Two demonstrations – a community-wide health information exchange in Indiana and an association of community care physician networks in North Carolina – are being implemented to encourage the delivery of improved care to an estimated 130,000 beneficiaries.
According to the Centers for Medicare & Medicaid Services, the demonstrations are part of the five-year Medicare Healthcare Quality (MHCQ) demonstration mandated by Congress in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. They're expected to make more effective use of best practice guidelines, encouraging shared decision-making between providers and patients and altering incentives for care delivery.
With approximately 800 providers, the Indiana Health Information Exchange (IHIE) demonstration is the first large-scale Medicare study to examine the impact of a multi-payer, quality reporting and improvement and pay-for-performance program. Common quality measures will be used to create incentives to improve the quality and cost of care provided to patients covered by private insurers, employer-sponsored group health plans, Medicare and Medicaid.
“IHIE is uniquely suited to implement and capture healthcare activities for about 100,000 Indiana Medicare beneficiaries,” said J. Marc Overhage, the IHIE's president and CEO.
“Under the current healthcare system, patient data is often inconsistent and housed in different systems, making it less useful to physicians,” said CMS Acting Administrator Charlene Frizzera. “As quality measures and incentives vary across payment and delivery systems, IHIE and subsequent demonstrations will work to combine fragmented data and standardize quality reporting and payments for greater efficiency.”
The North Carolina Community Care Networks (NC-CCN) demonstration will extend the medical home concept to low-income Medicare beneficiaries, those eligible for both Medicaid and Medicare. Consisting of eight regional healthcare networks in several counties, it combines community-based care coordination and health information technology to support more effective care management.
States that use effective care management programs in their Medicaid programs often don't extend them to those eligible for both Medicaid and Medicare. Eventually the NC-CCN intends to extend its program to those only eligible for Medicare.