Paying to Make Health IT Meaningful: A Discussion at the NCCN Policy Summit

Maximizing the utility of technology platforms and making them meaningful to ensure quality cancer care was the underlying theme of Emerging Issues and Opportunities in Health Information Technology, a National Comprehensive Cancer Network (NCCN) Policy Summit, held June 27, 2016.

For the first panel discussion at the meeting, payers, providers, and developers of technology platforms discussed Readiness to Support Alternative Payment Models and Reporting for Precision Medicine and Quality Care. Participants included Amy Abernethy, MD, PhD, FlatIron Health; Jonathan Hirsch, Syapse; Michael Kolodziej, MD, Aetna; Mia Levy, MD, PhD, Vanderbilt Ingram Cancer Center; Alexandra Mugge, MPH, Centers for Medicare & Medicaid Services; Marcus Neubauer, MD, McKesson Specialty Health; Allen Roeseler, NantHealth; and Bret Shillingstad, MD; Epic Systems Corporation.

Data silos that emerge because systems do not speak with each other is a significant problem. How does this absence of information affect patient care? Neubauer said that interoperability is a problem for the system. “Within our system, we are internally networked well enough to not have any such issues. Otherwise, clinics have to significantly depend on patient reporting,” he said, which can sometimes be a challenge. With respect to measuring the quality of care delivered, the more information the better. “Clinical pathways involve a design component and then there’s compliance. They are both distinct. We have capabilities to generate and share reports on compliance with payers,” Neubauer added.

Mugge said that at CMS “We try to listen to clinicians to make measures more meaningful. They could be targeted. Like just for [electronic health records].”

What is the major barrier that can be removed to mine the available data across systems? According to Levy it’s how the data is extracted.

“Quality metrics have been around for a long time, but they have not been grounded in the feasibility of measuring something, measure may be process oriented but they are not easy to extract,” Levy said. “The feasibility of being able to extract data in a more automated fashion is important,” she said.

Roeseler agreed. “We have these vast data sets…the question is how do you access this information?” Shillingstad suggested that specialty organizations and registries play a very important role in the process, and a registry of standards can be set up for oncology.

“The interesting thing with oncology is that some of the new data sources lend the opportunity to monitor and implement workflow changes and process changes. We have been able to work with one of these to institute such workflow changes,” added Hirsch.

But the necessary changes have to be implemented now, at the point where physicians and clinics are preparing to submit their reports for the Merit-Based Incentive Payment System (MIPS), Medicare Access & CHIP Reauthorization Act of 2015, and other alternative payment models (APMs). “So FlatIron is working to getting data organized to introduce it into registries and data sources,” Abernethy said. “It’s also important to record those quality measures that matter, and I foresee 2 challenges with that:

• The need for quality measures that are aligned with the current data systems
• Developing measures that are flexible enough to alter based on outcomes.

Neubauer complimented the way in which CMS’ Oncology Care Model (OCM) has been developed. “Initially, there were 20 quality measures within the OCM, and now they have been reduced to 12, 4 of which are requirements of the [Physician Quality Reporting System]. So quality metrics change as the program evolves. They were smart to do that with OCM,” he said. “While decision support tools are a good idea, they should contribute to making the physician workflow smoother, and not add to their burden,” Neubauer added.

Abernethy pointed out that physicians should remember to only add information that they need to enter. “If it’s not necessary information, the physician’s quality report drops off.”

How can health IT platforms support APMs?

Kolodziej said, “Oncologists are responsible for understanding the clinical profile before they treat the patient. MIPS and OCM are transitional models, not the end game. Understanding the clinical information and then coming up with alternatives for care…we need health IT.”

EHRs can support bundled payments, episodes-of-care and such, but they are very complex for oncology, said Shillingstad.

According to Abernethy, software solutions that guide physicians and buyers to the right solutions is the basic requirement. Additionally, predicting risks using algorithms that can predict which patient is at risk for specific problems.

“EHRs create a community practice. They create a mechanism for community oncologists to relate to each other and help each other,” Abernethy said, which was the objective behind FlatIron’s cloud-based EHRs.

“Cloud-based technologies and machine learning can provide increased data access. Cloud-based technologies and aggregated data can provide the solution,” said Roeseler.

Hirsch agreed. “Cloud-based systems, like Amy said, can help physicians share and learn from each other. We are currently collaborating with health system on this,” he said.

“Most of what is coming back is that customers are driving development,” Shillingstad said.