1. CMS Vision for e-Health; Value
Purchasing, and Accountable Care-
Better Care, Better Health, and Lower Costs through
Improvement
Georgia Partnership for TeleHealth Conference
Savannah, Ga.
March 13, 2013
Richard E. Wild, MD,JD,MBA, FACEP
Chief Medical Officer
CMS -Atlanta

2. Disclaimers
The presenter is a full time US Government employee and will
represent the positions of the Centers for Medicare and Medicaid
Services (CMS), US Dept. of Health and Human Services (DHHS).
The presenter reports no activities or conflicts of interest.
This presentation was current at the time it was published or uploaded onto the
web. Medicare policy changes frequently so links to the source documents have been provided
within the document for your reference.
This presentation was prepared as a tool to assist providers and is not intended to grant rights or
impose obligations. Although every reasonable effort has been made to assure the accuracy of the
information within these pages, the ultimate responsibility for the correct submission of claims and
response to any remittance advice lies with the provider of services. The Centers for Medicare &
Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, or
guarantee that this compilation of Medicare information is error-free and will bear no responsibility
or liability for the results or consequences of the use of this guide. This publication is a general
summary that explains certain aspects of the Medicare Program, but is not a legal document. The
official Medicare Program provisions are contained in the relevant laws, regulations, and rulings.
(CPT only, copyright 2008 American Medical Association. All rights reserved. CPT is a registered
trademark of the American Medical Association. Applicable FARSDFARS Restrictions Apply to
Government Use. Fee schedules, relative value units, conversion factors and/or related
components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending
their use. The AMA does not directly or indirectly practice medicine or dispense medical services.
The AMA assumes no liability for data contained or not contained herein.)

3. The Triple Aim Goals of CMS
Better Care
• Patient Safety
• Quality
• Patient Experience
More Efficient Care: (Reduce Per Capita Cost through
improvement in care)
• Reduce unnecessary and unjustified medical cost
• Reduce administrative cost thru process simplification
Improve Population Health
• Decrease health disparities
• Improve chronic care management and outcome
• Improve community health status

4. What’s Wrong with US Healthcare
Today?
Too Costly?
Inefficient?
Disparities in Access and Quality?
Evidence Base foundation often lacking?
Lack of Prevention focus?
Fragmentation of care, between providers and sites of
care? (Silos, care transitions)
Poor information and data sharing and transfer?
Patient safety and quality ? (Compare to aviation industry?)
A payment system that rewards providing services rather
than outcomes?
Coordinated, accountable or Uncoordinated, Unaccountable
care?

5. Aviation or Health Care ?

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7. Why E-Prescribing?
98,000 die from medical errors annually
• More than breast cancer, AIDS, or motor
vehicle accidents
1.5 million preventable adverse drug
events annually
• Hospitals, long-term care, outpatient
encounters
• 530,000 among Medicare beneficiaries
• $877 million per year for Medicare
beneficiaries
Source Institute of Medicine 1999, 2000, 2003, 2006

9. •
•
• Potential to save up to $35 billion dollars over three years.

10. How to Get Involved!
Join the Partnership for Patients – Sign the Pledge!
Go to www.healthcare.gov/center/programs/partnership

11. The CMS Vision of Leveraging
Meaningful Use of HIT

12. HIT Overview
 HIT and Congressional Initiatives
 ARRA of 2009, HITECH ACT, established CMS
E.HR incentive program for Meaningful Use of HIT
 Recent Studies: Archives of Internal Medicine,
Jan. 26 2009, Amarasingham, et.al,“Clinical
Information Technologies and Inpatient
Outcomes, a Multiple Hospital Study”
-Hospitals with automated notes and records, order
entry and clinical decision support had fewer
complications, lower mortality rates, and lower costs.

13. Health Care Delivery System
Transformation
Adoption of Enhancing
Health Health System Performance Transformation
Information Competencies Barrier
Technology
Clinical Care
Knowledge
Infrastructure Barrier
Barrier Integrated
Care
Accountable
Care
Personalized
Episodic/ Health Care
Uncoordinated Management

14. Timeline for Delivery System
Reform and Transformation
2011-2019
MU
Stage
MU Stage 3
2
MU Healthcare
Stage Delivery System
Program and
Reform and
1 Policy Redesign
Transformation
Successful 2016-2019
Payment and
Service Model 2014-2019
Innovation
2011-2019

15. Medical Home 1.0
E-
Prescribing
Electronic Medical Individual
Health Home Patient Care
Record 1.0 Plans
Care
Coordination
Capable

16. Medical Home 2.0
Advance
Chronic
Disease
Integrate Management
Patient
e-prescribing Registries
and COEs
E-Clinical
HIE
Connected Medical Decision
Making
Home
2.0
Electronic
Population
Patient Access
Health Bio
and
Surveillance
Communication
Electronic
Two Way Eligibility
Quality System
Report Interface

17. Medical Home 3.0
Advanced Care
Management
Fully e-Health Capable
Capable Clinical Practice
Translational
Research
Remote Bio
Metrics Connected to
Monitoring and Community
Tele health Medical Resource
Capable Databases
Home
3..0
Integrated
Electronic Clinical Patient E-Learning
Network Center
Interfaces
Community
Psycho/Social
Health
Evaluation and
Surveillance Intervention
Network

18. What are the Three Main
Components of Meaningful Use?
• The Recovery Act specifies the following 3
components of Meaningful Use:
1. Use of certified EHR in a meaningful manner
(e.g., e-prescribing)
2. Use of certified EHR technology for electronic
exchange of health information to improve
quality of health care
3. Use of certified EHR technology to submit
clinical quality measures (CQM) and other such
measures selected by the Secretary
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19. HITECH: How the Pieces
Fit Together
Regional Extension Centers
Improved Individual &
Medicaid EHR Program 1st Year Incentive ADOPTION Population Health
Workforce Training Outcomes
Increased
Transparency &
Efficiency
Medicare and Medicaid EHR
Incentive Programs MEANINGFUL USE
Improved
Ability to Study &
Improve Care Delivery
State Grants for
Health Information Exchange
Medicaid Administrative Funding for HIE EXCHANGE
Standards & Certification Framework
Privacy & Security Framework
Health IT Practice Research
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20. What do the Meaningful Use objectives and
measures really mean?
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21. What are the Requirements of
Stage 1 Meaningful Use?
• Stage 1 Objectives and Measures Reporting
• Eligible Professionals must complete:
• 15 Core Objectives
• 5 objectives out of 10 from menu set
• 6 total Clinical Quality Measures
(3 core or alternate core, and 3 out of 38 from additional set)
• Hospitals must complete:
• 14 core objectives
• 5 objectives out of 10 from menu set
• 15 Clinical Quality Measures
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22. Meaningful Use: Core
Objectives - Stage 1
• Eligible Professionals – 15 Core Objectives
1. Computerized provider order entry (CPOE)
2. E-Prescribing (eRx)
3. Report ambulatory clinical quality measures to CMS/States
4. Implement one clinical decision support rule
5. Provide patients with an electronic copy of their health information, upon request
6. Provide clinical summaries for patients for each office visit
7. Drug-drug and drug-allergy interaction checks
8. Record demographics
9. Maintain an up-to-date problem list of current and active diagnoses
10. Maintain active medication list
11. Maintain active medication allergy list
12. Record and chart changes in vital signs
13. Record smoking status for patients 13 years or older
14. Capability to exchange key clinical information among providers of care and
patient-authorized entities electronically
15. Protect electronic health information
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23. What is in the Stage 2 MU Rule
• Minor changes to Stage 1 of meaningful use
• Stage 2 of meaningful use beginning in 2014
• New clinical quality measures
• New clinical quality measure reporting
mechanisms
• Appeals
• Details on the Medicare payment adjustments
• Minor Medicare Advantage program changes
• Minor Medicaid program changes
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24. Meaningful Use:
Changes from Stage 1 to Stage 2
Stage 1 Stage 2
Eligible Professionals Eligible Professionals
15 core objectives 17 core objectives
5 of 10 menu objectives 3 of 6 menu objectives
20 total objectives 20 total objectives
Eligible Hospitals & Eligible Hospitals &
CAHs CAHs
14 core objectives 16 core objectives
5 of 10 menu objectives 3 of 6 menu objectives
19 total objectives 19 total objectives
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25. Closer Look at Stage 2:
Electronic Exchange
Stage 2 focuses on actual use cases of electronic
information exchange:
• Stage 2 requires that a provider send a summary of care record for more
than 50% of transitions of care and referrals.
• The rule also requires that a provider electronically transmit a summary
of care for more than 10% of transitions of care and referrals.
• At least one summary of care document sent electronically to recipient
with different EHR vendor or to CMS test EHR.
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26. Medicare Shared Savings Program
Accountable Care Organizations (ACOs)
Program
For more information:
www.cms.gov/sharedsavingsprogram/
Shared Savings Program
http://www.cms.gov/savingsprogram http://www.cms.gov/savingsprogram/
http://www.cms.gov/savingspr

27. Medicare Shared Savings Program
Goals
The Shared Savings Program is a new
approach to the delivery of health care
aimed at reducing fragmentation,
improving population health, and
lowering overall growth in
expenditures by:
• Promoting accountability for the care of
Medicare fee-for-service beneficiaries
• Improving coordination of care for
services provided under Medicare Parts A
and B
• Encouraging investment in infrastructure
and redesigned care processes

28. What entities could form an ACO?
Existing or newly formed organizations may form an ACO:
• ACO professionals in group practice arrangements
• Networks of individual practices of ACO professionals
• Joint ventures/partnerships of hospitals and ACO
professionals
• Hospitals employing ACO professionals
• Federal Qualified Health Centers (FQHCs) and Rural Health
Clinics (RHCs)
• Critical Access Hospitals (CAHs) that bill under method II
Secretarial discretion for other providers and suppliers of
services
• Other Medicare-enrolled entities may join the groups above
as ACO participants.

29. ACO Professionals
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30. ACO Quality Measurement &
Performance
Quality measures are separated into the
following four key domains that will
serve as the basis for assessing,
benchmarking, rewarding and improving
ACO quality performance:
• Better Care
1. Patient/Caregiver Experience
2. Care Coordination/Patient Safety
• Better Health
3. Preventative Health
4. At-Risk Population

31. ACO Quality Measurement &
Performance Continued
ACO Quality Performance Standard made up of 33
measures intended to do the following:
Improve individual health and the health of populations
Address quality aims such as prevention, care of chronic
illness, high prevalence conditions, patient safety,
patient and caregiver engagement and care
coordination
Support the Shared Savings Program goals of better care,
better health and lower growth in expenditures
Align with other incentive programs like PQRS and EHR

32. ACO Quality Data Reporting
Quality data collected three ways:
• Claims and other internal data
• ACO-GPRO tool
• Survey
Complete and accurate reporting in the first year qualifies
the ACO to share in the maximum available quality
sharing rate
Pay for reporting is phased in for the remaining
performance years
Shared savings payments are linked to quality performance
based on a sliding scale that rewards attainment
• High performing ACOs receive a higher sharing rate

33. Return on Investment from HIT
Wide Spread Adoption of Electronic Health Information
(EHI) Technologies for Better Outcomes , Lower Cost
, Improve Population Health
Improving Health Care Quality,
Cost Performance, Population Health
Better
ROI of EHI at Point of Care: Outcomes
• Improved Patient Safety
• Reduced Complications Rates Lower
• Reduced Cost per Patient Episode of Costs
Care
• Enhanced cost & quality performance
accountability
• Improved Quality Performance Population
• Improve Community Health
Health
Surveillance

34. More information:
NEW!!! CMS eHealth Webpage:
http://www.cms.gov/ehealth/
• http://www.cms.gov/EHRIncentivePrograms
• http://www.cms.gov/ERXIncentive/
• http://www.cms.gov/PQRS/
• http://www.cms.gov/center/physician.asp
• www.healthcare.gov/center/programs/partnership
• www.healthcare.gov/partnershipforpatients
• www.cms.gov/sharedsavingsprogram/
Thank You !! Questions ??
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