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Home / News & IndustryManaged Care Insight and Analysis
Updated: July 7, 2010
Medicare 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 type.

"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 management.

The demonstrations are described at CMS


  This article was taken from:
Pay-For-Performance Reporter

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