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Interoperability knowledge hub

Get everything you need to know about interoperability in healthcare and what it means for hospitals and providers today.

Alternative Payment Models

In its report, the ONC task force identifies one key driver to the establishment and achievement of comprehensive interoperability standards: "a supportive payment and regulatory environment [in which] rules that govern how health and care are paid for must create a context in which interoperability is not just a way to improve care, but is a good business decision."15  An essential component of this environment is a payment model or models that emphasize quality care versus quantity. 

To date, CMS incentive programs like Meaningful Use have moved the use of EHR systems forward, but not all clinicians are eligible for these incentives (including those providing post-acute care), limiting their impact on interoperability initiatives. The task force notes that alternative payment models (APMs) that reinvigorate the move toward quality, comprehensive care must be a central component in the plan to achieve national interoperability. They point to the Medicare Access and CHIP Reauthorization Act (MACRA) of April 2015 as an important first step "toward streamlining and expanding the use of value-based payment and quality reporting programs."16  Starting in 2017, MACRA will roll existing reporting and incentive programs (Meaningful Use, the Physician Quality Reporting System [PQRS]) into one Merit-Based Incentive Payment System (MIPS) as well as award bonuses to providers that participate in non-Medicare–related APMs.

Another initiative from the US Department of Health and Human Services (HHS) seeks to link payment to the quality, rather than the quantity, of care delivered. HHS aims "to have 85% of all Medicare fee-for-service payments tied to quality or value by 2016, and 90% by 2018."17 These programs demand an emphasis on quality care, at lower costs, and interoperability is essential to accomplishing that. It gets patient data and care information where it needs to be across the continuum, and it does so without so much of the waste and additional resources to move information via ineffective ways (e.g. fax, phone, etc.).




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