HealthStream buys New York Online Training Company for $15.4 Million

Nashville-based HealthStream has acquired Jericho, N.Y.-based Health Care Compliance Strategies, a company focused on interactive and engaging online compliance training for health care organizations, according to a news release.

HealthStream, which provides workforce development solutions for the health care industry, purchased HCCS for approximately $13 million in cash and $2.4 million in shares of HealthStream's common stock in a private placement, the release says. In addition, up to $750,000 in cash will be paid over a 12-month period following closing subject to the achievement of certain performance milestones.

The following are excerpts from today's news release:

Healthcare is one of the most highly regulated industries in the U.S. and the number of regulations continues to grow, which results in growing demands for compliance training. HealthStream has long been the leading provider of workforce development solutions in healthcare, which has included itsOSHA & accreditation compliance training in U.S. hospitals with its 3.7 million subscribers to its platform. With its added capabilities, courseware, and expertise from the acquisition of HCCS, HealthStream now has a comprehensive compliance solution—with a full continuum of services and training programs that addresses the broad range of compliance priorities.

"HealthStream is a perfect fit for HCCS to further support development of the healthcare workforce," said Ben Diamond, president, HCCS. "We are both focused on providing exceptional compliance solutions that, in turn, help to improve patient outcomes and promote compliance with ethical, legal, and accreditation guidelines. HealthStream has pioneered compliance solutions in healthcare and we are excited to play a role in building their robust compliance offering."

Through the acquisition of HCCS, HealthStream adds a comprehensive curriculum of premium compliance courseware and training programs, which include several bundled offerings—like the Quality Improvement Suite, Workplace Compliance Suite, General Compliance Suite, and the Research Compliance Suite. HCCS' courses use fast, rich content, with full motion video and interactivity. Examples of the diverse compliance topics in HCCS' courseware include HIPAA Compliance, Bioterrorism & Disaster Preparation, Patient Rights, Reducing Medication Errors, and Health Plan Compliance. Helping organizations comply with the training requirements of Corporate Integrity Agreements (CIAs) is another specialty area of HCCS that adds to HealthStream's overall compliance solution strategy.

HealthStream's workforce development solutions are also expanded with HCCS' SaaS-based application for tracking potential conflicts of interest disclosures, known as the COI-SMART system. Cumbersome manual processes are automated with COI-SMART as the system tracks and manages potential conflicts of interest among hospitals' physicians, executives, and other healthcare professionals. Correspondingly, courses are also offered in "Conflicts of Interest and Research Misconduct." COI-SMART will be offered on a subscription basis to healthcare organizations, adding another powerful, healthcare-specific application, which will be integrated with HealthStream's workforce development platform.

HealthStream's comprehensive compliance solution will be offered primarily to corporate compliance officers in hospitals, who represent an increasingly important role in healthcare organizations. At this time, 98 percent of healthcare organizations have a corporate compliance officer (CCO) with a staff, on average, of three full-time employees. The Health Care Compliance Association now has over 9,000 active members. Alongside the growing number of federal and state regulatory requirements, the industry-wide focus on improving patient safety has further contributed to the importance of compliance programs in healthcare organizations. The addition of HCCS brings a sales team dedicated to this channel, which will be immediately expanded to cover HealthStream's 10 sales regions.

"I would like to extend a warm welcome to HCCS' clients and employees," said Robert A. Frist, Jr., chief executive officer, HealthStream. "Providing OSHA & accreditation compliance solutions to healthcare organizations has been a core offering for HealthStream for over a decade and we are excited to expand the scope of our solutions in this important area. HCCS' premium content and thought leadership add important dimensions to our compliance solution strategy."

http://m.bizjournals.com/nashville/blog/2014/03/healthstream-buys-new-york-based.html?r=full

32 Recently Announced ACOs

The following accountable care organizations or value-based care delivery arrangements were covered by Becker's Hospital Review within the past month.

1. Humana struck up three new accountable care agreements.

• One is with Miramont Family Medicine, a medical group practice based in Denver. It covers Humana's Medicare Advantage HMO members in the area. 
• Another is with Edgewood, Ky.-based St. Elizabeth Healthcare.
• The third new agreement was formed with The Christ Hospital Health Network in Cincinnati.

2. Cigna was also very active, partnering with several provider organizations for collaborative accountable care initiatives, the payer's version of ACOs.

• One agreement is with Baton Rouge (La.) Clinic, a multispecialty group with about 90 physicians.
• The partnership between the payer and Springdale, Ark.-based PremierCare Northwest, a provider-owned network and collaborative effort between physicians and Northwest Health System, covers roughly 5,000 Cigna members.
• A third CAC initiative is with Brewer, Maine-based Beacon Health, a subsidiary of Eastern Maine Healthcare Systems, which covers 7,000 Cigna beneficiaries.

3. Anthem Blue Cross and Blue Shield in Missouri partnered with Esse Health, a St. Louis-based independent physician group, for an accountable care model.

4. LHS Health Network, which includes physician practices, hospitals and other providers and is affiliated with Camden, N.J.-based Lourdes Health System, partnered with Horizon Blue Cross Blue Shield of New Jersey for anACO.

5. Blue Cross Blue Shield of Michigan expanded its pay-for-performance initiative by signing value-based reimbursement contracts with 24 hospitals.

http://www.beckershospitalreview.com/accountable-care-organizations/32-recently-announced-acos-0314.html

Presidential Innovation Fellows Round 3: Serve. Create. Innovate.

Today, we are very excited to announce that applications are now being accepted  for the third round of the Presidential Innovation Fellows program. This initiative pairs talented, diverse individuals from outside government with top Federal innovators to implement game-changing projects that make the Federal Government work better for the American people. 

At its core, the Presidential Innovation Fellows Program is as strong as the incredible people that are willing to join this effort and serve their country. That’s why we want the best and brightest individuals—original thinkers, gifted designers, tech-savvy strategists, private-sector doers, inventors, entrepreneurs, and talented developers and engineers—to offer up their skills and expertise to create huge value for the American public.

Round 3 will include 14 projects that focus on addressing three high-impact initiatives:

• Making Digital the Default: Building a 21st Century Veterans Experience: The U.S. Department of Veterans Affairs is embarking on a bold new initiative to create a “digital by default” experience for our Nation’s veterans that provides better, faster access to services and complements the Department’s work to eliminate the disability claims backlog.
• Data Innovation: Unleashing the Power of Data Resources to Improve Americans’ Lives: This initiative aim to accelerate and expand the Federal Government’s efforts to liberate government data by making these information resources more accessible to the public and useable in computer readable forms, and to spur the use of those data by companies, entrepreneurs, citizens, and others to fuel the creation of new products, services, and jobs.
• By the People, for the People: Crowdsourcing to Improve Government: Crowdsourcing is a powerful way to organize people, mobilize resources, and gather information. This initiative will leverage technology and innovation to engage the American public as a strategic partner in solving difficult challenges and improving the way government works—from helping NASA find asteroid threats to human populations to improving the quality of U.S. patents to unlocking information contained in government records.

More information on each project is available here.

Since the initiative launched two years ago, Presidential Innovation Fellows, along with their government teammates, have been delivering impressive results—at start-up velocity. Fellows have unleashed the power of open government data to spur the creation of new products and jobs; improved the ability of the Federal government to respond effectively to natural disasters; designed pilot projects that make it easier for new economy companies to do business with the Federal Government; and much more. Their impact is enormous. 

For example, Fellows recently helped expand the Blue Button Initiative, which is helping Americans across the country gain secure, online access to their own healthcare information. Through the work of Fellows and their government teammates, the Blue Button Initiative has expanded its reach to more than 150 million Americans who are today able to use Blue Button-enabled tools to access their own health information from a variety of sources including healthcare providers, health insurance companies, medical labs, and state health information networks.

Another recent example of the Fellows in action is their work at the Smithsonian Institute to develop a crowdsourcing platform that allows the public to transcribe handwritten historic documents and records. This kind of innovative approach will not only support important research, but provide an important avenue for the public to help preserve our Nation’s history.  In just six months, Fellows developed and launched an end-to-end solution for creating digital records for historic files, which in turn engaged thousands of volunteers who have helped to transcribe and review more than 3,000 historic and scientific records —which are now easily accessible to the public for the first time.  

Looking ahead, the next round of Presidential Innovation Fellows will continue to build on these successes as well as tackle a new set of challenges.

This is an opportunity to truly transform how government works for the people it serves. The work will be challenging, but promises to be tremendously rewarding. The first step is to apply here. We can’t wait to see what the third round of Fellows will do!

Todd Park is Assistant to the President and U.S. Chief Technology Officer 

Dan Tangherlini is Administrator of the U.S. General Services Administration

http://www.whitehouse.gov/blog/2014/03/06/presidential-innovation-fellows-round-3-serve-create-innovate

What decides the success of ACO, population health models?

Not all health systems, hospitals, or physician practices succeed at implementing accountable care organizations.

More recent results published by the Centers for Medicare & Medicaid Services (CMS) showed returns within range of the federal agency’s expectations for the first year of the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Program. However, that news came nearly half a year after CMS revealed that nine accountable care organizations (ACOs) would be leavingthe more aggressive Pioneer ACO Program, two for good with the other transitioning to MSSP.

So what determines the likelihood of a healthcare organization and its providers making a successful goal of an ACO? According to the leaders of the MMSP ACO, TriState Health Partners (THP)-Meritus ACO, the answer to that question is a combination of two elements: a physician culture of accountability and an organizational structure built on collaboration and data sharing.

Historically, THP has had strong physician engagement as a result of its setup as a physician hospital organization (PHO) owned jointly by more than 200 physician and Meritus Medical Center. What’s more, its physicians were well versed in care coordination and clinical integration well in advance of ACO programs being made available.

“We’ve had data presented to the doctors so when the ACO opportunity came on the radar physicians felt that they had an understanding of what the global ideas were,” says THP CMO Robert Cirincione, MD. “There was very little ‘sell’ that had to be done. We went to our physicians were already part of THP and presented them with the various contracts.”

As a physician himself already espousing alongside his fellow physicians the key components of accountable care in his practice, Cirincione encountered little resistant when selling the concept of an ACO.  “From the physician’s standpoint it is: what does it cost to join (nothing); what is the downside risk (none); what do you want me to do (practice more efficient and patient-based medical care and achieve increased outcomes)?” he adds.

iStock/Thinkstock

According to ACO Program Director Shelley Grant, the organization was likewise primed for embracing the MSSP ACO model. “We were very well positioned from with our Tristate Health Partners organization — from a governance structure to a network of providers to reach out to — so we had more of an infrastructure already in place because of some of our previous work that we had done around clinical integration,” she reveals.

Because of the ownership structure of THP, many of the initial hurdles facing other aspiring ACOs were simply not there. “Unlike organizations that are starting out and just trying to pull providers together to educate them on the concept and then gain the trust to do the actual contracting, we already had a foot in the door,” Grant notes.

The challenge for the organization actually centered on its health IT infrastructure and the data being used to manage a patient population.

“We knew right away that the solution that had been in place was not going to be sufficient moving into the Shared Savings Program, and that’s where we really started to venture out,” Grant explains. “Through years of doing this, the technology that we had been using was solely claims-based and claims-based solutions will only get you so far in the management of a population and also when you’re looking at the overall performance of the healthcare provider community.”

The organization needed to be able to integrate its patient and provider data in a fashion similar to how THP had been coordinating and integrating care among its physicians for close to two decades. “We needed a system that would pull in those disparate data systems and be able to map those quality data elements and provide a more unified picture of how we were performing as an ACO,” says Grant.

While these two components are key to a successful ACO, they must be driven by the right philosophy — one that recognizes the value of the individual patient within the entire patient population.

“When we talk about population health, we tend to use very broad buckets — five percent of people in this bucket, twenty percent of people in that bucket,” Cirincione observes. “Practicing physicians tend to glaze over with discussions like that at some point because they really want to know about their patients who are in one of the buckets.”

What’s important to physicians in ACO or population health management is aligning views of a population with the needs of the individual. “Our challenge is to take what we can know from the segmenting of risk and then translate that into what that means to patients as they are going through the care so that the primary care physician or medical specialist is focusing on that patient relative to an evidence-based protocol and meeting the needs of the patient,” concludes Cirincione.

http://ehrintelligence.com/2014/03/04/what-decides-the-success-of-aco-population-health-models/

A Primer on Meaningful Use and HISPs

The Massachusetts State government offers low cost HIE services including Direct transport to all the stakeholders of the Commonwealth.    Recently. Micky Tripathi wrote this FAQ which is so good that I wanted to share it on my blog.   Feel free to use it with your stakeholders.

1. What is a HISP?
A Health Information Services Provider (HISP) is an organization that manages security and transport for health information exchange among health care entities or individuals using the Direct standard for transport.  There is no specific legal designation for a HISP, nor are HISPs specifically regulated by Meaningful Use certification rules.  The term HISP was coined to describe specific message transport functions that need to be performed to support scaled deployment of the Direct standard in the market.  HISP functions can be performed by existing organizations (such as EHR vendors or hospitals or HIE organizations) or by standalone organizations specializing in HISP services.

HISPs perform two key functions that support scalability of exchange using the Direct standard. 

a. Issue security certificates.  HISPs establish trust networks by defining policies for network participation and issuing security certificates tied to a HISP anchor certificate to enforce such policies
b. Issue direct addresses.   HISPs issue direct addresses tied to the HISP anchor certificate in accordance with conventions defined by the Direct standard

2. Do I need to use a certified HISP to attest for Meaningful Use Stage 2?
No, because there is no such thing as a certified HISP.  Meaningful Use certification applies to technology, not to organizations.  In order to attest for Meaningful Use Stage 2, you need perform certain activities using certified EHR technology (CEHRT).  For most EHR users, their EHR is certified for all of the functions that they need.  If it is not, you will need to incorporate specific additional certified technology solutions to fill the remaining gaps.  It doesn’t matter whether that additional technology comes from an EHR company or a HISP company – the only thing that matters is that the technology is certified.

3. Doesn’t DirectTrust certify HISPs?
DirectTrust is a private, non-profit organization that voluntarily certifies HISPs through its EHNAC DTAAP program.  This private, voluntary certification often gets confused with Federal Meaningful Use certification.  DirectTrust is NOT a Federal certification entity, and its EHNAC DTAAP certification process is purely private and voluntary and has no relationship with Meaningful Use Stage 2 attestation or certification requirements.

4. What role does a HISP play in Meaningful Use Stage 2?
A HISP provides specialized network services that connect your EHR to other EHRs that are also using the Direct standard for communications.  You don’t need a HISP in order to create Direct-compliant messages, but you do need to be connected to a HISP in order to send and receive Direct messages with other parties.  Using an email analogy, you may have Microsoft Outlook installed on your computer, but if it isn’t connected to an email network, your emails can’t go anywhere and none can get to you.  Similarly, your CEHRT can send and receive Direct-compliant messages, but those messages won’t go anywhere unless you and those who you are communicating with have valid
Direct addresses and are connected to a secure network that can get the messages safely and reliably from one endpoint to another.  These are the message transport functions that HISPs perform.

There are two Meaningful Use Stage 2 attestation requirements that require Direct transport:

• Summary care record for transitions of care (TOC)
• Patient ability to view, download, transmit their medical record (VDT)

Most HISPs (including the Mass HIway) do not yet have the ability to connect directly with patients, so they are not able to assist with the VDT requirement.

For the purposes of attestation, the Meaningful Use Stage 2 TOC requirement specifies that you must electronically send a standardized summary care document to another care setting, and that you must have reasonable assurance that the other care setting actually received the document.  The HISP performs the message transport functions to provide you with the assurance that your messages have been delivered to their intended recipients.

In order to attest for the TOC requirement, you need to send CCDA care summaries containing at least problem lists, medications, and medication allergies.  These summaries must be transmitted with your CEHRT using either the SMTP/SMIME or XDR/SOAP protocol.  There is no Federal certification for HISPs, so you can send your message to its intended recipient using any HISP or any number of HISPs, as long as you have assurance that the message will get delivered.  The only certified system that you need to use is the one that creates the Direct-compliant SMTP or XDR message – after that, your message may take any number of “hops” between your EHR and its final destination, and as long as you’re confident that the message will get delivered, you will have completely fulfilled your Meaningful Use Stage 2 attestation requirement.

5. How do I get assurance that my messages are delivered?
Meaningful use attestation requirements do NOT specify how you get assurance of delivery, they specify only that you have taken reasonable steps to be confident of delivery.  The most robust way for you to be assured of message delivery is for your system to receive message disposition notifications (MDNs) for each message sent by your EHR to the intended recipient.  However, not all receiving systems or HISPs can generate MDNs, and not all EHR systems can consume MDNs even if they are returned. 

Fortunately, you are not required to receive MDNs in order to be assured of delivery.  Other acceptable methods of assurance are through HISP guarantees of delivery after successful setup testing and/or notification of failure of delivery (like emails) and/or HISP central maintenance of delivery logs that can be made available as needed. 

The Mass HIway provides you with assurance of delivery through rigorous setup testing, and maintenance of a central log of delivery successes and failures.  This log is made available to participants as necessary in the event of an audit.  The Mass HIway will also return any MDNs or application-specific responses or acknowledgements generated by receiving endpoints, however, the Mass HIway cannot guarantee that any receiving endpoint will generate notifications, acknowledgements, or responses.

The one exception where delivery notification is available and required is public health.  The Massachusetts Department of Public Health requires that participants receive delivery notifications in order to satisfactorily meet the Meaningful Use Stage 2 public health requirements.  Massachusetts DPH does generate automated acknowledgements, which are sent automatically via the Mass HIway in response to each message successfully received.

6. Is the Mass HIway a HISP?
Yes.  The MA HIway is a trust community that issues security certificates and Direct addresses to eligible participants and provides Direct-compliant message transport services for its participants.

7. Is the Mass HIway certified as an EHR module for Meaningful Use Stage 2?
No, the Mass HIway is not certified as an EHR module for Meaningful Use Stage 2.  Most providers will not require the Mass HIway to be certified in order to use it to help fulfill their Meaningful Use Stage 2 attestation requirements.  (See discussion above in FAQ on HISP roles.)  As long as your CEHRT delivers a Direct-compliant SMTP or XDR message to the Mass HIway (either to the LAND appliance or directly to the central site), you do not need the Mass HIway to be certified.

If your CEHRT does not send a Direct-compliant SMTP or XDR message to the Mass HIway (for example, if you are sending messages to the LAND appliance in a format other than SMTP or XDR), then you will need to change your interface to send Direct-compliant SMTP or XDR to the Mass HIway (including the LAND appliance) in order to count any of these transactions for Meaningful Use Stage 2 TOC requirements.

Even though you do not need the Mass HIway to be certified for Meaningful Stage 2 in most cases, you will still need to have assurance of delivery of messages sent over the Mass HIway to meet your Stage 2 TOC attestation requirements.  The Mass HIway provides this assurance by delivery after successful setup testing.

8. Must I be connected to the Mass HIway in order to attest for Meaningful Use Stage 2?
Yes, you need to be connected to the Mass HIway in order to meet the Meaningful Use Stage 2 public health requirements for immunization and cancer registries, and syndromic surveillance.  The Massachusetts Department of Public Health will accept public health transactions only through the Mass HIway.  Thus, though there is no Federal requirement that you be connected to the Mass HIway for Meaningful Use Stage 2, you will not be able to meet core public health requirements for Meaningful Use Stage 2 without being connected to the Mass HIway.

You do not need to be connected to the Mass HIway in order to meet the Meaningful Use Stage 2 TOC requirement.  However, over 100 providers and payers are already live on the Mass HIway HISP.  Thus, connecting to the Mass HIway will likely make it easier for you to meet your TOC requirements because you will be immediately connected with many of the providers you share patients with.

9. The Meaningful Use Stage 2 rules refer to the eHealth Exchange – is that the same as the Mass HIway?

No.  The eHealth Exchange is a health information exchange network comprising federal agencies and other large non-federal organizations.  The Mass HIway is not connected with the eHealth Exchange in any way.

10. Do I have to be connected to the eHealth Exchange in order to meet my Meaningful Use Stage 2 attestation requirements?

Absolutely not.  While the Meaningful Use Stage 2 rules do allow special dispensation for eHealth Exchange members, few providers will attest using this mechanism.  No Massachusetts providers or payers are currently members of the eHealth Exchange.

11. Who are the other HISPs in Massachusetts, and can I join any HISP that I want?
There are a wide variety of HISPs operating in the Commonwealth.  Whether you join any particular HISP depends on a number of factors.  The biggest factor is which HISPs your EHR vendor allows you to join.  Some vendors require that you use a specific HISP (either their own or the one they are integrated with), while other vendors (such as Meditech and Epic) allow the provider to choose which HISP they would like to connect to.  CMS and ONC do not require that you use any particular HISP for meaningful use, but in practice, your EHR vendor will dictate which HISP options are available to you.

If your vendor allows you to choose which HISP to connect to, you can connect directly to the Mass HIway HISP.  If your vendor requires that you use their designated HISP, you will have to connect to the Mass HIway through their HISP, as long as their HISP is connected to the Mass HIway.
Please contact the Mass HIway (http://www.masshiway.net) if you have any questions about your connection options.

12. Is the Mass HIway part of DirectTrust?
No, the Mass HIway is currently not a member of DirectTrust.  DirectTrust is a voluntary private non-profit collaborative that is helping HISPs to connect with each other.  The Mass HIway is connecting directly with the major HISPs operating in the Massachusetts market.  The Mass HIway may join DirectTrust at some point in the future if it provides additional value to participants.  Providers, EHRs, or HISPs do NOT need to be part of DirectTrust in order to meet their Meaningful Use Stage 2 certification and attestation requirements.

13. If I’m in another HISP, can I still be on the Mass HIway?
Yes.  You can connect to the Mass HIway even if you are a member of another HISP.   The Mass HIway is actively connecting with the major HISPs operating in the Massachusetts market so that messages can be sent between HISPs.  You do still have to join the Mass HIway by signing a participation agreement even if you are in another HISP.  As a member of another HISP, you will pay whatever fees are charged by your local HISP and your Mass HIway fees will be waived.  Once you have joined the Mass HIway, your local HISP will configure your system to enable access to the Mass HIway network.  Your local HISP will still provide you with your security certificate and your Direct address, but you will be able to send and receive messages over the Mass HIway network. 

Below is a current list of HISPs that are expected to be connected to the Mass HIway.  The HISP market is evolving rapidly so more HISPs will be added as demand grows.  Please contact the Mass HIway (http://www.masshiway.net) if you would like to discuss your connection options.

HISP Live date
eClinicalWorks April 2014
Surescripts April 2014
eLINC/SES April 2014
Allscripts/MedAllies TBD
Athenahealth TBD
Wellport/Alere TBD

http://geekdoctor.blogspot.com/2014/03/a-primer-on-meaningful-use-and-hisps.html

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HHS FY 2015 budget to reduce Medicare-Medicaid fraud, waste

The Department of Health & Human Services has release its budget for fiscal year 2015, which the department claims is both “fiscally responsible” and aims to strengthen its two most important programs — and doing so by reducing healthcare fraud and waste.

“On the mandatory side, we’ll contribute a net $369 billion toward deficit reduction over the next decade,” Secretary Kathleen Sebelius said in a press conference earlier today. “By incentivizing high-quality and efficient care and by continuing to reduce healthcare cost growth, this budget also strengthens two very important programs — Medicare and Medicaid — with $415 million in net savings over the next decade and extends the solvency of the Hospital Insurance Trust Fund by five years.”

According to Sebelius, a major focus of the FY 2015 budget is to control the year-to-year growth of Medicare over the next ten years. “It will reduce the average annual growth in Medicare over the next decade from 6.3 percent to 5.3 percent. What’s more, by expanding competitive bidding for durable medical equipment, it also produces additional savings for Medicare and its beneficiaries alike,” she added.

An important part of these cost-reduction efforts highlighted in today’s press conference and budget was the work of Health Care Fraud and Abuse Control Program (HCFAC), whose investment is apparently paying off.

“[The budget] invests $428 million in HCFAC and the Medicare Integrity Program, both of which are proven to deliver results in fighting fraud. Every dollar we invest in HCFAC, for example, returns $8.10 of the money we recover. We’ve now announced recovering a record-breaking $4.3 billion,” she explained.

The budget indicates that preventing fraud and reducing improper payments are “top priorities” for the current administration. The investments in HCFAC and Medicaid program integrity funds are expected to yield $13.5 billion in gross savings for Medicare and Medicaid over the next decade.

The budget is also proposing the introduction of new tools via legislative action to increase program integrity oversight. For the Medicare program, these include:

• Allowing prior authorization for Medicare fee-for-service items;

• Allowing civil monetary penalties for providers and suppliers who fail to update enrollment records;

• Allowing the Secretary to create a system to validate practitioners’ orders for high-risk items and services;

• Increasing scrutiny of providers using higher-risk banking arrangements to receive Medicare payments

• Retaining a percentage of incentive reward payment recoveries

For Medicaid, the following proposal are being made:

• Increasing investment in and expanding authority of the Medicaid Integrity Program;

• Supporting Medicaid Fraud Control Unites for the territories;

• Expanding Medicaid Fraud Control Unit review to additional care settings;

• Tracking high prescribers and utilizers of prescription drugs in Medicaid;

• Consolidating redundant error rate measurement programs;

• Preventing use of federal funds to pay state share of Medicaid or CHIP;

• Improving program integrity for Medicaid drug coverage.

Read the complete HHS FY 2015 budget here.

http://ehrintelligence.com/2014/03/05/hhs-fy-2015-budget-to-reduce-medicare-medicaid-fraud-waste/

Florida Health Choices launches state exchange

MIAMI (AP) — The troubled Florida Health Choices program launched an insurance exchange Tuesday, after several delays, that is separate from the Affordable Care Act marketplace.

CEO Rose Naff delayed the launch last month after 10 times higher than anticipated interest in the site prompted technology experts to retool the website. But Naff announced they were open for business with a single vendor, which is offering five different plans, including a prescription discount card and bundled discount products that includes vision, dental, telemedicine and prescriptions.

The program is separate from Obama's federal health law and will not offer tax credits. Consumers seeking to buy insurance on the federal exchange who mistakenly end up on Florida Health Choices' site will be directed to healthcare.gov. For now, major insurers have not signed on to offer plans through Florida Health Choices and coverage under the program will not count as comprehensive health coverage under the Affordable Care Act.

Instead, Florida Health Choices will cater to consumers who don't like the president's law or may be seeking gap coverage, pharmacy discount cards and limited vision or dental plans. The program will add more vendors going forward, which will provide coverage for prepaid health clinics, primary care and outpatient visits. Florida Health Choices also hopes to offer some type of coverage to the roughly 1 million Floridians who make a bit too much money to qualify under stringent Medicaid standards but not enough to qualify for tax credits through the federal exchange.

Naff said she learned from the bungled rollout of the federal health law and delayed the launch several times to ensure the website was ready. Site capacity was increased to handle 30,000 users a day, including 1,000 simultaneous applications, she said.

Critics have complained that Florida Health Choices, the brainchild of former House Speaker Marco Rubio, started in 2008 and still doesn't have a single enrollee more than five years later. But Republicans, many who were eager to an alternative to so-called "Obamacare," have championed the program. Lawmakers have given Florida Health Choices about $1.5 million over the years.

Florida Health Choices hopes to enroll 67,000 consumers in its first year to break even. Naff said she isn't planning to ask lawmakers for additional funds this year.

http://www.naplesnews.com/news/2014/mar/04/fla-health-choices-launches-state-exchange/

FCC Creates Task Force To Boost Wireless Health Adoption

Wednesday, March 5, 2014

TOPIC ALERT:

• Telehealth

Click on topic to receive periodic emails.

On Tuesday, the Federal Communications Commission announcedthat it will create a new task force to examine ways to accelerate health care organizations' adoption of wireless technologies, The Hill's "Hillicon Valley" reports (Hattem, "Hillicon Valley," The Hill, 3/4).

Task Force Details

The task force -- called Connect2HealthFCC -- will be led by Michele Ellison, who has served as chief of FCC's Enforcement Bureau since 2009. Ellison will work with FCC's Director of Health Care Initiatives, the chiefs of the Wireline and Wireless Bureaus and the Office of Engineering and Technology, as well as, public and private health care stakeholders.

In a statement, FCC Chair Tom Wheeler said the task force would work to:

• Identify regulatory barriers and incentives to expand the use of wireless health technologies; and
• Strengthen partnerships with stakeholders in the telehealth and mobile health industries.

He said, "We must leverage all available technologies to ensure that advanced health care solutions are readily accessible to all Americans, from rural and remote areas to underserved inner cities" (Slabodkin, Health Data Management, 3/5).

http://www.ihealthbeat.org/articles/2014/3/5/fcc-creates-task-force-to-boost-wireless-health-technology-adoption

Malcolm Gladwell Keynotes Healthcare Data Interoperability Summit

The global narrative for “digital health” is relatively easy because the opportunities are so enormous. The only real limit is our imagination. Some of the more recent developments have been breathtaking – and include everything from genomics and personalized medicine to 3-D printing to putting healthcare literally in the palm of our hands (or the embedded sensors we will all wear or consume). At the core of it all is a single strategic component – data.

But the challenges are equally enormous – and nowhere is that more evident than data interoperability. This key alignment is at the heart of enormous (often competing) financial interests, true patient engagement and the health (both financial and clinical) of nations – including our own. The lack of this alignment is more than just inconvenient because it often results in gross inefficiencies, fraud, misaligned incentives and errors – all of which result in outcomes that are more expensive and less than desirable (including death).

There were a fair number of healthcare events last month including the largest healthcare IT event of the year – HIMSS. Now in its 53rd year, HIMSS attendance is nearing 40,000 with about 1,000 vendors and hundreds of educational tracks – all of which descended on Orlando, Florida for the better part of last week. As the CEO of Aetna Aetna, Mark Bertolini’s keynote stood out (here) and Hillary Clinton was standing room only.

But HIMSS wasn’t the only significant event last month. There was a second, smaller event that took place in the nation’s O.R. of healthcare policy – Washington, D.C.

Sponsored by West Health Institute (previous coverage by Forbes colleague Zina Moukheiber here), the daylong event – Health Care Innovation Day – was notable for three reasons. First, it had a singular focus on healthcare data interoperability; second because it was co-sponsored by the Office of the National Coordinator (ONC); and third because it included a compelling keynote by master storyteller and serial-bestselling author Malcolm Gladwell.

Gladwell’s latest book – David and Goliath – is the biblical metaphor for many modern endeavors and industries – including, of course, healthcare. In fact, the event itself was a kind of David in the shadows of the HIMSS Goliath.

Gladwell’s healthcare credentials are often overlooked but he did reference them in his opening remarks. From 1987 to 1996 he covered the healthcare industry for the Washington Post and so he openly wondered what his coverage would have been in his former capacity.

He often generates controversy, but whatever else, he is a master storyteller and there were three compelling vignettes for this keynote. They weren’t cut from healthcare cloth, but an opening line helped to frame their relevance.

But I’m only going to spend a little time talking about healthcare proper – both because I think  it’s often more useful to approach some of these issues from an angle by looking at the world outside of the one you’re engaged in – and secondly because I have a rule that I never talk about something my audience knows more about than I do. Malcolm Gladwell – Author

It’s that skewed angle – punctuated with relevant stories – as told by a master storyteller – that really puts Gladwell at the forefront as a speaker. Relative to data interoperability, Gladwell recounted the stories to help “reframe” the data interoperability dialog that continues to gridlock much of the healthcare industry – and the promise of digital health.

The first was The Beqaa Valley Turkey Shoot in reference to the rapid defeat of Syria by Israeli air supremacy in 1982. The swift and decisive victory was orchestrated by bringing different technologies together in a new and far more integrated way.

Using drones, AWAC’s and laser-guided missiles, the Israeli’s were among the first to carefully orchestrate their coordinated use in real time. The Israeli’s didn’t invent any of the component technologies, but they “integrated” their use in a new way that revolutionized military strategy with an exponentially lethal capacity.

The second story was The Shipping Container and recounted the story of Malcolm McLean – who revolutionized the shipping industry. He didn’t invent the shipping container, but he re-framed the problem in a way that transformed both domestic and international shipping.

By standardizing all of the components (containers, trucks, trailers, railways, docks, cranes and ships) in a new way (Lego at an industrialized scale), he effectively reduced the cost of loading and unloading from $5.50 a ton to $0.15 a ton. From his recognition that the problem required a broader systemic solution (not a component solution in isolation), domestic and international trade mushroomed exponentially.

The third story was The MP3 Player and how digitizing music revolutionized every aspect of the music industry. The effect of digitizing music was to make it interchangeable and interoperable. Almost overnight, music was transformed from being an album and episodic experience into one of personal and continuous use. Individual devices like record, cassette and CD “players” artificially constrained the way music was consumed.

Music stores, a dominate part of the retail landscape (and music experience) disappeared entirely within about 5 years. By un-tethering music from a rigid distribution model around proprietary formats, music enjoyment and sales exploded. From 2000 to 2010, growth in live performances and album sales both tripled.

In all three cases, it’s the combined interoperability that has the truly disruptive and exponential effect. The underlying component technology isn’t always a new invention – or exponentially disruptive.

“Sometimes when we look at innovation we make the mistake of thinking that innovation is specific to an individual invention or device. But all of those [individual] views miss the greatest transformation that’s brought about by technology – and that’s when you bring these various pieces and have them work together in combination – it’s the synergies between these tools that bring about the greatest changes in the world that we live in. You are on to something very crucial here – and I wish you all the best.” Malcolm Gladwell – Author

The urgent need for interoperability in healthcare is well understood. It could well be that interoperability isn’t the biggest problem in healthcare today – it’s just the first.

The HCI-DC conference was really designed to emphasize and accelerate the much needed national dialogue on driving medical interoperability to enable a smarter healthcare system across all the different interests. Ultimately, we’re all patients and we all deserve better care than the chaotic, proprietary and unconnected system we experience today. Together, we are working with key stakeholders to transform healthcare delivery in this country to make high-quality healthcare more accessible at a lower cost.” Nick Valeriani – CEO, Gary and Mary West Health Institute

The archived content for the day long event Sponsored by West Health and ONC (including Gladwell’s keynote) is now available in it’s entirety online (free but registration required) here.

http://www.forbes.com/sites/danmunro/2014/03/02/malcolm-gladwell-keynotes-healthcare-data-interoperability-summit/