Phila.-Area Primary Care Doctors in Medicare Program Now Receiving Reports on Their Performance through HSX

More than 200 primary care practices in the Delaware Valley who participate in the government’s new medical-home model for Medicare patients now have a centralized data portal on which to view their performance in the program.  Comprehensive Primary Care Plus (CPC+) is a national initiative that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation.  HealthShare Exchange (HSX), the nonprofit health information exchange for the Delaware Valley (including southeastern Pennsylvania and southern New Jersey) now serves as the data aggregator in the Greater Philadelphia CPC+ program, for the program’s regional health plan participants — inclusive also, earlier this year, of claims data from the Centers for Medicare & Medicaid Services (CMS).

CMS launched CPC+ to help incent medical practices to improve care quality and reduce unnecessary services that patients receive, and now data aggregations will help them to achieve this goal.  HSX generates quarterly reports for CPC+ practices on their progress on these goals, and provides them with online portal access for reviewing their results on specific quality measures, based on medical claims information — and now also the data from CMS.

“Going live at the end of 2018 with our performance reporting portal, based on data from participating insurers, was a huge step in helping our area’s primary care providers to succeed with CPC+,” says Pam Clarke, HSX’s Senior Director of Member Services and Population Health and Chief Policy Officer.  “Adding CMS data during this past quarter, is another big milestone for the regional program.”

This type of primary care data aggregation is a first for the region.  The Greater Philadelphia program is one of largest CPC+ collaboratives, with the participation of more than 1,300 local doctors and other healthcare providers serving some 200,000 attributed Medicare beneficiaries.  Although 17 other regions in the U.S. are part of the CPC+ program, only a few of those regions, have created the kind of accessible portal for family practices and other primary care providers (PCPs) that HSX has now established.  HSX partnered with Onpoint Health Data to process and quality control this reported data for the claims-based Medicare measures.

The healthcare practitioners will continue to receive cumulative and quarterly reports.  As part of their participation, these providers who volunteered for the program have a chance to earn Medicare incentive dollars.  By better understanding how they are performing on outcome and expenditure measures, the PCPs can better gauge and adjust the effectiveness and efficiency of their practices, both to benefit patients and manage costs.

“This portal will help doctors better understand how they are being evaluated and identify gaps in care that need to be met to provide higher-quality and more-efficient healthcare,” says Richard Snyder, MD, Chief Medical Officer at Independence Blue Cross, one of the founding insurers of HSX.

At the primary care offices, designated Administrative Users have credentials to access the portal.  These users often include nurse care managers who have the ability to review practice measures for the reporting period at both the practitioner level and for individual patients.  In some cases, patients may be attributed to a practice as a result of a single visit.  The CPC+ data can guide medical staff members in more closely evaluating individuals for whom they are responsible, helping to point care managers to patients to whom they can reach out to achieve better care management.  The practice summary scores also help these offices to adjust internal patient-care procedures and monitor trends over time.

“Evidence shows that this type of data-driven approach helps to improve care and gain control over costs.  It also supplements data that these practices are getting directly from insurer health plans,” says Benjamin Alouf, MD, MBA, FAAP, Senior Medical Director at Aetna. “The evolving CPC+ guidelines are going to help PCPs.”

HealthShare Exchange meanwhile delivers additional services to primary care practices that help them to achieve CMS requirements in the Care Management and the Comprehensiveness and Coordination categories.

“And now, the data portal is another vital new tool to help organizations come together and make progress for patients in prevention and health management, with our region’s largest health plans involved — and to help us continue to adapt to produce the best overall results for the program by 2020,” says Clarke.