1. CMS’s Health Information Technology Initiatives in Massachusetts Craig D. Schneider, Ph.D. Boston Regional Office Quality Colloquium Cambridge, MA August 23, 2005

2. Outline CMS’s Quality Roadmap Pay-for-Performance Initiatives DOQ-IT MCMP Bridges to Excellence VistA Office EHR E-Health Collaborative

3. Quality Roadmap Based on IOM’s 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. Doctor’s 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 -- VHA’s 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@cms.hhs.gov