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CMS Official Points to Health Data Sharing Gains

By Kerry Young, CQ Roll Call

May 14, 2015 -- Increased ease of data sharing helped the Centers for Medicare and Medicaid Services (CMS) score a win this month for those who advocate shifting toward a more coordinated approach to delivering health services, a top agency official said last week.

CMS on May 4 announced savings of about $385 million from the Pioneer Accountable Care Organization, or ACO, model, which is aimed at improving communication between providers and Medicare patients and promoting more follow-up visits after hospital stays.

Some of this success is due to improved design of these programs, along with the use of systems allowing doctors and other health professionals more easily communicate about their work, Patrick Conway, the chief medical officer for CMS, said in a recent interview after a Senate Finance Committee hearing. Those working in ACOs have opportunities to share knowledge through both state and CMS networks, he said. The Pioneer ACO results mark a stark change from some earlier disappointing findings from experiments with coordinated care.

"Providers are learning from each other as they go," Conway said in an interview. "We are much more rapid cycle in both our sharing of data and our evaluation."

At the hearing, Senate Finance Chairman Orrin G. Hatch, R-Utah, highlighted a Congressional Budget Office (CBO) that had found discouraging results for 34 test programs that Medicare used to gauge disease management and care coordination. CBO had said in 2012 that, after accounting for the fees that Medicare paid to the programs, spending appeared to be either unchanged or higher for nearly all of them.

The finding ran counter to the widespread belief that coordinated care contain improve people's health while also leading to reduced spending on medical services. There's strong bipartisan support for the approach to medical care, seen as one of the tools to contain the growth of Medicare spending as the baby boomers age and experience more ill health. Older people are more likely to suffer from several simultaneous chronic conditions such as diabetes and heart disease. Hatch announced last week that he had appointed Johnny Isakson, R-Ga., and Mark Warner, D-Va., to form a chronic care reform working group.

Hatch said that he is expecting the work of CMS' Center for Medicare and Medicaid Innovation to provide his committee with more insight on how to shape Medicare to better treat those with chronic illnesses.

"My hope is that this research will yield long-term results," Hatch said. "By identifying cost-effective data-driven ways to improve patient health, policymakers can better target scarce federal resources to get more value for the dollars spent."

At CMS, the results seen for the Pioneer model are aiding in the expansion of this approach through what's called the Next Generation ACO program, which will include additional coverage for services provided in the home after hospital stays and telehealth, Conway said.

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