The Big Healthcare Push: Where Are Policymakers Taking Us?

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
The Big Healthcare Push

Suggest a discussion of home health regulations and policies and you’ll probably get some eye rolls. Still, my session on that topic was well-attended at this year’s McKesson Homecare and Hospice National Users’ Conference. Home health professionals understand that recent policies and proposals from a number of government agencies are pushing the industry toward major change, presenting an opportunity for those who climb aboard early.

Many of the home health regulations center around organizations’ ability to share select patient data with other providers, de-identified data with the healthcare community and patient records with patients themselves.

These home health regulations create opportunities for organizations to demonstrate their value to the healthcare community, form partnerships based on that value and gain a seat at the table. Along the way, we’ll help move the country from a focus on healthcare to one on health, where all individuals feel responsible for their own health, leading to lower costs.

See the plans, read the maps

Here are some major recent policy proposals and legislation that home health organizations should be aware of:

  1. The Federal HIT Strategic Plan for 2015-2020. Published in December 2014, the comment period for this plan has closed. Its goals are to expand health IT adoption; advance secure and interoperable health information; strengthen healthcare delivery; advance the health and well-being of individuals and communities; and advance research, scientific knowledge and innovation. In other words, how can we get to the point where we can collect care data from any system, share it with providers and communities and use it to advance health and wellness?
  2. ONC’s Shared Interoperability Roadmap. Currently in draft form, this outlines 20 elements of clinical information that should be shared among providers, including medication, allergies, devices, vital signs and the patient care plan. The document outlines a goal for providers to have the ability to send, receive and use a common clinical data set by 2017; expand the system’s users, sophistication and scale by 2020; and achieve a broad-scale learning health system by 2024.
  3. HHS’s payment reform goals. In late January, CMS published for the first time specific goals aimed at moving from fee-for-service payments to alternative payments such as ACOs and bundled payments. It’s targeting to have 50% of payments in category 3 (alternative payments) and category 4 (population-based payment) by the end of 2018.
  4. ONC 2015 Edition HIT Certification. This proposal, from the Office of the National Coordinator for Health Information Technology (ONC), aims to improve interoperability by incorporating enhanced data portability, care transitions and application programming interface (API) capabilities into the program.
  5. Permanent SGR Fix. The Medicare Sustainability Growth Rate fix, signed into law in April, ended a pending 21% cut to Medicare providers. It requires EHRs to be interoperable by 2018 and prohibits providers from blocking information sharing from other EHR vendor products.
  6. 21st Century Cures Initiative. The goal of this bill is to speed up the process of incorporating new scientific discoveries into patient care, modernize clinical trials and enable data sharing so that big data can be used to improve patient outcomes. The bill defines interoperability and establishes a deadline to achieve it and creates a new risk-based framework for the regulation of health IT. The bill unanimously passed the House Energy and Commerce Committee and awaits consideration by the full House.

With so many home health regulations trying to address interoperability, patient data and health IT, this is clearly not the time to stick our heads in the sand and hope nothing will change In fact, many of the proposed changes, both legislative and regulatory, converge between 2017 and 2019.

That makes the next couple of years critical for determining how we can prepare for what’s coming while protecting what’s important to us. We know that healthcare in 2020 will be entirely centered on the patient, with better care, better connectivity and better business—and it’s up to us to figure out how to get there.

Do you want to learn how to create more opportunities for your organization in today’s home care regulatory environment? Download this e-book.

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