Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Healthcare Interoperability, Rule Reform Key to Value-Based Payment

HHS is focused on advancing healthcare interoperability and reducing regulatory burden to support the transition to value-based payment, the HHS Deputy Secretary shared.

Healthcare interoperability and value-based payment

Source: Thinkstock

By Jacqueline LaPointe

- Healthcare interoperability is vital to the transition to value-based payments, the second in command at HHS recently stated at the Office of the National Coordinator for Health Information Technology (ONC) annual meeting.

“Advancing Health IT is inextricably bound up with what may be the most important priority that HHS has today, which is transforming our healthcare system into one that pays for value,” HHS Deputy Secretary Eric D. Hargan said. “Nowhere is that truer than with interoperability. It is actually impossible to move to a future health system, one that we need, one that pays for value rather than sickness, without a truly interoperable health IT system.”

“Now, sadly, that remains in our future,” he stressed to attendees.

Healthcare interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged, according to HIMSS.

Achieving healthcare interoperability enables providers across the care continuum to coordinate care for patients and better influence the cost and quality outcomes of patient care regardless of where the patient seeks treatment – all top priorities of value-based payment and care.

READ MORE: Best Practices for Value-Based Purchasing Implementation

However, the healthcare industry is lagging with healthcare interoperability. The lack of data standards, stakeholder coordination, and industry-wide enforcement are major obstacles to true interoperability, resulting in lackluster results.

For example, only four in ten hospitals can send and receive secure electronic messages containing patient health information to and from sources outside of the organization or health system. And just about one-third of individuals report that clinical laboratories allow them to directly access test results, the ONC reports.

“Patients need to be able to access their own records. Period. When they move to a new provider, they ought to be able to bring their records. Period,” Hargan said. “How all that happens is really up to you. And that is part of what the private sector brings to the table, which is the understanding of how we get to where we need to go.”

To support the department’s value-based payment goals, HHS plans to work with the private sector to accelerate health IT innovation and healthcare interoperability adoption through application programming interfaces (APIs).

APIs allow software programs to communicate with one another, acting like a bridge between the applications to enable the flow of data from one program to another regardless of how the program was originally designed.

READ MORE: Understanding the Value-Based Reimbursement Model Landscape

HHS and the ONC have been aggressively exploring the use of APIs through the Blue Button system, which is currently in its second iteration, Blue Button 2.0. The system contains four years of Medicare Part A, B, and D data for 53 million beneficiaries.

“The new Blue Button system gives us open APIs to allow patients to connect their data to apps that are run by private tech developers,” Hargan explained. “In other words, leveraging the private sector to let the patient own, use, and understand their own data.”

Leaning on the private sector for healthcare innovation is a Trump Administration priority.

For example, HHS recently created the Innovation and Investment Summit (DSIIS). The summit is a “year-long collaboration between healthcare innovation and investment professionals and HHS personnel who will meet quarterly to discuss the innovation and investment landscape within the healthcare sector, emerging opportunities, and the government’s role in facilitating more investment and accelerated innovation.”

The Food and Drug Administration (FDA) is also working with private healthcare companies to roll out healthcare applications.

READ MORE: Preparing the Healthcare Revenue Cycle for Value-Based Care

“Today, the world of mobile apps has tremendous potential to empower patients and inform clinical decision-making,” Hargan stated. “The world of regulating health software is still a largely new one. We have to be careful to take a practical approach to regulate it, not having a heavy hand on people who are developing these apps.”

“Overall, we hope that this will encourage more developers, including those that are new to the healthcare space to translate digital advances into tools that benefit patients,” he stressed.

At the same time, HHS is seeking regulatory reform to support the transition to value-based payment, Hargan added.

Ensuring federal regulations support both health IT innovation and value-based payment is crucial to moving the system away from fee-for-service. HHS is trying to achieve regulatory reform through the Regulatory Sprint to Coordinated Care initiative.

The initiative, led by Hargan, analyzes current regulations that may be impeding the move to value-based care and devises ways to reform the rules to support value-based payment. Through the initiative, HHS is currently examining key regulations, like the anti-kickback statute and HIPAA.

“The Regulatory Sprint is not an ordinary regulatory burden exercise. It's specifically focused on understanding as quickly as we can, hence the sprint, how current interpretations of these laws may be impeding value-based transformation and coordinated care, which is an important leg of value-based transformation,” Hargan emphasized.

The initiative also addresses how current regulations prevent health IT innovation. Recent roundtables with industry leaders, such as the College of Healthcare Information Management Executives (CHIME), are shedding light on how rules like HIPAA impede the development of health IT, which in turn impede value-based payment efforts.

“We have ambitious goals for our health system and we know that means ambitious goals for health IT, as well,” Hargan concluded. “Secretary Azar has laid out a vision for what a health system that pays for value will look like. American patients become empowered consumers, able to shop among providers. These providers are, in turn, accountable stewards of patient decisions rather than processors of paperwork.”

“That is a dramatically different kind of health system than we have today. And to get there, we need the expertise and help that all of you can offer.”


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