HIMSS19: CMS innovation center could jumpstart interoperability models

By | February 15, 2019

Dive Brief:

  • CMS may move to push early adoption of infrastructure​ promoting transparency and stymieing data blocking, Adam Boehler, the head of the agency’s payment model testing and innovation center, hinted Wednesday.

  • Speaking at HIMSS19, the head of the Center for Medicare and Medicaid Innovation said the center’s models could “drive [transparency initiatives] sooner” than the private industry, due to its ability to create, test and fine-tune advanced models.

  • Boehler, who also serves as HHS deputy administrator and HHS Secretary Alex Azar’s value-based care adviser, said the industry could expect such proposals as soon as the next few months, but that any such models could be staggered across participants, types and time.

Dive Insight:

HHS has spent the giant health IT meeting touting its interoperability agenda, and Wednesday proved no different. Boehler teased several looming agency announcements many HIMSS attendees see as linchpin for interoperability.

The former Landmark health executive spoke at an end-of-day panel with previous U.S. Chief Technology Officer Aneesh Chopra and longtime venture capitalist John Doerr.

“Who would have thought that the government is the place this innovation comes from?” Doerr said.

In tandem with an interoperability rule drop from ONC, CMS issued a proposed rule Monday to expand the FHIR-compatible API to Medicaid and qualified health plans in the federal exchanges, among other plans, in order to provide their 125 million patients with electronic access to their personal health info by 2020.

“From the CMMI perspective, you can even take that further in our models, given that we have voluntary participation,” Boehler told reporters Wednesday in a wide-ranging conversation that included the agency’s actions on accountability and risk, unnecessary quality metrics, payment for outcome and social determinants of health.

The rules set the stage for transparency, Boehler said. Now, CMMI can work on the other end to align incentives. “The proposed rules go a long way in giving us a common set of things we can look at,” he said.

CMMI wants “patients and their delegates — physicians, etcetera — to get free access to electronic, easy-to-use information within 24 hours,” Boehler said — and unlike other rungs of the healthcare ladder, CMMI doesn’t have to wait.

HHS is taking a close look at revamping kidney care through a variety of lenses, Boehler said, including a CMMI model or something closer to the Health Resources and Services Administration’s policies on organ transplant information.

“CMMI can drive at their own pace,” Boehler said. “I think you’ll see us innovating further and not waiting.”

Along with the potential models, Boehler announced Wednesday that CMS is partnering with the American Academy of Family Physicians for a predictive AI competition, with a hefty cash prize.

Throughout his one-day appearance at HIMSS, Boehler often came back to two main points: releasing patient data and changing incentives. “Those two things when combined are very significant. It’s one reason why I think [CMS] Administrator [Seema] Verma’s rule was so important to value because I think it’s hard to do both — one without the other — to some extent.”

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