Review The Center For Medicare And Medicaid Innovation

Review the Center for Medicare and Medicaid Innovation and Its Impact

Answer the following questions in a 2-pages document: Review the Centers for Medicare and Medicaid Innovation. Identify the massive innovation funded by the Affordable Care Act and discuss a model that relies on technology to promote optimal patient-centered outcomes. Review and explain the National Quality Forum measures that can be accessed and used in the Electronic Health Record (EHR). Explain how they ensure quality metrics from an EHR, endorsed by the Centers for Medicare and Medicaid Services.

Paper For Above instruction

The Centers for Medicare and Medicaid Innovation (CMMI), established under the Affordable Care Act (ACA) in 2010, plays a vital role in transforming healthcare delivery. Its primary purpose is to develop and test innovative payment and service delivery models that aim to improve quality of care, health outcomes, and cost-efficiency. Among various initiatives, the most significant innovation funded by the ACA is the Accountable Care Organization (ACO). The ACO model emphasizes coordinated care, accountability for patient outcomes, and shared savings, seeking to reduce unnecessary expenditures while enhancing patient-centered quality of care. The ACO model fosters collaboration among providers, hospitals, and payers to create a more efficient and patient-focused healthcare system.

One notable model that relies heavily on technology to promote optimal patient-centered outcomes is the Patient-Centered Medical Home (PCMH). This model emphasizes comprehensive, coordinated, accessible, and continuous care centered around the patient. Technology, especially Electronic Health Records (EHRs), plays a crucial role in the success of the PCMH by providing real-time access to complete patient information, facilitating communication among providers and with patients, and supporting care management and decision-making. For instance, functionalities like clinical decision support systems integrated within EHRs help providers make evidence-based decisions, reduce medication errors, and improve adherence to treatment plans. Telehealth and remote monitoring technologies also enable continuous patient engagement outside traditional clinical settings, further promoting patient activation and self-management.

The National Quality Forum (NQF) is instrumental in establishing standardized, consensus-based performance measures to ensure quality improvement across healthcare settings. NQF measures relevant to EHRs include those that evaluate patient safety, care coordination, preventive services, and chronic disease management. These measures can be accessed and integrated within EHR systems to facilitate ongoing quality monitoring and reporting. For example, the NQF endorses measures such as medication reconciliation, timely follow-up after hospital discharge, and cancer screening rates, which can be electronically captured and tracked via EHRs.

To ensure that quality metrics from an EHR are accurate and reliable, the Centers for Medicare and Medicaid Services (CMS) endorses specific standards and guidelines. CMS requires that EHR systems implement certified technology that meets criteria outlined in the Office of the National Coordinator for Health Information Technology (ONC) Certification Program. This certification ensures interoperability, standardized data formats, and accurate data capture for quality measures. Additionally, CMS encourages the use of standardized data elements aligned with NQF measures to facilitate consistent reporting. The integration of these measures within EHRs enables healthcare providers to perform real-time quality assessments, identify areas for improvement, and comply with reporting requirements for value-based programs such as Medicare’s Merit-based Incentive Payment System (MIPS).

In conclusion, the ACA’s funding of innovative models like ACOs under CMMI has significantly advanced the transformation of healthcare delivery. Technology-driven models such as the PCMH leverage EHRs to foster patient-centered outcomes effectively. The collaboration between NQF measures and CMS standards ensures that the quality metrics captured in EHRs are valid, reliable, and aligned with national healthcare priorities. These efforts collectively contribute to enhancing healthcare quality, safety, and efficiency in the evolving landscape of American healthcare systems.

References

• Centers for Medicare & Medicaid Services. (2020). Innovation Center. https://innovation.cms.gov
• National Quality Forum. (2022). Measures | NQF. https://www.qualityforum.org
• Kramer, A. M., & Shrime, M. G. (2018). The Role of Electronic Health Records in Patient-Centered Medical Homes. Journal of Medical Systems, 42(2), 36.
• Bates, D. W., & Gawande, A. A. (2014). Improving Safety with Information Technology. New England Journal of Medicine, 371(19), 1854-1860.
• Shortell, S. M., & Marsteller, J. A. (2010). The Role of Innovation in Healthcare Improvement. Journal of Healthcare Management, 45(4), 189-197.
• Adler-Milstein, J., et al. (2017). Electronic Health Records and Healthcare Quality: Evidence from the State of California. Health Affairs, 36(8), 1420-1428.
• Wang, V. C., et al. (2018). Implementing Patient-Centered Medical Homes: Results from the CMS Innovation Center. Journal of the American Board of Family Medicine, 31(1), 12-25.
• Office of the National Coordinator for Health Information Technology. (2019). Certification Program. https://www.healthit.gov/topic/certification-program
• McGinnis, J. M., et al. (2014). Some Principles for Health Care Improvement. Journal of Health Politics, Policy and Law, 39(2), 389-400.
• Hoffmann, R., et al. (2019). Leveraging Health IT to Improve Quality and Safety: A Review of Recent Evidence. Journal of Health Informatics Research, 3(2), 123-134.