To participate in the Centers for Medicare and Medicaid Services’ sponsored programs like MIPS and CPC+, provider organizations must submit performance data on clinical quality measures. Acuitas Health partnered with Health Catalyst to optimize existing technology for efficient reporting and data management across multiple EMRs, avoiding high costs associated with implementing a new uniform EMR.
In order to participate in the Centers for Medicare and Medicaid Services’ (CMS) sponsored programs such as Merit-based Incentive Payment System (MIPS) and Comprehensive Primary Care Plus (CPC+), and payer sponsored programs that include additional measure sets, provider organizations across the country are required to select and electronically submit their performance on a number of payer and CMS mandated clinical quality measures. Payment is given to healthcare organizations based on an incentive scale, rated by electronic clinical quality measures (eCQMs), and other payer measure sets. CMS performance data must be submitted through a certified health IT product, and payer measures are typically satisfied with claims. While most EMRs qualify, healthcare organizations made up of multiple practices using disparate EMRs makes aggregating and analyzing this data difficult. This is further compounded by additional payer valuebased programs that provide financial incentives for performing well on claims metrics.
Acuitas Health, a population health services organization providing services to multiple provider practices, sought to make it easier for its clients to manage performance on and report eCQMs, and manage payer measures in a consolidated manner. Because implementing a new, uniform EMR carried significant costs, the organization collaborated with long-time partner Health Catalyst to certify existing technology that could bring the data together to ensure efficient, accurate reporting without substantial cost.
Many CMS sponsored programs, and payer sponsored programs, include extensive reporting requirements for participating practices, as CMS and other payers prospectively pay, and retrospectively reconcile, a performance-based incentive for a variety of measures, including patient experience, clinical quality, and utilization measures that drive the total cost of care.1 Practices must also meet specific health IT requirements, including a required electronic submission of all performance data using an Office of the National Coordinator for Health Information Technology (ONC) Certified Health IT Product. It is beneficial for organizations to report eCQMs and other measures used to determine pay for performance in aggregate at the tax ID level as it allows the organization to average performance data across all providers, reducing the risk of penalty for any low-performing outliers.
One of the primary barriers to accurate, timely reporting is a lack of uniformity in EMR systems among practices. Disparate systems isolate the data necessary for efficient reporting. Consolidating all practices to a single EMR to support aggregate reporting can cost up to $70,000 per physician and often negatively impacts income. Organizations have reported more than a 50 percent reduction in adjusted income in the first seven months following EMR implementation,2,3 leaving many looking for an alternative.
Acuitas Health is a population health services organization that empowers physicians to make a successful transition to a value-based care delivery system. Acuitas Health supports its partner practices by providing the necessary expertise and resources in analytics and adaptive consulting to deliver high-value healthcare while preserving the independent practice of medicine. As part of its mission, Acuitas Health looks to better improve value-based payment by providing partner physicians with the data they need to meet reporting requirements without forcing them to take on new, burdensome costs.
Acuitas Health recently had a client group merge with another physician group, and sought to report its eCQMs in aggregate across the expanded organization. However, Acuitas Health faced a barrier that impacted its ability to report the data in aggregate—the physician groups used disparate EMRs, creating roadblocks for data sharing and analytics.
Acuitas Health’s customer considered migrating the recently merged physician group to a new EMR, but the substantial cost associated with implementing a new EMR was very high. Additionally, it needed to begin using a certified software product at the start of the reporting window in order to meet CMS sponsored program requirements, and any potential EMR implementation could not be completed in time for Acuitas Health to electronically report its eCQMs. The organization needed a way to quickly and efficiently aggregate data from the separate EMRs to generate a single set of eCQMs that could be submitted to CMS electronically, preferably without the cost burden of implementing a new EMR.
Acuitas Health continually works to be leaner, and to create a faster time to value for its independent physician practice partners. The ability to effectively conduct data analytics is incredibly important in today’s competitive healthcare market. It was not effective for Acuitas Health and the physician practices it supports to use one resource for its analytics, and a different resource for eCQM and claims reporting.
After reflecting on its unique business needs, Acuitas Health chose to partner with Health Catalyst to develop a solution that would enable it to meet the eCQMs and claims reporting requirements rather than purchase another product. Acuitas Health first investigated what it would take to deliver the service it needed, ensuring everyone was in agreement on the problem to be solved. It engaged with ONC to obtain counsel about what it would take for the Health Catalyst platform and products to meet the certifying requirements, using open source tools available from the federal government to test the submission process and confirm the proposed solutions were able to meet the certification requirements. Ultimately, Acuitas Health, after consulting with Health Catalyst, determined to pursue certification of the Health Catalyst® Data Operating System (DOS™) platform, rather than certifying only one specific product.
Pursuing certification for DOS provides Acuitas Health substantial flexibility in how it delivers the information its independent providers need to effectively manage their patients and flourish in various value-based care programs. Using DOS, Acuitas Health is able to gather and integrate data from multiple sources, including the EMRs used by the practices, claims data from payers, care management data sources, and data from the health information exchange. It is able to consolidate these various sources of data and submit eCQMs electronically, and analyze and close both eCQM and payer gaps. By leveraging the DOS infrastructure as the foundation for its measures solutions, Acuitas Health is also able to surface quality measures data and deliver eCQM and payer performance data back to the independent practitioners and practices it supports in an easy to use tool.
Acuitas Health is able to use the analytics platform to easily obtain, monitor, and share meaningful performance data for Medicare Access and CHIP Reauthorization Act (MACRA), MIPS, payer, and other value-based programs. Acuitas Health is able to aggregate and pull data from multiple EMR systems to identify and close gaps in care to increase performance in these programs and improve efficiencies at the practice site. Rather than sending multiple reports to providers, Acuitas Health is able to send its independent practices consolidated analyses with all the data needed for their patients, including hospital census, patients who have recently been readmitted, various models that predict patient risks, hierarchical condition coding opportunity reports, and information about the specific quality measures the patient qualifies for and outstanding items that may still need to be addressed.
Acuitas Health tailors the information provided to the practices to meet the unique needs of the individual provider and is able to push data back into the EMR, filing the appropriate data at the patient record level. Providers are able to obtain all of the data they need to address their patients’ specific needs in just a few clicks, bringing data back to the point of care so it can be used to drive meaningful improvement.
In just three months, the Acuitas Health and Health Catalyst collaboration achieved the desired result. DOS is now an ONC Certified Health IT Product and has been validated as able to correctly calculate and submit regulatory quality measures, providing assurance to Acuitas Health that it can confidentially use it to submit its eCQMs, as it meets the U.S. Department of Health and Human Services technological capability, functionality, and security requirements.*
“Many organizations tend to think about the problem and have an immediate gut reaction solution, and that leads to hasty decisions that have unforeseen negative impacts. When taking on any major improvement effort, the long-term is what should be given the most consideration.”
– Keegan Bailey, MS, Strategy and Technology Leader
Acuitas Health plans to expand eCQM and claims reporting across its customer base, and is folding in more small practices, integrating data for additional EMRs into DOS, enabling more independent providers to successfully make the transition to value-based care.
*Health Catalyst Data Operating System is (2015) Edition compliant and has been certified by an ONC-ACB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services.
