New CMS Initiatives Spark Interest

Both initiatives speak to patient-centric care.

EDITOR’S NOTE: Stanley Nachimson, a former CMS career professional, is a popular presenter on Talk Ten Tuesdays.

The Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) initiative is a new model for ACOs operating under Medicare. It will be tested under the Centers for Medicare & Medicaid Services (CMS) Innovation Center’s authority and will adhere to the following priorities: a greater focus on health equity and closing disparities in care; an emphasis on provider-led organizations and strengthening beneficiary voices to guide the work of model participants; stronger beneficiary protections through ensuring robust compliance with model requirements; increased screening of model applicants and increased monitoring of model participants; greater transparency and data sharing on care quality and financial performance of model participants; and stronger protections against inappropriate coding and risk score growth.

This is an example of CMS’s commitment to achieving health equity in Medicare. Another example is the recent publication of a Request for Information on Access to Coverage and Care in Medicaid & CHIP (Children’s Health Insurance Program). CMS is seeking feedback on topics related to healthcare access, such as enrolling in and maintaining coverage, accessing healthcare services and supports, and ensuring adequate provider payment rates to encourage provider availability and quality in the Medicaid and CHIP programs.

I also wanted to provide a few details about the TEFCA, or Trusted Exchange Framework and Common Agreement. This is, in my view, the latest incarnation of the National Health Information Network that was envisioned maybe 20 years ago. TEFCA provides a common set of rules for Qualified Health Information Networks, or QHINS, to develop and exchange information across the country. The QHINS are envisioned as hubs that allow for the secure exchange of information, with the common agreement serving as the rules of the road for the exchange. Participants can connect to a QHIN, and, if following all the rules, access data from participants in any QHIN. This will enable an emergency room doctor in California to potentially access the data for a patient from, let’s say, Maine, who is brought to that emergency room.

We can contrast this approach to the approach of an individual collecting all of their medical records on a single application on their phone or tablet, and potentially provide that. It will be interesting to see which approach works better.