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  • 21 Mar 2018 11:49 AM | Brian Kelley (Administrator)

    Here are two job positions that have recently opened at the Commonwealth of Massachusetts' Department of Public Health.

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  • 23 Feb 2018 2:23 PM | Brian Kelley (Administrator)

    Dr. Neel Shah, former Eliot Stone intern, has been working to reduce unnecessary C-sections, and is quoted in this NPR segment.  Dr. Shah is speaking at MHDC on "System Complexity and the Challenge of Too Much Medicine" on March 15.

    Neel Shah, an assistant professor at Harvard Medical School and a leader in the movement to reduce unnecessary C-sections, praised the study as "a remarkable paper — novel, ambitious, and provocative." He said licensed midwives could be used to solve shortages of maternity care that disproportionately affect rural and low-income mothers, many of them women of color. "Growing our workforce, including both midwives and obstetricians, and then ensuring we have a regulatory environment that facilitates integrated, team-based care are key parts of the solution," he said.

    Read the full NPR story here.

  • 01 Dec 2017 10:34 AM | Brian Kelley (Administrator)

    By Rachel Z. Arndt  | September 9, 2017  |

    On Tuesday, Apple executives will deliver a keynote address—the inaugural event at the Steve Jobs Theater in Cupertino, Calif.—showing off new software and gadgets. There's rampant speculation that the company will unveil new iPhones.

    Those devices may soon be the key to—or even a replacement for—electronic health records. Ever-secretive Apple is rumored to be rethinking EHRs, potentially pulling together healthcare data on the iPhone, which, as it sits in the patient's hands, is a real-life, physical embodiment of buzzy patient-centered care.

    "Consumers are demanding more control," said Morris Panner, CEO of Amra Health, a healthcare cloud software company. "Apple is fundamentally a consumer-oriented company, and consumer systems are going to try to empower patients."

    The iPhone, which turned 10 this summer, already aggregates some health data in apps. But most of that is patient-generated. If the company can add information from doctors offices and clinics—test results, visit summaries, medication lists—the iPhone could become an important healthcare tool in achieving interoperability, which has for so long frustrated the industry.

    To do that, Apple has already tapped important interoperability organizations, like the Argonaut Project, and people, including developers who've worked on the Fast Healthcare Interoperability Resources, or FHIR, standard.

    The iPhone isn't the only device Apple hopes will affect the healthcare industry. The Apple Watch is important too. In August, Apple and Aetna held private talks about giving the watches to Aetna members.

    Last year, the insurer gave the watch for free to its 50,000 employees. 

    A recent patent also suggests a more definitive move into healthcare. In August, the company received a patent for an electronic device with a camera, light sensor, and proximity sensor, which together are used to gather health data. "Traditionally, health data is provided to users by healthcare professionals," according to the company. "However, it may be beneficial for users to have more access to health data."​

  • 01 Dec 2017 10:12 AM | Brian Kelley (Administrator)

    By Virgil Dickson  | November 30, 2017  |  from

    The CMS has finalized its decision to toss two mandatory bundled-payment models and cut down the number of providers required to participate in a third.

    Only 34 geographic areas will be required to participate in the Comprehensive Care for Joint Replacement Model, or CJR, according to a rulemaking released Thursday. Initially, 67 geographic areas were supposed to participate.

    Up to 470 hospitals are expected to continue to operate under the model. That includes the CMS' estimate that 60 to 80 hospitals will voluntarily participate in CJR. Originally, 800 acute-care hospitals would have participated under the program.

    With so many hospitals getting a reprieve, the CMS estimates the model will save $106 million less over the next three years versus what it would have saved if CJR had remained mandatory for all 67 geographic areas. The model is now expected to save $189 million over those years instead of $295 million.

    The rule comes weeks after the CMS finalized a proposal to allow knee-replacement surgeries to take place in outpatient settings. When the proposal was released in July, some questioned if it was an attempt to undermine the CJR model.

    The CMS has also finalized plans to cancel the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model, which were scheduled to begin on Jan. 1, 2018. Eliminating these models gives the CMS greater flexibility to design and test innovations that will improve quality and care coordination across the inpatient and post-acute-care spectrum, the agency said. 

    These cardiac pay models were estimated to save Medicare $170 million collectively over five years. 

    The agency acknowledged that some hospitals wanted the models to continue on a voluntary basis, as they had already invested resources to launch them, but said those arguments were not detailed enough for the agency to do so.

    "We note that commenters did not provide enough detail about the hiring status or educational and licensing requirements of any care coordinator positions they may have created and filled for us to quantify an economic impact for these case coordination investments," the CMS said.

    On average, hospitals have five full-time employees, including clinical staff, tracking and reporting quality measures under value-based models, according to the AHA. They are also spending approximately $709,000 annually on the administrative aspects of quality reporting.

    More broadly, the average community hospital spends $7.6 million annually on administrative costs to meet a subset of federal mandates that cut across quality reporting, record-keeping and meaningful use compliance, according to the trade group. 

    Ultimately, the CMS decided to not alter the design of these models to allow for voluntary participation since that would potentially involve restructuring the model, payment methodologies, financial arrangement provisions and quality measures, and it did not believe that such alterations would offer providers enough time to prepare for the changes before the planned Jan. 1, 2018 start date.

    The CMS acknowledged that hospitals and other stakeholders have voiced concerns that the Trump administration may not be as committed to value-based care as the Obama administration, but it insists that's not true. The CMS said the Trump administration just believes voluntary models are the better way to go. 

    "We take seriously the commenters' concerns about the urgency of continuing our movement toward value-based care in order to accommodate an aging population with increasing levels of chronic conditions," the agency said in the rule. "We continue to believe that value-based payment methodologies will play an essential role in lowering costs and improving quality of care, which will be necessary in order to maintain Medicare's fiscal solvency."

  • 01 Dec 2017 9:55 AM | Brian Kelley (Administrator)
    CASEY ROSS @caseymross  |  |  NOVEMBER 29, 2017

    Value is medicine’s mantra of the moment.

    It is the centerpiece of efforts to reform payment and change the way medicine is delivered. Backers of the value movement believe the entire medical system — and every transaction within it — must be based on this seminally important five-letter word.

    But a survey released Wednesday by the University of Utah shows that, in health care, value has no universal meaning — 88 percent of doctors equated value with quality care, while patients and employers provided a more nuanced definition, mixing in measures of cost, customer service, and worker productivity.

    The lack of consensus is not merely a philosophical matter. It is a huge stumbling block in the effort to deliver more bang for the buck in American health care, said University of Utah chief medical quality officer Dr. Bob Pendleton, who worked on the survey and argues the term value has become political “propaganda” in medicine.

    “It seems to be used in any way people want it to be used, to fill their own agendas,” he said. “The conversation around value is driven by large lobby groups — hospital associations and large corporate medical groups. What’s missing is the voice of practicing doctors, patients, and employers.”

    The national survey, conducted by Leavitt Partners, collected responses from 5,031 patients, 687 physicians and 538 employers. All parties agreed the cost of health care is too high. But they gave cost different levels of significance in their value equations. Doctors tended to focus almost entirely on quality measures. But employers said cost is a matter of primary concern, with nearly 60 percent ranking it as a key component of value.

    Patient definitions of value were divided among quality, cost, convenience, and customer service. When asked to choose statements that reflect what they value, the one patients selected most (45 percent) was that out-of-pocket costs must be affordable.

    Dr. Lisa Simpson, chief executive of Academy Health, a research and policy group that was not involved in compiling the survey, said it will take more clarity around costs and quality to get patients and doctors on the same page.

    She said neither party knows what medical services cost, and quality measures often miss the mark, focusing on technical definitions or process issues rather than whether a knee replacement patient can climb stairs or lift a grandchild.

    “You want to measure functional outcomes,” Simpson said. “It’s not just, ‘Did you get better? Or did you get an infection and get re-hospitalized?’ It’s more about whether you were able to return to function.”

    In the survey, 76 percent of physicians said they consider cost when making treatment decisions. But Pendleton said physicians lack access to accurate pricing information and are often flying blind in those discussions.

    Furthermore, he said, the average doctor takes care of patients with 14 or 15 different insurance plans, adding yet another layer of complexity. “Somehow we have to create a path where in the clinic those costs can become an effective part of the conversation,” he said. “Right now, they are certainly very opaque.”

    The disconnect is becoming even more pronounced at a time when patients are paying higher deductibles. Part of the rationale for those higher deductibles is that they turn patients into smart shoppers who carefully consider what they buy.

    But Allan Baumgarten, a health care consultant and researcher, said providers have an incentive to obscure cost information from patients, so they can steer them into settings where they can charge added fees. A common example is a provider that schedules a lab test in a hospital where it can charge a “facility fee” that often adds hundreds of dollars to the bill.

    “Providers systems will cloak that information so that it’s not readily apparent to the consumer,” Baumgarten said.

    Among doctors who answered the survey, 73 percent expressed dissatisfaction with the prices patients pay for medical services. Fifty-five percent said one of the most important components of value is selecting the most appropriate test or treatment for the patient.

    Pendleton said in determining appropriateness, physicians must consider clinical and cost factors at the same time, so that ordering an MRI for a patient with low back pain is done in a calculated way, and not as a matter of course.

    “For that patient with low back pain, there is more and more evidence to say a trial of physical therapy and over-the-counter ibuprofen actually has as good, if not better, outcomes,” he said. “And if we look at the cost of that, it’s a tenth or a hundredth of some of the other options.”

    Read the original post here at

  • 30 Nov 2017 12:35 PM | Brian Kelley (Administrator)

    MARINA DEL REY, Calif., Nov. 30, 2017 /PRNewswire/ -- 4medica announced today that it has joined the Massachusetts Health Data Consortium (MHDC), one of the most active non-profits in the nation dedicated to leveraging data and technology to improve health outcomes. 4medica joins the association as an executive member whose expertise in clinical data integration, along with large-scale, accurate patient identity matching, will be of particular value for MHDC's focus on speeding the exchange and sharing of data between providers and payers in 2018.

    "As an organization that is committed to bringing in the best thinking around the country, we are delighted to welcome 4medica to the Massachusetts Health Data Consortium. We look forward to the insight 4medica leaders will bring to our members and health technology leaders, for whom health data exchange and interoperability are top priorities," said Denny Brennan, Executive Director, Massachusetts Health Data Consortium.

    Brennan added that the company's solutions also address these member objectives. "4medica's innovative and cloud-based eMPI and clinical data exchange capabilities enable healthcare organizations of all sizes to leapfrog more costly and time-consuming on-premises solutions," he noted.

    What's driving the hunger for health information

    Now that America's health records have been largely digitized, the next phase is to combine this clinical information with claims and other data sources in order to glean insights that lower our national healthcare bill while raising overall quality of care. States have varied in their progress here, with Massachusetts emerging as an undeniable trailblazer. Today, almost all contracted physicians in the state work under value-based or risk-based contracts. Further, Massachusetts hospitals will be seeing significant increases in the number of patients under risk-based contracts.

    In order for these contracts to succeed, providers and payers must be able to access, share and make use of large troves of patient data. 4medica fits well in this landscape with certain key capabilities. First, via its clinical data exchange solution, 4medica can offer access to a fuller, timely picture of patient health than mere claims data can. Second, 4medica can assure this picture is about the right patient, with its powerfully accurate patient identity matching technology that processes millions of identities in seconds.

    "The Massachusetts Healthcare Data Consortium really gets that data is indispensable for healthcare today, especially the ability to share data about patients inside and outside of the hospital. Their charter and mission mirror our own vision to improve healthcare, so we really look forward to demonstrating our value to their members--not just as a software company, but as a mentor in the value-based era," concluded Gregg Church, President, 4medica.

    About MHDC

    Since 1978, the Massachusetts Health Data Consortium (MHDC), a not-for-profit corporation, remains the trusted and objective facilitator of health information and technology transformation among payers, providers, industry associations, state and federal agencies, individuals and technology and services companies. The Consortium is the oldest organization of its kind in the country.

    Founded by the Commonwealth's major public and private healthcare organizations and chartered by the Commonwealth of Massachusetts, MHDC strives to improve the quality and cost effectiveness of healthcare through:

    • Rigorous and accessible health data analyses,
    • Education and leadership development; and
    • Trusted, objective and effective convening of the Commonwealth's health information community in advancing multi-stakeholder collaborations.

    To join the Consortium, or for more membership info, visit us at

  • 21 Nov 2017 9:33 AM | Brian Kelley (Administrator)

    Dr. Neel Shah, our first Elliot Stone intern, has written an interesting piece at Politico about models of care that are less bed-focused than the traditional model.  Here's a snippet....:

    "Some corners of the health care world are already starting to embrace new, less bed-focused models of care. Ambulatory surgical centers have latched on to a strong business model for the growing number of operations for which several days in bed are neither required nor recommended. A venture-capital based birthing center franchise is currently aiming to do the same—birthing families are often admitted and discharged on the same day, and beds are in the corner of the room (for resting and breastfeeding after the baby is born), rather than in the center; the idea is to encourage the mom to use movement as much as possible to support her labor by literally sidelining the bed. Health systems are increasingly investing in other types of spaces where bedrest is not the default, including skilled nursing and rehabilitation facilities, as well as home visiting nurses and health coaches to help high-need patients with acute and chronic conditions stay out of the hospital."

    Here's a link to the full article.

    Dr. Neel Shah is an Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School, and director of the Delivery Decisions Initiative at Ariadne Labs.

  • 23 Jun 2017 2:22 PM | Brian Kelley (Administrator)
    Positions available include:
    • Health Informatics Analyst
    • Health Policy Analyst - Health Analytics and Finance
    • Health Policy Analyst - Pricing
    • Network Administrator
    • Part-Time Editor - Betsy Lehman Center
    • Project Manager
    • Research Analyst, Health System Performance
    • Senior Health Informatics Analyst
    • Senior Research Analyst, Health System Performance

    Click here for more information and to apply for any of these positions.

  • 14 Jun 2017 1:21 PM | Brian Kelley (Administrator)

    Retrieved from Harvard Business Review, June 14, 2017
    by Harsha Madannavar, Todd Clark & Joseph Johnson

    Most data-driven healthcare IT (HCIT) providers aren’t going to survive. Their business models are at serious risk of failure in the next three to five years. To beat those odds, they need to evolve dramatically, and fast, to a point where they are not selling data at all.

    Like any number of industries, healthcare is being transformed by the explosion of low-cost data. In healthcare, the transformation is driven in large part by electronic medical record adoption and digitization. There have been many benefits. End users can take advantage of quantities of newly available information to solve problems in population health, clinical decision support, and patient engagement, among other applications. And ease of access means ease of market entry: Emerging data providers can get on their feet quickly and create new sources of competition. For example, AiCure and Propeller Health are using very different methods to generate patient medication adherence data. Competition leads to better offerings and more choice. What could go wrong?nty, actually. End users can be overwhelmed by the flood of raw data and reports that may not fit well with their existing workflow or answer their specific question. And for data providers, ubiquitous availability of information and low barriers to entry means that the competitive advantage gained from the data itself can be quickly eroded.

    Yet too many HCIT providers are still pursuing that data-centric advantage. The bulk of HCIT investment supports startups that sell data — clinical or operational information that is otherwise difficult for clients to obtain or to organize. These firms regard data as the source of business value. But as more data and more data providers flood the marsssket, a competitive position based solely on data becomes impossible to defend. Consider the move by the Centers for Medicare and Medicaid Services to publish extensive Medicare enrollment and utilization data, and to make it accessible and easy to interpret via the CMS website. Information that would once have been proprietary — and premium-priced — is now widely available, for free.  CMS’s move illustrates a broad trend. Increasingly, for most HCIT firms, data is a commodity.

    What’s a data provider to do?

    One solution is to become the authoritative source for a particular kind of information. Some firms have managed it, in healthcare and in other arenas — think of QuintilesIMS as a source of pharmaceutical sales data, Nielsen as the authority on TV viewer habits, and the U.S. Census for information about U.S. demographics. In theory, a healthcare IT provider can follow their lead and try to corner the market on a data set. But to do this in today’s landscape is a tall order. The same dynamics we’ve described — widespread access, low costs, low barriers to entry, commoditization of data sets — mean it’s an open question whether this strategy can work.

    A better option is to evolve from providing data to providing insight.

    Companies moving this direction aim to solve problems within a use case, for example, decision support. They might focus on a specific population such as cancer, diabetes, or Alzheimer’s patients and a specific insight about disease progression, pain management or treatment options. They address an underlying stakeholder need such as managing the total cost of care. Clients get what’s really needed —raw data transformed to support better decisions. And HCIT providers escape the commodity trap.

    The marketplace is rapidly moving in this direction. IBM established its Watson Health business unit to apply cognitive computing analyses to healthcare and in 2016 announced plans to acquire Truven Health Analytics for $2.6 billion. IBM plans to leverage Truven’s vast data collection — sourced from more than 8,500 insurers, hospitals and government agencies — to  support specific use cases, using Watson’s analytical capabilities. For example, some Watson Health initiatives focus on improving oncology diagnostics and identifying the most effective treatment protocols for specific cancer patient subgroups.

    Another solution provider, Proteus Digital Health, is engaging with health systems to provide insights into actual medication use and resulting health patterns. Understanding treatment effectiveness for at-risk patients — in particular for patients with uncontrolled hypertension and diabetes —  is a priority for many health plans. Proteus analytics support patient and family engagement and care-team coaching to drive clinical improvement. Other data analytics services based on accurate medication-intake information, in combination with physiological measures, also promise to improve clinical decision-making, reduce doctors’ workload, and improve outcomes.

    The transformation from data provider to data analytics services is hard. It requires significant changes in business models, staffing and management approach. But we believe it’s the only option. The late economist and marketing professor Theodore Levitt famously said “People don’t want to buy a quarter-inch drill, they want a quarter-inch hole.” In health care, providers don’t want data, they want solutions that lower costs and improve outcomes. HCIT firms that deliver those solutions are the ones that will be around in five years’ time.

  • 12 Jun 2017 8:40 AM | Brian Kelley (Administrator)

    Press release June 8, 2017

    BOSTON – The Baker-Polito Administration announced today that 18 health care organizations across the state have been selected to participate in MassHealth’s Accountable Care Organization (ACO) program beginning January 2018.  The 18 ACOs, networks of physicians, hospitals and other health care providers will work together to provide integrated  health care for their patients with the goals of improving their health and containing costs.  These ACOs are expected to cover over 900,000 MassHealth members and include approximately 4,500 primary care providers.

    "Our administration was pleased to secure an innovative Medicaid waiver worth over $50 billion for the Commonwealth and it has allowed us to begin making the first major overhaul of MassHealth in 20 years,” said Governor Charlie Baker. “The restructured Accountable Care Organization program will promote integration and coordination to benefit patients, while holding providers accountable for their quality and cost.”

    “We are pleased with the overall quality and depth of the health care providers that are joining us in restructuring MassHealth’s current fee-for-service payment system,” said Massachusetts Secretary for Health and Human Services Marylou Sudders.  “All of the ACOs selected will integrate their efforts with community-based health and social service organizations to improve behavioral health, long-term supports and health-related social needs for MassHealth members as appropriate.”

    The ACO program is a major component in the state’s five-year innovative 1115 Medicaid waiver that brings in significant new federal investment to restructure the current health care delivery system for MassHealth’s 1.9 million members.   The waiver provides $1.8 billion in new federal investments, referred to as Delivery System Reform Incentive Payments (DSRIP), to support the transition of health care providers providing value-based care.

    "We know the current fee-for-service system leads to gaps in care and inefficiencies,” said Dan Tsai, Assistant Secretary and Director of the MassHealth program. “The ACOs we selected demonstrate a strong commitment to improving care for the members they serve and will be held to high standards for quality and access of care.”

    Since December 2016, six ACOs have been participating in the MassHealth ACO Pilot program covering approximately 160,000 members and have already demonstrated early successes.  For example, Partners Healthcare ACO is connecting members with home and community based services to avoid costly hospitalizations wherever possible, and to bring primary care services to members in their homes.  MassHealth anticipates that the positive results demonstrated by the Pilot ACO program will continue with the full implementation and investments under this reform.

    There are three ACO models giving providers a range of options to reflect the diversity in the Massachusetts delivery system.  Two of the models include ACOs partnering with Managed Care Organizations (MCOs) to improve care for members, while in the third model ACO providers will contract directly with MassHealth. All models support MassHealth’s commitment to:

    • Expand substance misuse disorder treatment,
    • Invest in primary care and community workforce development,
    • Invest in Community Partners for behavioral health and long term services and supports. MassHealth is currently in the process of certifying Community Partners and anticipates entering contract negotiations in August 2017,
    • Provide clinical and cultural support for populations with behavioral health and long term service needs, and
    • Allow for innovative ways of addressing the social determinants of health.  

    When fully implemented, ACOs will be the way the majority of MassHealth members receive care.  Member enrollment into ACOs is tied to their relationship with their current primary care physician to ensure continuity of this important relationship.   Members who wish to opt-out of the ACO enrollment may do so within 90 days of being enrolled in a plan.  MassHealth will also maintain the traditional managed care organization (MCO) program and is in the process of re-procuring it this year. In addition to partnering with ACOs, MCOs will continue to serve MassHealth members not enrolled in ACOs.

    Additional information on MassHealth’s planned restructuring and payment reforms for its 1.9 million members may be found on the MassHealth Innovations website at

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