Medicare Contracting Reform: Report to Congress
CMS and Personal Health Records (PHRs): Initiatives For Medicare Beneficiaries Elizabeth S. Holland, MPA Office of E-Health Standards and Services Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services 2/2009 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
1
Brief History of CMS PHR Endeavors •
2005 RFI solicited public feedback on CMS’ role with regard to PHRs (over 50 responses). CMS should: – make Medicare data available – focus on privacy and security – NOT build its own PHR
•
2006 Feasibility test used Medicare claims data: – Successfully tested the transfer of Medicare claims data into existing internet-based PHRs – Claims data translated into plain English/consumer friendly language
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
2
Information for people with Medicare
• Medicare pilots with PHRs – PHR controlled by the beneficiary – Medicare data used to populate PHR – Additional information can be added by the beneficiary – Information can be sorted and viewed in different ways
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
3
CMS Initiatives (2007 – 2009) • Medicare Advantage/Part D Enrollee Pilot • Medicare Fee-for-Service pilot in South Carolina (MyPHRSC) • Medicare PHR Choice
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
4
Medicare Advantage/Part D Enrollees Personal Health Record Pilot • Voluntary study with Commercial Health Plans offering a Medicare Advantage and/or Part D Drug Plan - based on recommendation by the Consumer Empowerment Work Group of AHIC (Registration Summary & Medication History) – Participating plans already offered a PHR to commercial members – Some plans already offered the PHR to Medicare members – Other plans have recently extended availability to Medicare members
• Pilot officially launched June 2, 2007 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
5
Medicare Advantage/Part D Enrollees Personal Health Record Pilot (con’t) •
•
Four plans active as of June 2007: – HIP USA (New York) – Humana – Kaiser – UPMC (Pittsburgh) Three additional plans launched October 2007 – BCBS Arkansas – BCBS Louisiana – Medcore
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
6
Mymedicare.gov
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
7
Mymedicare.gov
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
8
Beneficiary Access to Information
• PHRs – allow people with Medicare gather, store, manage, and share their health data with family members, caregivers, health care providers • MyMedicare.gov – View claims – View eligibility, entitlement, and preventive services information – View enrollment information – Beneficiaries cannot add information
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
9
Medicare Advantage/Part D Enrollee PHR Pilot Evaluation • Evaluation activities through early 2009 • Received support from ONC, working with AHRQ • Current Evaluation Goals – To assess the value of PHRs for Medicare Advantage & Part D enrollees – Identify key barriers and enablers to PHR adoption and use INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
10
FUNCTIONS
Kaiser
Humana
HIP
Medcore
BCBSLA
BCBSAR
UPMC
●
●
●
●
●
●
●
Insurance info
●
●
●
●
●
●
●
Emergency Contact
●
●
●
●
●
●
●
●
●
●
●
●
●
●
View medications
●
●
●
●
●
●
●
Refill an Rx
●
Demographic information
Medication History
●
Add or remove medications
●
●
●
●
●
Over-the-counter or herbals
●
●
●
●
●
Interactions checker
●
Tests
●
●
●
Results of tests included
●
Visits/appointments
●
●
●
Immunizations
●
●
Allergies
●
●
Message Center
●
● ●
●
●
● ●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
Reminders/Health Tracker Tools
●
●
●
●
Health Conditions/Diagnoses
●
●
●
●
●
Scheduling appointments/calendars
●
Health Education materials
●
●
●
●
●
●
Print Health Summary
●
●
●
●
●
●
●
●
●
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
11 11
Early Evaluation Findings
• Methods for managing healthcare information – – – –
Paper records (even those using a PHR) Written notes Electronic files, spreadsheets Calendar for appointments
• Perceived benefits of PHRs • Communication with providers/caregivers • Convenience • Continuity of care
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
12
Most used PHR Functionalities
• Driven by available functionality – – – – – – –
Prescription management (esp. re-fills) Secure messaging / email Tracking lab results Reminders for indicated tests, visits Appointment scheduling Managing out of pocket expenses Managing legal documents
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
13
Medicare Fee-for-Service PHR Pilot • Medicare Fee-for-Service Pilot - MyPHRSC • Testing outreach to, and adoption of PHRs by FFS Medicare beneficiaries • Comprehensive outreach plan • Working with CMS Regional Office and local partners for support
– Initial target - 100k beneficiaries in South Carolina – Use existing commercial PHR – HealthTrio – Medicare contractor to provide claims data – Palmetto
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
14
MyPHRSC
• Outreach through MyMedicare.gov users and local health fairs • Over 3,700 beneficiaries have signed up since April 2008
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
15
MyPHRSC
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
16
MyPHRSC
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
17
MyPHRSC • Collaboration with the Department of Defense (DOD) – working with the DoD to add additional data for 65 TRICARE and TRICARE For Life (TFL) beneficiaries residing in South Carolina who participate in the MyPHRSC pilot. – Those targeted are Medicare beneficiaries first and have TRICARE as their secondary payer. – DoD wants to make medical information such as active meds, allergies, and other information contained in their medical IT systems available to their TFL participants to supplement the Medicare information in MyPHRSC. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
18
MyPHRSC Pilot Evaluation •
ASPE has funded and is overseeing evaluation
•
Utilization Statistics • • •
•
Number of registrants Number of repeat users Other demographics (age, sex, disability etc)
Focus groups and/or surveys of stakeholders to assess: • • • • •
Ease of use Perception of privacy and security features Favored functions and desired functionality Perceived value for managing health conditions Most effective outreach methods (to impact adoption) INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
19
Early Evaluation Findings
• Why do beneficiaries use MyPHRSC? – – – – – – –
To manage my health information To view my illnesses and conditions To view my health care visits To view my procedures and immunizations To learn about health related information To keep track of my medications To share information INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
20
Medicare PHR Choice • Fee-for-Service Pilot for people with Medicare in the states of Arizona and Utah. • Since January 2009, beneficiaries with FFS Medicare can sign up for an online PHR from one of the vendors selected for Medicare PHR Choice. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
21
Medicare PHR Choice
• CMS’ contractor, Noridian Administrative Services, led the intensely competitive selection process. • Vendors selected are: – – – –
PassportMD NoMoreClipboard.com HealthTrio GoogleHealth INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
22
Medicare PHR Choice
• Structure of the pilot – Noridian has a contract with CMS – CMS has data use agreements with the PHR vendors. Vendors agree to adhere to certain requirements (e.g. security, acceptance of claims data in a standard format)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
23
Medicare PHR Choice
• These PHR choices offer beneficiaries a range of product choices: – Some free – One offers “concierge” service – Beneficiaries can choose features and/or look and feel that appeals to them
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
24
Medicare PHR Choice
• PHRs have the same core functionality • Each PHR offers different strengths and additional features • All will provide up to 24 months of Medicare claims and updates over the course of the pilot.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
25
Medicare PHR Choice
• Medicare beneficiaries visit www.Medicare.gov/phr to learn about the pilot • Visit vendor websites to learn about their choices • Choose their PHR and register • Get passed to Noridian where they give the authorization to have their data moved to their PHR. • Data is moved via HITSP Summary Document (C32) INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
26
Medicare PHR Choice
• Evaluation will be conducted to determine impact on beneficiaries
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
27
PHRs looking ahead
• Completion of CMS evaluations • Issues: – – – – – –
Privacy Security Standards Interoperability CCHIT certification Ability to offer PHRs to all Medicare beneficiaries INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
28
1
Brief History of CMS PHR Endeavors •
2005 RFI solicited public feedback on CMS’ role with regard to PHRs (over 50 responses). CMS should: – make Medicare data available – focus on privacy and security – NOT build its own PHR
•
2006 Feasibility test used Medicare claims data: – Successfully tested the transfer of Medicare claims data into existing internet-based PHRs – Claims data translated into plain English/consumer friendly language
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
2
Information for people with Medicare
• Medicare pilots with PHRs – PHR controlled by the beneficiary – Medicare data used to populate PHR – Additional information can be added by the beneficiary – Information can be sorted and viewed in different ways
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
3
CMS Initiatives (2007 – 2009) • Medicare Advantage/Part D Enrollee Pilot • Medicare Fee-for-Service pilot in South Carolina (MyPHRSC) • Medicare PHR Choice
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
4
Medicare Advantage/Part D Enrollees Personal Health Record Pilot • Voluntary study with Commercial Health Plans offering a Medicare Advantage and/or Part D Drug Plan - based on recommendation by the Consumer Empowerment Work Group of AHIC (Registration Summary & Medication History) – Participating plans already offered a PHR to commercial members – Some plans already offered the PHR to Medicare members – Other plans have recently extended availability to Medicare members
• Pilot officially launched June 2, 2007 INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
5
Medicare Advantage/Part D Enrollees Personal Health Record Pilot (con’t) •
•
Four plans active as of June 2007: – HIP USA (New York) – Humana – Kaiser – UPMC (Pittsburgh) Three additional plans launched October 2007 – BCBS Arkansas – BCBS Louisiana – Medcore
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
6
Mymedicare.gov
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
7
Mymedicare.gov
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
8
Beneficiary Access to Information
• PHRs – allow people with Medicare gather, store, manage, and share their health data with family members, caregivers, health care providers • MyMedicare.gov – View claims – View eligibility, entitlement, and preventive services information – View enrollment information – Beneficiaries cannot add information
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
9
Medicare Advantage/Part D Enrollee PHR Pilot Evaluation • Evaluation activities through early 2009 • Received support from ONC, working with AHRQ • Current Evaluation Goals – To assess the value of PHRs for Medicare Advantage & Part D enrollees – Identify key barriers and enablers to PHR adoption and use INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
10
FUNCTIONS
Kaiser
Humana
HIP
Medcore
BCBSLA
BCBSAR
UPMC
●
●
●
●
●
●
●
Insurance info
●
●
●
●
●
●
●
Emergency Contact
●
●
●
●
●
●
●
●
●
●
●
●
●
●
View medications
●
●
●
●
●
●
●
Refill an Rx
●
Demographic information
Medication History
●
Add or remove medications
●
●
●
●
●
Over-the-counter or herbals
●
●
●
●
●
Interactions checker
●
Tests
●
●
●
Results of tests included
●
Visits/appointments
●
●
●
Immunizations
●
●
Allergies
●
●
Message Center
●
● ●
●
●
● ●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
Reminders/Health Tracker Tools
●
●
●
●
Health Conditions/Diagnoses
●
●
●
●
●
Scheduling appointments/calendars
●
Health Education materials
●
●
●
●
●
●
Print Health Summary
●
●
●
●
●
●
●
●
●
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
11 11
Early Evaluation Findings
• Methods for managing healthcare information – – – –
Paper records (even those using a PHR) Written notes Electronic files, spreadsheets Calendar for appointments
• Perceived benefits of PHRs • Communication with providers/caregivers • Convenience • Continuity of care
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
12
Most used PHR Functionalities
• Driven by available functionality – – – – – – –
Prescription management (esp. re-fills) Secure messaging / email Tracking lab results Reminders for indicated tests, visits Appointment scheduling Managing out of pocket expenses Managing legal documents
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
13
Medicare Fee-for-Service PHR Pilot • Medicare Fee-for-Service Pilot - MyPHRSC • Testing outreach to, and adoption of PHRs by FFS Medicare beneficiaries • Comprehensive outreach plan • Working with CMS Regional Office and local partners for support
– Initial target - 100k beneficiaries in South Carolina – Use existing commercial PHR – HealthTrio – Medicare contractor to provide claims data – Palmetto
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
14
MyPHRSC
• Outreach through MyMedicare.gov users and local health fairs • Over 3,700 beneficiaries have signed up since April 2008
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
15
MyPHRSC
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
16
MyPHRSC
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
17
MyPHRSC • Collaboration with the Department of Defense (DOD) – working with the DoD to add additional data for 65 TRICARE and TRICARE For Life (TFL) beneficiaries residing in South Carolina who participate in the MyPHRSC pilot. – Those targeted are Medicare beneficiaries first and have TRICARE as their secondary payer. – DoD wants to make medical information such as active meds, allergies, and other information contained in their medical IT systems available to their TFL participants to supplement the Medicare information in MyPHRSC. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
18
MyPHRSC Pilot Evaluation •
ASPE has funded and is overseeing evaluation
•
Utilization Statistics • • •
•
Number of registrants Number of repeat users Other demographics (age, sex, disability etc)
Focus groups and/or surveys of stakeholders to assess: • • • • •
Ease of use Perception of privacy and security features Favored functions and desired functionality Perceived value for managing health conditions Most effective outreach methods (to impact adoption) INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
19
Early Evaluation Findings
• Why do beneficiaries use MyPHRSC? – – – – – – –
To manage my health information To view my illnesses and conditions To view my health care visits To view my procedures and immunizations To learn about health related information To keep track of my medications To share information INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
20
Medicare PHR Choice • Fee-for-Service Pilot for people with Medicare in the states of Arizona and Utah. • Since January 2009, beneficiaries with FFS Medicare can sign up for an online PHR from one of the vendors selected for Medicare PHR Choice. INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
21
Medicare PHR Choice
• CMS’ contractor, Noridian Administrative Services, led the intensely competitive selection process. • Vendors selected are: – – – –
PassportMD NoMoreClipboard.com HealthTrio GoogleHealth INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
22
Medicare PHR Choice
• Structure of the pilot – Noridian has a contract with CMS – CMS has data use agreements with the PHR vendors. Vendors agree to adhere to certain requirements (e.g. security, acceptance of claims data in a standard format)
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
23
Medicare PHR Choice
• These PHR choices offer beneficiaries a range of product choices: – Some free – One offers “concierge” service – Beneficiaries can choose features and/or look and feel that appeals to them
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
24
Medicare PHR Choice
• PHRs have the same core functionality • Each PHR offers different strengths and additional features • All will provide up to 24 months of Medicare claims and updates over the course of the pilot.
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
25
Medicare PHR Choice
• Medicare beneficiaries visit www.Medicare.gov/phr to learn about the pilot • Visit vendor websites to learn about their choices • Choose their PHR and register • Get passed to Noridian where they give the authorization to have their data moved to their PHR. • Data is moved via HITSP Summary Document (C32) INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
26
Medicare PHR Choice
• Evaluation will be conducted to determine impact on beneficiaries
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
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PHRs looking ahead
• Completion of CMS evaluations • Issues: – – – – – –
Privacy Security Standards Interoperability CCHIT certification Ability to offer PHRs to all Medicare beneficiaries INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.
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