Workflow, data sharing issues arise for states in CMS innovation initiative

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While states participating in Round 1 of the Centers for Medicare & Medicaid Services State Innovation Models Initiative relied heavily on data sharing and the use of health information technology in the quest to enhance care delivery efforts, problems arose, according to a new report on the second year of the program.


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Published Wednesday by CMS, the report offers a summary of the policy levers and strategies employed by each of the six states in the program--Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont. For instance, it notes that in Maine, goals included connecting behavioral health providers to the state’s health information exchange, HealthInfoNet, and piloting patient access to medical records via the Blue Button project. For the former effort, financial support was provided to behavioral health organizations to improve their electronic health record technology.

Other strategies outlined include:

  • In Minnesota: Increasing EHR and HIE use among providers in ACOs and the broader community, as well as creating an eHealth Roadmap to increase adoption of such tools by behavioral health providers
  • In Arkansas: Using the state’s HIE to send emergency and admit-discharge-transfer information to Medicaid patient-centered medical home providers
  • In Massachusetts: Creating a portal, Community Connect, for caregivers and beneficiaries to access home care records
  • In Oregon: Implementing an HIE system, CareAccord, for secure messaging
  • In Vermont: Exploring telehealth initiatives

The report, however, notes several challenges faced by each of the states. Massachusetts, Maine and Oregon, for instance, experienced issues incorporating innovations into provider workflow.

“Oregon’s direct messaging technology has seen little uptake by providers, many of whom already have a preferred internal secure messaging system,” CMS writes.

In addition, the validity and completeness of data has proven to be an issue for states; in Arkansas, for example, a “lack of patient-specific behavioral health data” hindered provider efforts to treat patients.

CMS Principal Deputy Administrator and Chief Medical Officer Patrick Conway says in a blog post it’s “too early to attribute specific quantitative results” to the initiative. However, he believes the findings to date show that progress is being made by states when it comes to declines in ER visits and inpatient readmissions.