Tag Archives: Electronic Health Records

Small healthcare providers: The challenge of quality measure reporting

How is your hospital, healthcare system, or clinic measuring up to national standards? Are your patients receiving proper and timely care? For many small and rural systems, these are difficult questions to answer without proper (and often third-party) support.

In late 2017, the Centers for Medicare and Medicaid Services (CMS) introduced the Meaningful Measures initiative, with a goal to improve the delivery of care while also reducing costs for both patients and providers through the culling and prioritizing of existing quality measures. Part of this initiative aimed to reduce the burden of reporting for providers. For large hospitals in urban settings, it is likely there are employees whose roles are dedicated to the encumbrance of quality reporting. When new quality initiatives come down the pike, adjusting priorities may take some time, but these teams are largely equipped to handle it. For smaller clinics, measuring success—let alone demonstrating it—under complex and shifting quality standards is a huge challenge. Small clinics are also less likely to have adequate health information technology, which adds another layer of difficulty. There are several options that should be considered as small providers look to improve their quality performance.

Health information exchanges

As healthcare has moved more toward patient-centered care, health information exchanges (HIEs) have increased in popularity. If a patient had an emergent event at Big Hospital A but a follow-up appointment at Small Clinic B, does Small Clinic B have access to the medical records completed at Big Hospital A? HIEs help to improve the timely sharing of medical information among providers, aiding in record completeness and informing better decision making at the point of care. Many HIEs are free to join and work with a wide variety of electronic health record (EHR) vendors. Additionally, these HIEs will often provide analytics tools designed to help providers keep tabs on their quality metric performance.

Upgraded EHR systems

The American Recovery and Reinvestment Act of 2009 saw the call for nationwide adoption of EHR systems by all eligible providers. With additional funding and incentives made available, a veritable swarm of EHR vendors suddenly appeared, and today we’re left with hundreds of EHR platforms. As time has passed, several large players have emerged, and these vendors, though expensive, can offer up enhanced quality measure reporting at the click of a button. Unfortunately, some of the price tags of the bigger EHR platforms make them unfeasible for practices with small budgets. Still, grants may be available for those who are in desperate need of an upgrade, and benefits beyond quality measures are frequently seen.

EHR vendor support

It could be that a small clinic’s EHR vendor already has quality measure capabilities, but the clinic lacks the staff or knowledge to successfully retrieve and analyze the data. This is where an EHR vendor contact can come in handy. Check your EHR vendor’s website or manual for contact information, and fire away. They should be happy to show you the more advanced features of your EHR, including quality measure reporting. It is also worth reaching out to other clinics and practices that utilize the same EHR. Sharing challenges and accomplishments in using an EHR vendor is a good way to learn.

Third-party contractors and software

Many smaller organizations choose to “outsource” their quality measure tracking to third-party vendors who specialize in such calculations. This is a wise choice for many, given that these third parties can provide the technology and manpower that is lacking within the organization. However, it’s prudent to thoroughly vet these types of vendors, as the options are extensive within the healthcare industry. Some questions to keep in mind include:

  • How will quality measures be reported?
    • On an aggregate level, or on the patient level? Will individual physicians or clinics be able to see their overall performance?
  • How are quality measure reports delivered?
    • Is it a web-based dashboard? Is it interactive? Will we need separate software to view results? Can I easily share the results with others?
  • How often will results be updated?
    • Monthly? Daily?
  • How often is the measure logic updated to conform to specifications?
    • Is there an extra annual fee for these updates?
    • Is the vendor certified by the National Committee for Quality Assurance?
  • What other health plans use this technology?
  • Is the vendor compliant with HIPAA regulations?
    • How will data be transferred to you?
    • How will data be stored?

It’s important to find a vendor that will help your organization reach and exceed its own unique goals. Do your research and you will see benefits.

Start small

Keeping track of the myriad quality measures can be overwhelming. Many small practices have found success in focusing their efforts on a few measures, which can be a great way to build confidence and momentum among staff. For clinical quality measures, diabetes, high blood pressure, and tobacco use are popular for beginners to focus on, as well as high-impact for patients. Using internet searches to find examples of workflows and processes other small clinics have been successful with can help to ease the initial burden.

While small providers and clinics face challenges unseen by larger organizations when it comes to tracking their quality performance, these challenges are not insurmountable. Small providers and clinics will be able to succeed by utilizing the options above and several more support options available to them.

This blog post was first published by Katherine on LinkedIn.

Milliman Advanced Risk Adjustment™ (MARA™) software tops the competition in risk scoring study

laurent-dianeMilliman’s popular Milliman Advanced Risk Adjusters™ (MARA™) software topped the competition in the latest study by the Society of Actuaries (SOA), “Accuracy of Claims-Based Risk Scoring Models.” Milliman achieved the highest overall performance among concurrent models, beating out 11 other vendors. MARA’s prospective models scored similarly well, ranking at or near the top in all four primary metrics measured.

MARA’s performance is proof of what we’ve known all along—the Milliman Advanced Risk Adjusters software is a leader in claims-based risk scoring models, and one of the most accurate tools on the market.

Since the passage of the Patient Protection and Affordable Care Act (ACA), risk scoring models play a central role in predicting or explaining healthcare expenditures. As in each of the previous SOA studies, coefficient of determination, or R2, was used as one measure of predictive accuracy and indicates how well data fit a statistical model. With an R2 of 55.4%, MARA’s concurrent diagnosis and pharmacy model (CxAdjuster) leads the competition with the highest observed R2 for uncensored costs. For costs censored at $250,000, the same model achieved the highest R2 to occur in the study, at 66.7%.

We were especially pleased that in an exploration of ensemble methods of modeling, more weight was put on the MARA model than any other. To me that indicates that giving MARA the most credence resulted in the best performing composite prediction.

MARA models are valued by clients because they produce separate risk scores for major categories of service, including inpatient, outpatient, emergency room, physician, pharmacy, and other medical care. Beyond risk scores, all MARA models provide a probability of inpatient admission and emergency room visits, plus the contribution of clinical risk drivers for more than 1,000 medical conditions.

The study, released Monday October 25, is published by the Society of Actuaries.




Federal health exchange risk adjustment model now available in Milliman Advanced Risk Technologies’ MARA software

Milliman has announced the expansion of its Milliman Advanced Risk Adjusters (MARA) software to include greater flexibility for calculating risk scores in and outside of health exchanges. The latest release includes the federal risk adjustment model developed by the U.S. Department of Health and Human Services (HHS) for use in the individual and small group marketplaces starting in 2014. The complex HHS-HCC model set, which employs the hierarchical condition category (HCC) grouping logic, requires specific diagnosis and demographic handling to calculate risk scores.

“Our latest product release is a testament to our commitment to provide healthcare organizations with on-demand risk scoring solutions in support of their reform initiatives,” said Diane Laurent, MARA’s managing director.

The HHS-HCC risk adjustment model is provided in a platform-independent software package that is easy to install in any environment. Clients who wish to tightly integrate the processing engine receive automated processing interface support. Milliman’s MARA product is proven technology with analytical support available from Milliman’s consulting actuaries and other industry experts.

“The MARA tools give the industry on-demand processing of metallic-level and cost-sharing reduction (CSR) risk scores, with completely transparent scoring. Adding the HHS-HCC risk adjustment model means plans and others have another powerful tool for understanding and managing risk in their own technical environments,” added Hans Leida, Milliman principal and consulting actuary.

In addition to the HHS-HCC risk adjustment model, MARA includes a library of more comprehensive, higher-performing risk adjustment tools that are widely deployed in solutions offered by leading healthcare technology providers, including business intelligence, care workflow solutions, and electronic medical records (EMR) vendors. MARA adds insight for population health activities in accountable care organizations (ACOs), primary care medical home programs, and other health-based budgeting, pricing, and risk-based performance measurement programs.

For more information, go to www.millimanriskadjustment.com.




New steps in the use of electronic health records

The U.S. Department of Health and Human Services (HHS) announced the next steps in the president’s effort to help doctors and hospitals use electronic health records. Here is an excerpt from the HHS’ news release:

Today, HHS’ Centers for Medicare & Medicaid Services and HHS’ Office of the National Coordinator for Health IT released final requirements for stage 2 that hospitals and health care providers must meet in order to qualify for incentives during the second stage of the program, and criteria that electronic health records must meet to achieve certification.

The requirements announced today:

• Make clear that stage two of the program will begin as early as 2014. No providers will be required to follow the Stage 2 requirements outlined today before 2014.
• Outline the certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they use will work, help them meaningfully use health information technology, and qualify for incentive payments.
• Modify the certification program to cut red tape and make the certification process more efficient.
• Allow current “2011 Edition Certified EHR Technology” to be used until 2014.

For Milliman’s perspective on electronic health records, click here.




Veterans Administration builds on electronic record system

President Obama today announced an effort to computerize the medical records of all military personnel and better integrate records between the Defense Department and the Department of Veterans Affairs. This is a complicated issue, as was made apparent during tonight’s PBS coverage of the announcement:

The proposal builds off of an existing infrastructure. The VA has a robust electronic health record system in place already, as Gail Graham discussed at the EHR Town Hall in December:




Wal-Mart, healthcare innovator?

Wal-Mart announced today that it would market electronic record systems to small physician practices, a group that has not adopted these systems as widely as integrated payer and provider groups such as the Veterans Administration and Group Health.

This is not the first time Wal-Mart has provided a low-cost alternative in healthcare. Milliman principal and consulting actuary William Pollock recently published research about the market-changing success of Wal-Mart’s $4 generic prescription drug offering.