Driving Interoperability: MIPS as a Gateway to Value-Based Care (VBC)

As part of PointClickCare’s ongoing commitment to provide our customers with industry-leading technologies, we continue to innovate in areas that enable them to successfully embrace VBC, improve health outcomes and maintain regulatory compliance.

Our recent announcement of a new EHR certification from the Office of the National Coordinator (ONC) signified that our customers and their care partners can now fully leverage the benefits of interoperability and bridge the data gap between the post-acute setting and all other care setting across the continuum. Additionally, this enables them to benchmark, track and report on quality measures that are tied to VBC incentive payments.

CMS mandates that all providers participating in value-based payment models meet the requirements of the Quality Payment Program (QPP), which includes submitting data to the Merit-based Incentive Payment System (MIPS) though an ONC certified EHR.

This is essential as timely and accurate data for MIPS is critical to advancing VBC. Read on to explore how leveraging our ONC certified EHR not only offers the collaborative benefits of interoperability but also simplifies MIPS reporting to help providers maximize value-based reimbursements, improve health outcomes and maintain compliance while reducing administrative burden.

What are ONC CEHRT and ONC HIT Certifications?

An ONC Certified EHR Technology (CEHRT) Certification specifically pertains to EHR technologies, meaning PointClickCare meets or exceeds the criteria and standards set by the ONC to be considered a certified EHR technology.

To achieve an ONC CEHRT Certification, a health IT organization must meet the criteria set by the 2015 Edition Cures, which includes:

• Care transitions and third-party integration via API capabilities
• Enhanced and comprehensive demographic data capture
• Data segmentation
• Standardization and consistency across the organization

ONC CEHRT Certification demonstrates compliance with the regulations outlined in the 21st Century Cures Act prohibiting information blocking and mandating EHR interoperability, which is designed to aid in the acceleration of medical product development, innovation and advances in patient care.

ONC Health IT Certifications

ONC Health IT (ONC HIT) Certification broadly covers a variety of healthcare technology products, but it does not denote EHR interoperability like an ONC CEHRT Certification.

An ONC HIT certification verifies an organization meets or exceeds specific criteria for functionality, security, and interoperability, and signifies specific healthcare technologies adhere to regulatory standards and best practices. However, it does not address the seamless exchange of data information between EHR systems.

Achieving true interoperability involves considerations including standardized data formats, communication protocols, and the ability for diverse EHR systems to work cohesively – aspects that extend beyond the scope of an ONC HIT certification.

ONC CEHRT and MIPS

In MIPS provider performance is measured across four areas:

• Quality
• Cost
• Improvement activities
• Promoting interoperability

As providers continue to meet MIPS reporting requirements, they qualify for two additional options to participate in:

• Alternative Payment Model (APM) performance pathway
• MIPS Value pathway

Improving Performance Monitoring for APM Participants

APMs offer payment approaches that incentivize delivering high-quality care while controlling costs. By participating in an APM, providers can earn additional incentives for meeting specific quality and cost targets, promoting a shift toward value-based care.

Within the APMs complex framework, enhanced interoperability emerges as a pivotal factor in MIPS performance monitoring. Look at six ways that enhanced interoperability through an ONC CEHRT certified system benefits APM participants:

1. Improved regulatory compliance
   Meeting MIPS requirements is more manageable with enhanced data interoperability, as data reporting and sharing align more seamlessly with regulatory standards.
2. Efficient metric tracking
   Enhanced interoperability helps effectively track key performance metrics specified in MIPS APMs, while also reducing hours of administrative burden. This includes monitoring quality measures, cost measures, and improvement activities.
3. Secure access to real-time insights
   Seamless, secure, and real-time data sharing provides actionable, up-to-date insights into patient outcomes and can improve overall performance.
4. Data-driven decision-making
   Improved interoperability supports making informed and strategic decisions related to resources allocation, care protocols, and quality improvement initiatives.
5. Targeted improvement opportunities
   With the ability to analyze data on a granular level, providers can pinpoint specific aspects of care delivery that may require attention. This allows for targeted interventions to enhance overall performance.
6. Reach or exceed benchmarks
   Enhanced interoperability allows providers to compare their performance with peers, identify leading practices, and implement strategies to align or exceed established benchmarks.

Overall, enhanced interoperability contributes to a healthcare landscape where patient outcomes and cost-effectiveness take center stage, and the ability to identify improvement opportunities ensures an ongoing commitment to elevating the quality of care, aligning seamlessly with the principles of VBC.