Projects Upping Odds For Community-Wide Health Role
Two demonstrations – one using a
community-wide health information exchange in Indiana, and another
using a consortium of several community care physician networks in
North Carolina – are being implemented to encourage the
delivery of improved quality care. An estimated 130,000 beneficiaries
in those states will be affected, according to the CMS.
Both demonstrations will make more effective use
of best practice guidelines, encouraging shared decision making between
providers and patients, and altering incentives for care delivery.
The demonstrations are part of the national,
five-year Medicare Health Care Quality demonstration mandated by
Congress in the Medicare Prescription Drug, Improvement and
Modernization Act of 2003.
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 P4P
program. Medicare data will be used by the IHIE, along with clinical
and administrative data from other sources, to provide participating
physicians with better information on the patients they treat.
IHIE’s program will test whether quality improvement and P4P
are effective in a multi-payer environment.
Nearly 800 involved Indiana providers are treating
the majority of Medicare fee-for-service patients in the Indianapolis
area, regardless of the patient’s health status or
affiliation with aspecific physician group, health system or insurance
"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.
The North Carolina Community Care Networks
(NC-CCN) demonstration extends the ‘medical home’
concept to low-income Medicare beneficiaries eligible for both Medicaid
and Medicare. NC-CCN combines community-based care coordination and
health information technology to support more effective care
The demonstrations are described at CMS