Press release

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

Sponsored by Businesswire

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.

About HealthShare Exchange

HealthShare Exchange (HSX) is a health information exchange organization
founded in 2009 and incorporated as a nonprofit in 2012. HSX was formed
as a collaboration among its region’s major healthcare stakeholders,
including health plans and acute-care hospitals, to enable the
electronic exchange of patient information to improve patient outcomes
and to manage and lower healthcare costs. For more information, please