health models
and recommend policy changes to promote the flow of
information across settings.
II. Measurement for Care Improvement and Advanced
Payment Models
Explore the future trajectory of accountability measurement
concepts and principles that promote application of
performance metrics that are truly meaningful for patients,
clinicians, and communities.
III. HIT Tools to Support Individual Patient and Population
Health Management
Explore challenges that are inhibiting the
adoption/effectiveness of HIT tools that
have been
identified as a high priority within advanced health models,
such as CDS, care coordination, and population health
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management tools.

Sample Agenda Topics

Data Sharing

Measurement

Tools and Services

Data Infrastructure

Facilitating use of
data for patient
event notification
services (e.g. ADT
data)
HIE requirements for
multi-sourced data
to support advanced
payment models
Transparency on
performance
measures around
exchange

Measures that
matter: to patients
(e.g. patient
reported outcomes);
to communities (e.g.
valid measures for
comparison); to
clinicians (e.g.
health care delivery
process/outcomes).
Measures that
encourage
collaborative models
of care across
organizations
Common data
standards to support
linkages across
registries and EHRs
and make registries
less dependent on
data entry

Clinical and
financial decision
support tools for
clinicians and
patients (e.g. cost
transparency at
point of care)
Dynamic shared
care planning
Population health
management tools
(e.g. enabling
registries, risk
stratification, tools)
Mobile devices
Telehealth (including
remote monitoring)

Scalable models for

integrating claims,
clinical, and
operational data
Infrastructure to
collect social
determinants of
health data
State mechanisms
(APCDs)
Access to EHR data
by other
applications
Achieving vision of a
patient-centered
measurement
infrastructure across
disease states and
settings

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SHORT TERM GOALS

23

Comment on Federal HIT Strategic Plan

Strategic Plan tentatively scheduled

for release in December 2014
WG to provide recommendations to
HITPC by January

24

Comment on published version

of Interoperability Roadmap

Interoperability roadmap draft

tentatively scheduled for release in
early Q1 2015
WG to provide recommendations to
by March
Review October 15th joint
HITSC/HITPC meeting on draft
Interoperability Roadmap,
Interoperability Vision paper during
future meetings

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Comment on MU3 NPRM

MU Stage 3 NPRM tentatively

scheduled for release in Q1 2015
AHM WG will lead response
Tentatively planning to have
recommendations to HITPC by April
Conduct review of March 2014 final
MU WG recommendations during
future meeting
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Potential hearing and recommendations on

HIT Infrastructure for Accountable Care
Communities

Consider in-person hearing or listening session for Q2

2015
Draft Objectives:
Share examples of communities that have integrated
community and formal healthcare resources
Understand how to scale HIT infrastructure to
support accountable care communities
Advance efforts to capture social determinants of
health data identifying priority domains/existing
standards
Witnesses to include community-focused
Medicaid/Medicare and private-sector accountable care
arrangements, providers from across the continuum of
care including behavioral health, long term post-acute
care, state and local health and human service leaders,
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Potential hearing and recommendations

on electronic care planning

Consider potential hearing for Q3

2015
Focus on opportunities to improve
standards based approaches to
electronic care planning
Representatives from across the
clinical community to ensure care
planning is incorporated into clinical
workflows
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AHM Draft Work plan

Tasks

Workgroup Kick-off

Start Date Due Date 14 14 14 15 15 15 15 15- 15 15 15 15

- - - - - - - Ma - - - Oc No De Ja Fe Ma Ap y Ju Jul Au Se
t v c n b r r
n
g p

10/17/201 10/17/201
4
4

Presentations to prepare
for response to FACA
milestones

10/18/14

12/31/14

Comment on Federal HIT

Strategic Plan TBD

TBD Q4/Q1

TBD Q4/Q1

Comment on published
version of Interoperability
Roadmap TBD

TBD - Q1

TBD - Q1

Comment on MU3 NPRM

- Lead WG

TBD - Q1

TBD - Q1

Potential hearing and

recommendations on HIT
Infrastructure for
Accountable Care
Communities

TBD Q2

TBD Q2

Potential hearing and

recommendations on
Electronic Care Planning

TBD Q3

TBD Q3
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NEXT STEPS

30

PUBLIC COMMENT

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