1. Kevin Larsen MD Medical Director, Meaningful Use Office of the National Coordinator of Health IT Improving Outcomes with HIT ASCO Oct 17 2014

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3. Framework for Progression of Payment to Clinicians and Organizations in Payment Reform Category 1: Fee for Service – No Link to Quality Category 2: Fee for Service – Link to Quality Category 3: Alternative Payment Models on Fee- for Service Architecture Category 4: Population- Based Payment DescriptionPayments are based on volume of services and not linked to quality or efficiency At least a portion of payments vary based on the quality or efficiency of health care delivery Some payment is linked to the effective management of a population or an episode of care Payments still triggered by delivery of services, but, opportunities for shared savings or 2-sided risk Payment is not directly triggered by service delivery so volume is not linked to payment Clinicians and organizations are paid and responsible for the care of a beneficiary for a long period (eg, >1 yr) Examples Medicare Limited in Medicare fee-for-service Majority of Medicare payments now are linked to quality Hospital value- based purchasing Physician Value- Based Modifier Readmissions/Hospi tal Acquired Condition Reduction Program Accountable Care Organizations Medical Homes Bundled Payments Eligible Pioneer accountable care organizations in years 3 – 5 Some Medicare Advantage plan payments to clinicians and organizations Some Medicare-Medicaid (duals) plan payments to clinicians and organizations MedicaidVaries by state Primary Care Case Management Some managed care models Integrated care models under fee for service Managed fee-for-service models for Medicare- Medicaid beneficiaries Medicaid Health Homes Medicaid shared savings models Medicaid waivers for delivery reform incentive payments Episodic-based payments Some Medicaid managed care plan payments to clinicians and organizations Some Medicare-Medicaid (duals) plan payments to clinicians and organizations 3 Rajkumar R, Conway PH, Tavenner M. The CMS—Engaging Multiple Payers in Risk-Sharing Models. JAMA. Doi:10.1001/jama.2014.3703

4. Meaningful Use 4 Data capturing and sharing Advanced clinical processes Improved outcomes Stage 1 Stage 2 Stage 3

5. Percent of physicians e-prescribing using an EHR Collecting Data Success in e-prescribing rates nationwide

6. Health care providers capability to capture laboratory results electronically Among hospitals participating in Meaningful Use, on average, 96% of laboratory results were captured as structured data, meaning they are readily available for public health reporting 2,900 hospitals registered their intent to send ELR for 2014. In 2013, 15% of hospitals participating in MU reported laboratory results to their local public health agency # of lab results available for ELR from Hospitals # of lab results available for ELR from health care professionals 2011 154 million 75 million 2012 2.0 billion 422 million 2013 2.9 billion 912 million Based on CMS EHR Incentive Program data through August, 2014. “Health care professionals” includes Medicare eligible professionals.

7. HHS Measurement Alignment MU, PQRS, IQR, ACO, VBP, HRSA,CDC current Unified Outcome Measures EHR as primary reporting platform, with secondary reporting from registry, claims

8. MU2 eCQM Certification Policy through 2017 Capture Data > QRDA1 Calculate QRDA3 Report QRDA1, QRDA3 8 Modular- choose which measures you want Validate to QRDA standard (schematron)

9. Car with no dashboard 9

10. popHealth Open Source Community Page 10 Publicly available demonstration via the popHealth website or Open Source Development Active community sharing http://projectpophealth.org/

11. “I am the expert about me.” 11 Patient Reported Outcomes

12. 12 Source: CDC, July 2012 HIV Cascade

13. Health Information Exchange

14. OHIO Only Handle Information Once

15. INTEROPERABILITY

17. Sharing Data Principles to Guide Path to Interoperability Build on existing health IT infrastructureOne size does not fit allEmpower individualsLeverage the marketSimplifyMaintain modularityConsider the current environment and support multiple levels of advancementFocus on valueProtect privacy and security in all aspects of interoperability 17

18. Vision for the Decade Ahead – Improvements Due to the Sharing of Interoperable Data 2017 Connect Care: Ensure providers and individuals can send, receive, find and use a basic set of essential health information 2020 Connect for Health: Expand sources and users of information; Continue improving quality and lowering cost; Increase automation Scale broadly 2024 Learning Health System: Precision medicine Reduce time from evidence to practice Virtuous learning cycle 18 Core technical standards and functions Certification to support adoption and optimization of health IT products & services Privacy and security protections for health information Supportive business, clinical, cultural, and regulatory environments Rules of engagement and governance

19. BD2K NIH Big Data to Knowledge 19

20. Common Data Elements- the future A terminology based metadata solution frees data consumers from data interpretation

21. Questions? Kevin.larsen@hhs.gov For more information about ONC visit: healthIT.gov 8/29/2015 Office of the National Coordinator for Health Information Technology 21