Greater access to shared data needed for successful transition to APMs

While the Medicare Access and CHIP Reauthorization Act requires the move to alternative payment models, providers face major barriers to transitioning because of information blocking, the lack of interoperability and other factors limiting access to data.

That’s the message the chair and vice chair of the Physician-Focused Payment Technical Advisory Committee (PTAC) delivered to members of Congress on Wednesday.

Created by MACRA, PTAC is tasked with evaluating physician-focused alternative payment model (APM) proposals against 10 criteria established by the Secretary of Health and Human Services—including encouraging the use of health information technology—and then making recommendations regarding those proposals to HHS. The panel has 11 members appointed by the Comptroller General of the United States.

MACRA specifically encourages the development of physician-focused payment models (PFPMs). So far, PTAC has received 19 full proposals and has submitted five evaluations to the HHS Secretary.

“There is a need for greater access to shared data—this is a common barrier identified by submitters,” Elizabeth Mitchell, PTAC’s vice chair, testified before a House health subcommittee hearing on MACRA and APMs. “Specifically, applicants need community wide all-payer claims and clinical data sharing across communities to successfully implement models. Providers cannot manage risk, care or cost without timely, comprehensive data.”

Also See: Why IT isn’t ready to fully support the shift to value-based care

APMs are one of two value-based care tracks from which providers can choose that would reward them for quality, cost-efficient care and improved health outcomes—the Merit-Based Incentive Payment System (MIPS) is the other. APMs can focus on a specific clinical condition, a care episode or a population; Advanced APMs are a subset of APMs that let practices earn more for taking on some of the risk related to their patients’ outcomes.

“Most of the proposals PTAC has received require coordination of care across practices, providers and communities, but if data is not shared effectively, participants cannot coordinate patient care across episodes or populations,” Mitchell told lawmakers. “We ultimately must address the barriers to community wide data access in order to enable the successful transition to APMs.”

Rep. Larry Bucshon (R-Ind.) pointed out that only 5 percent of physicians are participating in APMs, according to the Centers for Medicare and Medicaid Services.

Jeffrey Bailet, MD, chair of PTAC, made the case that larger and more sophisticated integrated healthcare systems have made infrastructure investments in electronic health records, data analytics and population health tools that “really help them be successful in an alternative payment model environment.”

Bailet also noted that the PTAC has received several physician-focused APM proposals that include proprietary technology.

However, Mitchell emphasized that “technology is important but it is also insufficient—this is really about sharing the data freely and effectively across sites, and many of the barriers to doing that are not technology barriers—they are business or otherwise.”

She concluded that “it is certainly possible to share data across platforms” and that “there can be incentives for data sharing.” Mitchell also added that “you could actually ask the vendors to ensure that there is no data blocking so that data can effectively be shared.”