Consortium News

  • 16 Jul 2015 9:33 AM | Anonymous

    From Healthcare-informatics.com  |  July 15, 2015  |  Rajiv Leventhal

    The Centers for Medicare & Medicaid Services (CMS) has reported that the agency’s advanced analytics system, the Fraud Prevention System, identified or prevented $820 million in inappropriate payments in the program’s first three years.

    The Fraud Prevention System uses predictive analytics to identify troublesome billing patterns and outlier claims for action, similar to systems used by credit card companies.  The system identified or prevented $454 million in calendar year 2014 alone, a 10 to 1 return on investment, CMS reported.

    The Fraud Prevention System was created in 2010 by the Small Business Jobs Act, and CMS has extensively used its tools, along with other new authorities made possible by the Affordable Care Act, to help protect Medicare trust funds and prevent fraudulent payments. The system helps to identify questionable billing patterns in real time and can review past patterns that may indicate fraud, CMS said.

    In one case, one of the system’s predictive models identified a questionable billing pattern at a provider for podiatry services that resulted in Medicare revoking the provider’s payments and referring the findings to law enforcement. The Fraud Prevention System also identified an ambulance provider for questionable trips allegedly made to a hospital. During the three years prior to the system alerting officials, the provider was paid more than $1.5 million for transporting more than 4,500 beneficiaries.  A review of medical records found significant instances of insufficient or lack of documentation. CMS also revoked the provider’s Medicare enrollment and referred the results to law enforcement. 

    "We are proving that in a modern healthcare system you can both fight fraud and avoid creating hassles for the vast majority of physicians who simply want to get paid for services rendered. The key is data," CMS Acting Administrator Andy Slavitt said in a statement. "Very few investments have a 10:1 return on taxpayer money."


  • 10 Jul 2015 2:45 PM | Anonymous

    Register for a free Webinar Thu, Jul 30, 2015 1:30 PM - 2:30 PM EDT to explore #PopulationHealthManagement and learn #CareCoordination best practices.

    This webinar, which is the second in a series of three, will focus on providing strategies and guidance for adoption and implementation of Population Health Management, covering the various methods of care coordination, the value of risk stratification and the basics of data analysis. 

    We will touch upon the various methodologies of care coordination, such as: 

    • Risk Stratification: Primary or Secondary 
    • Disease-based Stratification 
    • Practice-based care coordination 
    • In-Patient or Out-Patient 
    • Centralized vs. De-centralized 
    • Practice Embedded Case Managers 
    • Psycho-social 

    We will discuss some best practices for combining risk stratification and care coordination, honing in on the most useful types of reports that can be generated. We’ll also share our own risk stratification process and classification: 

    • Using an algorithm based on industry standards and claims data to risk-stratify 
    • We stratify into populations based on: 
    • high-risk groups (with complex care needs) 
    • moderate-risk or rising-risk groups (with chronic conditions), and 
    • low-risk groups (preventive services/wellness). 

    Next, we will cover the types of data, and how to present that data to facilitate care coordination, from the various reports that are generated such as utilization reports, quality measures, drug & lab, cost reports, ER, trends and distribution. 

    We will explore what the analytics from these various reports mean to your organization, with results explaining what has happened, what could happen, and what to do about it. Finally, we’ll uncover how the data in these reports can have the most impact on a care network utilizing this predictive modeling process. 

    The Speakers: 

    • Laura Tompkins, RN, BSN, Nurse Care Coordinator, Allegiance Health Group
    • Denny Brennan, Executive Director, Massachusetts Health Data Consortium
    • Dr. Anthony Akosa, Chief Medical Officer, HealthEC®
    Thu, Jul 30, 2015 1:30 PM - 2:30 PM EDT 

  • 07 Jul 2015 2:56 PM | Denny Brennan (Administrator)

    The Health Care Transformation Task Force, a consortium of patients, payers, providers and purchasers, released a white paper on best practices for identifying costly patients with complex needs who might benefit from targeted care management, ultimately improving care and reducing total costs for the entire health care system.

    Read the white paper...

  • 07 Jul 2015 10:52 AM | Denny Brennan (Administrator)

    Emdeon has entered into a definitive agreement to acquire Altegra Health, a national provider of technology and intervention platforms, for $910 million.

    Read more...

  • 07 Jul 2015 10:49 AM | Denny Brennan (Administrator)

    Arcadia Healthcare Solutions announced Tuesday that Dr. Richard Parker, chief medical officer for the 2,300 physician network Beth Israel Deaconess Care Organization, has joined Arcadia as the company’s new chief medical officer.

    Read more...

  • 07 Jul 2015 9:42 AM | Denny Brennan (Administrator)

    Please view the guidance, for more details.

  • 06 Jul 2015 2:07 PM | Denny Brennan (Administrator)

    Healthcare Informatics, July 6, 2015 by David Raths

    Researchers encounter interoperability issues that create barriers to implementation.

    Read more...

  • 29 Jun 2015 11:15 AM | Anonymous

    Washington: June 19, 2015

    The Agency for Healthcare Research and Quality is currently funded to the tune of about $440 million for fiscal year 2015. If the House Appropriations Committee has its way, that funding will vanish in FY16.

    Part of the U.S. Department of Health and Human Services, AHRQ supports research to improve healthcare quality and outcomes. That includes studies on health information technology, patient safety, disease prevention, care management and more.

    Just this week, for instance, AHRQ announced plans to fund three centers of excellence across the country to better understand how high-performing health systems drive evidence-based care delivery.

    The three grants, which will begin in September, would provide some $52 million over five years to study how complex delivery systems disseminate evidence-based findings and draw lessons from them.

    "New evidence is valuable only if it is used," said AHRQ director Richard Kronick. "We expect this effort will give us a better understanding of how successful health care delivery systems disseminate new evidence so we can enable the rapid adoption of best practices throughout the health care system and improve patient outcomes."

    But in the draft FY16 Labor, Health and Human Services funding bill released June 16 by by the House Appropriations Committee, AHRQ has been left out in the cold. Effective Oct. 1, 2015, the agency would be "terminated" if the legislation were to pass.

    "This legislation continues our efforts to reduce wasteful spending, to stop harmful and unnecessary regulations that kill jobs and impede economic growth, and to make wise investments in proven programs on behalf of the American taxpayer," said Hal Rogers, chair of the appropriations committee.

    Predictably, there's been an outcry in the health IT community, with the hashtag #SaveAHRQ proliferating on Twitter.

    "Health IT improves quality," wrote one healthcare industry lobbyist, pointed to the work AHRQ is doing "to implement effective population health practice."

    "Cutting funding to AHRQ would be a huge mistake in our mission to improve the quality & efficiency of healthcare," wrote one surgeon.

    "High-value care relies on AHRQ's innovative and high-impact research," tweeted another physician. "Save AHRQ."

    "Don't defund programs that supply evidence for policy making," wrote a public health professional. "Penny wise, pound foolish this Congress."

    Indeed, as the Coalition for Health Funding pointed out on Twitter, "AHRQ only represents .01 percent of all healthcare spending yet saves much more."

    Of course, there's a lot of legislating left to do before any of this comes to pass, but two other health IT-focused agencies with a mandate to drive innovation in quality and efficiency would also be targeted in the new budget: the Center for Medicare and Medicaid Innovation and the Patient-Centered Outcomes Research Institute would see funding reduced by $6.8 billion and $100 million, respectively.

    Both groups were created as part of the Affordable Care Act. Both, apparently are in the crosshairs of a bill its sponsors say will "roll back harmful Obamacare provisions (and) cut wasteful spending."

    Meanwhile, the budget for the Office of the National Coordinator would sit tight at $60.4 million, according to the draft budget – but still much less than the $91.8 million requested by the White House.

    Read the draft bill here.


  • 26 Jun 2015 3:42 PM | Denny Brennan (Administrator)

    "Life as a Healthcare CIO," Wednesday, 24 June 2015

    The June 2015 HIT Standards Committee focused on celebrating the accomplishments of those individuals who have reached their federal advisory committee term limits.

    Read more...

  • 26 Jun 2015 2:02 PM | Denny Brennan (Administrator)

    One of the oldest, earliest telemedicine companies is shutting down.

    Read more...

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