Congress late last night passed legislation to reform how physicians are paid. This is part of a comprehensive push to improve the outcomes and efficiency of the U.S. healthcare system. To support this transition the bill would also allow qualified healthcare entities to share Medicare data for the purpose of transparency and quality improvement. This places Regional Health Improvement Collaboratives (RHICs) at the center of the new congressional value-based payment system. RHICs are independent, non-profit organizations comprised of multiple stakeholders who come together to improve health and healthcare. Over 30 regional collaboratives are members of the Network for Regional Healthcare Improvement (NRHI).
“This is a significant step for regional health improvement collaboratives who are doing the actual work at the local level to support the national Triple Aim goals of reducing healthcare costs, increasing quality and improving access to care,” says Elizabeth Mitchell, President and CEO of Network for Regional Healthcare Improvement. “Our members will play an even more pivotal role in providing clear health information to consumers, providers and employers.”
Historically, Medicare data was unavailable for use by community stakeholders. The H.R.2 – The Medicare Access and CHIP Reauthorization Act of 2015, also called the Sustainable Growth Act (SGR) or “doc fix” legislation includes a provision to lift those restrictions and enable Qualified Entities (QEs) to enhance their ability to compare and share Medicare data. The bill has passed the Senate and is expected to be quickly signed by the President.
There are 13 Qualified Entities, 11 of which are NRHI members. The Qualified Entity Program allows organizations that are certified by the Centers for Medicare & Medicaid Services (CMS) to combine Medicare claims data from CMS with claims data from other payers to evaluate the performance of health care providers and suppliers. QEs must demonstrate the ability to protect the privacy and security of the Medicare claims data and may use it only for purposes of the QE Program.
“This will allow us to realize the potential of quality reporting and demonstrate how having the right data can and will result in transformational change at the practice level,” says Mitchell. “We can now use and share data more effectively to develop actionable steps in improving healthcare quality and reforming costs.”
The legislation also sets aside $20 million per year for 5 years (2016-2020) which CMS would use to enter into contracts with regional entities that have proven success in providing technical assistance to small or rural practitioners as well as those transitioning into alternative payment models. The legislative language explicitly mentions Quality Improvement Organizations (QIO)s, regional extension centers, and regional health collaboratives as “appropriate entities” to offer this assistance. These entities are all NRHI members.
“With these resources, we can help stakeholders be successful in their transition to a reformed payment and delivery system,” says Mitchell.
“There are many elements to the SGR bill that impact healthcare transformation from both a payment reform and sustainability perspective,” says Mylia Christensen, Executive Director for Oregon Healthcare Quality and Board Chair for NRHI. “Having the ability to analyze both Medicare data and multipayer data lets us take a more holistic approach toward changing healthcare delivery and payment models. And for Regional Healthcare Improvement Collaboratives, the $20 million technical assistance provision provides a funding opportunity for RHICs to provide the critical technical assistance needed to implement and sustain meaningful payment reform. This is a terrific opportunity.”
The legislation will also support health transparency efforts across the country, including the Center for Healthcare Transparency (CHT), an initiative of NRHI and the Pacific Business Group on Health. CHT is working with regional health collaboratives and others to make information about the relative cost and quality of healthcare available for 50 percent of the U.S. population by 2020.
“This provides the legislative framework to scale what CHT has learned works at the community level, using local expertise and successes to drive national transformation,” added Mitchell.