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

2 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 3

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. Arthur Davidson, Denver Public Health Department Marty Fattig, Nemaha County Hospital (NCHNET) Frederick Isasi, National Governors Association Lisa Marsch, Center for Technology and Behavioral Health Norma Lang, University of Wisconsin Devin Mann, Boston University Ginny Meadows, McKesson Corporation Terrence O’Malley, Partners Neal Patterson, Cerner Mark Savage, National Partnership Charlene Underwood, Siemens Michael H. Zaroukian, Sparrow Health System Amy Zimmerman, Rhode Island Office of Health & Human Services Ex Officio Members Jessica Kahn, Centers for Medicare and Medicaid Services Robert Fleming, Center for Medicare and Medicaid Innovation John Pilotte/Terri Postma, Centers for Medicare and Medicaid Services Marty Rice, Health Resources and Services Administration Stephan Fihn, Veterans Health Administration Shaun Terrell, Administration for Community Living Lisa Patton, Substance Abuse and Mental Health Administration ONC Staff Samantha Meklir, Office of Policy (Lead WG Staff) Alex Baker, Office of Care Transformation (Lead WG Staff) 4

HITPC OVERVIEW 5

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 6

Advanced Health Models and Meaningful Use Chair: Paul Tang Co-chair: Joe Kimura HITPC Workgroups and Chairs 7 Interoperability & Health Information Exchange Chair: Micky Tripathi Co-chair: Chris Lehmann HIT Implementation, Usability & Safety Chair: David Bates Co-chair: Larry Wolf HIT Strategy and Innovation Chair: David Lansky Co-chair: Jennifer Covich Privacy and Security Chair: Deven McGraw Co-chair: Stanley Crosley Health Information Technology Policy Committee Chair: Karen DeSalvo Vice Chair: Paul Tang Consumer Perspective and Engagement Chair: Christine Bechtel Co-chair: Neil Calman

8 HIT Policy and HIT Standards Committees Information Flow

WORKGROUP CHARGE AND CONTEXT 9

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 value-based payment. 10

11 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

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 from providers and vendors. Link to April 1, 2014 Transmittal and Slides 12

Previous ACWG Final Recommendation Highlights Focus AreaSelected Recommendations I. Exchanging Information across the Healthcare Community 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 II. Data Portability for Accountable Care 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 accountability by ensuring products not only send data, but can also receive and process data. 13

Previous ACWG Final Recommendation Highlights Focus AreaRecommendation 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 IV. Leveraging Existing Sources of Information to Support Data Infrastructure for Value-Based Programs 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) Drive progress on standardization and capture of social determinants of health data elements 14

Previous QM Recommendation Highlights Measurement Framework 15 OVERALL MEASURES

Previous QM Recommendation Highlights Domain Framework 16 Current state Desired future state

Previous QM Recommendation Highlights Summary of Key Recommendations 17 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 patient-focused 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. Link to July 21, 2014 Transmittal Letter and Slides

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 advanced health models. 18

VISION AND SCOPE 19

Vision The AHM workgroup can take many different directions. To keep discussions focused, we propose focusing our work around a common vision—the 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 and healthcare outcomes 20

21 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 management tools. IV. Data Infrastructure for Advanced Payment  Consider how HHS can advance the infrastructure needed to support advanced health models and population health.

Sample Agenda Topics 22 Data Sharing 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 Measurement 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 Tools and Services 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) Data Infrastructure 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

23 SHORT TERM GOALS

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 Q WG to provide recommendations to by March Review October 15 th joint HITSC/HITPC meeting on draft Interoperability Roadmap, Interoperability Vision paper during future meetings 25

Comment on MU3 NPRM MU Stage 3 NPRM tentatively scheduled for release in Q 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 26

Potential hearing and recommendations on HIT Infrastructure for Accountable Care Communities Consider in-person hearing or listening session for Q 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, etc. Review NCVHS work on community health data during future meeting 27

Potential hearing and recommendations on electronic care planning Consider potential hearing for Q 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 28

AHM Draft Work plan 29 TasksStart DateDue Date14- Oct 14- Nov 14- Dec 15- Jan 15- Feb 15- Mar 15- Apr 15- May 15- Jun 15- Jul 15- Aug 15- Sep Workgroup Kick-off10/17/2014 Presentations to prepare for response to FACA milestones 10/18/1412/31/14 Comment on Federal HIT Strategic Plan TBD TBD - Q4/Q1 Comment on published version of Interoperability Roadmap TBD TBD - Q1 Comment on MU3 NPRM - Lead WG TBD - Q1 Potential hearing and recommendations on HIT Infrastructure for Accountable Care Communities TBD – Q2 Potential hearing and recommendations on Electronic Care Planning TBD – Q3

30 NEXT STEPS

31 PUBLIC COMMENT