Kansas HIE goes live with Direct messaging

TOPEKA, KS – State officials announced on Tuesday that Kansas has become the latest newcomer to join the burgeoning number of states and providers now using Direct messaging technology to facilitate secure, provider-to-provider communication.

As of June 30, the Kansas Health Information Network (KHIN) – a statewide provider-led HIE initiative – connects a total of 2,000 healthcare providers statewide using Direct protocols through Health Information Service Protocol (HISP) transactions.  

“Our goal is to provide health information exchange technology to all of our providers in the state of Kansas,” said Laura McCrary, executive director KHIN. This goal, she explained consists of three stages.  

The first stage is to deliver Direct message capabilities – supplied by the Nashville, Tenn.-based ICA exchange services company. Officials hope Direct will encourage providers to move away from the more antiquated fax technology.

“We really feel that the fax machine has contributed to a lot of issues related to patient safety – due to incomplete data or data being faxed to the incorrect location or data being collated incorrectly, filed incorrectly," said McCrary. "So our goal is to really utilize the Direct messaging capability that we have available to improve patient safety and patient care because complete information will be available to the physician in a timely manner.”

Secondly, the next stage consists of creating a provider portal, which officials say will allow physicians and other authorized users to access patient data in a longitudinal view. This will enable the physician to “see any information that’s available on that patient across all of the providers that are providing care to that patient in Kansas,” said McCrary.  

The portal is slated to go live for five early adopter facilities in the next couple of weeks. All providers across the state will be able to view data in the exchange, and 20 more organizations are expected to join on by the end of the fiscal year.   

The third and final stage comes down to integration – when providers can integrate their own facilities data into the exchange. 

The benefits of the three-part initiative, officials said, are obvious. One of its many advantages, as McCrary explained, is Direct's resemblance to Microsoft Office, which many providers are familiar with. “So most physicians require little or no training to begin using Direct to share information with other providers.” 

The ICA CareAlign HIE-connecting platform serves all of Kansas including 132 hospitals and more than 4,500 physicians. Foundational members include the Kansas Medical Society, the Kansas Hospital Association and the Wichita Health Information Exchange. This effort is one of the largest in the U.S covering 82,000 square miles and approximately 3,000,000 patients.

"KHIN took a very careful and rational approach to developing this HIE," said Gary Zegiestowsky, chief executive officer at ICA. "The project started with a small working group of physicians and other providers. The success of this group led to aggressive provider recruitment and word began to spread. That KHIN now has over 1,400 physicians with a total of 2,000 users participating in its statewide HIE, and the CareAlign platform is enabling HIEs to connect with each other, speaks highly of everyone involved, and it is likely that KHIN will become the standard by which other states measure success in HIE.” 

"We have long believed that this technology will have community-wide benefits for improving care and getting costs under control," said McCrary. "So after a successful provider recruitment effort and nearly a year of technology planning and testing, we have been pleased at how smoothly the launch went. In fact, the technology is so intuitive that when we made additional training available to providers not a single provider indicated that they needed it."

[See also: Ohio first state to use Direct messaging across state lines.]

According to a June HealthIT Buzz blog post, just shy of 30 statewide HIEs can now utilize Direct messaging. Other groups that have recently expanded Direct messaging technology include Pennsylvania’s eHealth Collaborative, which initiated a grant program that will provide a year of free Direct services to health care providers, rural Indiana’s Adams Memorial Hospital and Oregon’s HIE, CareAccord, that now subsidizes its Direct messaging for providers.

Blueprint Health, Humana look to drive innovation at summer session

NEW YORK – Humana has partnered with New York-based accelerator program Blueprint Health to help spur the development of new and innovative healthcare IT projects.

Blueprint Health's summer session, which kicked off on Monday, connects participants with other entrepreneurs, investors and executives. The program provides seed capital, office space and access to mentors with deep healthcare, start-up and technology experience, officials say. The organization aims to help fledgling health IT firms validate their business models, scale up, secure clients and raise capital.

“Blueprint Health is focused on identifying partners who have a strong strategic fit with our mission and are interested in encouraging innovations in healthcare technology,” said Brad Weinberg, MD, Blueprint's founder. “Partnering with Humana, a company focused on innovation, provides a great opportunity for our program participants. There was a natural connection between Humana and Blueprint Health’s goals to facilitate health and well-being through technological innovation.”

Humana will work as an integrated member of the program, reviewing candidates, and meeting with companies during the first week of the program and mentoring participants throughout. The partnership offers Humana an opportunity to work closely with the entrepreneurs and inventors of tomorrow, officials say.

“We’re excited to partner with Blueprint Health to encourage creativity and innovation in the health care and well-being space,” said Shankar Ram, vice president of innovation at Humana. “At Humana, we believe we must employ a consumer-oriented approach to well-being. And as technology makes its way into more areas of our lives, we must turn to these advances in technology as agents of positive change and take healthcare into the future.”

9 ways future EHRs need to support ACOs

Just a few years ago, the industry saw most vendors touting their support for meaningful use. Today, that focus is slowly shifting to the "ready for ACO" mentality. But unlike meaningful use, said Shahid Shah, software analyst and author of the blog, The Health IT Guy, the technology required for ACOs isn't as well defined, leaving most vendors' claims "untestable."

"Don’t be fooled into buying health IT applications that promote an 'ACO in a box' solution," said Shah. "There is no such technology, and there really can’t be. ACOs are not a technology problem; they are a business model problem first, and until the business side has decided how it will identify savings – and share those savings – any purchase will likely be useless.

"The EHR systems and IT required for MU is a quite different from what will be required for ACOs," Shah continued. "It will be nowhere as easy for existing legacy EHRs to simply retool their current platforms, like they did for MU."

With that said, Shah outlines nine ways future EHRs need to support ACOs.

1. Sophisticated patient relationship management (PRM). According to Shah, today's EHRs are more document management systems, rather than sophisticated, customer/patient relationship management systems. "For them to be really useful in ACO environments, they will need to support outreach, communication, patient engagement, and similar features we're more accustomed to seeing, from marketing automation systems than transactional systems."

2. Getting data from your systems through business intelligence and reporting. Meaningful use in its first stage, said Shah, is all about getting data into your systems, all with little outward sharing. "Data collection is something we've been doing for decades – even before MU came along, we knew how to build systems that can collect and store data bases," he said. What most people have never been good at though, he continued, is getting data out of a system in a useful way. "Now with ACOs, business intelligence reporting, and analytics across dozens of disparate systems is a real requirement," said Shah. "Today we all have problems getting data out from a single departmental EHR to help with billing inquiries and clinical decisions support." With ACOs, he said, you not only have to pull data and tie it together with departmental and local systems in your organization, but outside your organization as well.

3. Data integration for analytics capabilities. "This doesn't mean we toss in HL7 routers and hope for the best," said Shah. Most IT environments have the ability to send messages from one system to another. "That's called 'transferring' data, which we've been doing for decades," he said. "Integrating data, though, means much more – the ability to store and understand information in data marts, data warehouses, and clinical data stores and repositories from a variety of sources." Having an EHR, he added, doesn't mean you're ready for data integration; instead, you need tools "beyond what health IT firms provide," he said. "Traditional data integration vendors should be getting most of your attention here, as opposed to healthcare-specific."

4.Granular clinical data sharing. The ability to integrate data into your own system is one thing, said Shah, but granularly sharing that same data across ambulatory practices, lab partners, and other shared providers is going to require HIEs of varying levels of sophistication. "Early on, you might even need to try to bypass the HIEs and create your own local exchange using the Direct Project to make sure you're in control." Using the Direct Project to transfer secure data between partners — while building your data marts and warehouses outside traditional EHRs – will be "your best architecture bet," he said.

Continued on the next page.

Court Gives States Ammunition In Health Care Battle

Nothing breeds lawsuits like uncertainty. That being the case, the Supreme Court's landmark health care ruling is almost certain to open the door to lawsuits challenging the federal government's authority.

The court ruled the federal government can't force states to participate in a major expansion of Medicaid or else risk losing existing Medicaid funds from Washington. That threat amounted to unconstitutional coercion.

"In this case, the financial 'inducement' Congress has chosen is much more than 'relatively mild encouragement' � it is a gun to the head," Chief Justice John Roberts wrote in his majority opinion.

Congress and federal agencies frequently put strings on the money they give to states. But the high court's health ruling didn't draw a clear line between the types of financial conditions that are OK and those that are unfair to states.

"The way Roberts wrote the opinion, it's a deliberate invitation to litigation," says Brian Galle, a law professor at Boston College.

Testing The Limits

This could become a very significant ruling if they're willing to be aggressive about elaborating on this.

- Tim Conlan, public policy professor at George Mason University

It's possible that this ruling will have broad implications, because Congress uses the threat of financial penalties to get states to do all kinds of things, such as meeting clean air requirements and making elementary school children take annual standardized tests.

It's also possible that it won't mean much, because Medicaid is such an exceptionally large program. "This could be a sui generis situation," says Tim Conlan, a public policy professor at George Mason University. "No other federal-state program comes close to the size of Medicaid."

But Conlan says there appear to be a majority of justices willing to ask larger questions about the limits on congressional spending power than has been the case for decades.

"This could become a very significant ruling if they're willing to be aggressive about elaborating on this," he says.

The justices probably will get a chance to do so. States are likely to be emboldened to challenge other federal strictures. If courts find financial penalties that are much smaller than Medicaid to be unconstitutionally harmful to states, this could lead to a massive shift in relations between the states and the federal government � Congress would become much more limited in its ability to impose national standards over a vast amount of domestic policy.

New Ammunition For States

A spokeswoman for the National Association of Attorneys General says the group's members are still sorting out what the health care ruling means for other federal-state program. The offices of individual state attorneys general, including some who challenged the health care law, similarly say they haven't yet thought through all the implications.

We've had very little guidance about the point at which a condition becomes coercive. I'm not sure we really have any more guidance now.

- Richard Garnett, associate dean of Notre Dame Law School

State attorneys general and governors often challenge new rules out of Washington. Typically, they don't win. "I don't know that states have won anything since the New Deal," says Ray Scheppach, a former executive director of the National Governors Association.

But the Medicaid ruling gives them new impetus to try.

"States are not going to stand passively by and allow the federal government to pass detrimental legislation," says Susan Frederick, federal affairs counsel for the National Conference of State Legislatures. She added: "What we can take away from the Affordable Care Act litigation is that states are no longer afraid to challenge federal legislation."

Conlan agrees. "If there's ever been an open invitation for attorneys general to pursue cases, this was it," he notes. "The court did not do what it did in Bush v. Gore, which was to say there will never be another case with these characteristics, which they could have done easily."

Congress has been imposing requirements on states in exchange for money for at least a century, Conlan says. During the 19th century, Congress handed out land grant and college funds without any real provisos. Since then, however, Congress has used its spending authority to force states to change the way they do business in lots of areas, from highway administration to welfare policy.

"In a sense, Congress learned its lessons about just providing the funds and leaving it up to states' good judgment," Conlan says.

No Clear Guidance

But the Medicare decision upends that dynamic. If governors in states such as Louisiana, Florida and Texas make good on recent announcements that they won't participate in the Medicaid expansion, the federal government lacks leverage to do much about it.

"It is true that this is the first time that the court has invalidated an expansion based upon restraint on federal power," says James Blumstein, a law professor at Vanderbilt University who wrote an amicus brief in the Medicaid case that anticipated Roberts' ruling.

"But they've always said for years, decades, that this [limit] existed," Blumstein says. "If this [Medicaid rule] had not crossed the line, the line wouldn't have existed."

So where exactly is the line now? No one is certain.

In his health care opinion, Roberts cited a 1987 decision, South Dakota v. Dole, in which the court found that it wasn't "impermissively coercive," as the chief justice put it, to require states to raise the minimum drinking age to 21 or lose 5 percent of their federal highway funds.

The sum at stake amounted to less than one-half of 1 percent of South Dakota's budget at the time � a lot less than the share of federal Medicaid money that makes up every state's budget, which is about 15 percent, according to the National Association of State Budget Officers.

But because there's such a big gap between the amount of money the court has said is permissible and the amount it has ruled is unconstitutional, no one has a clear sense of how much leverage Congress can wield over the states.

"We've had very little guidance about the point at which a condition becomes coercive," says Richard Garnett, associate dean of Notre Dame Law School. "I'm not sure we really have any more guidance now."

Redefining The Lines

It's possible that the Medicaid ruling will remain an outlier. Medicaid is far and away the largest federal-state program, and it was an unusual move for Congress to put the entirety of existing Medicaid dollars at risk, as opposed to a small percentage of program funding.

Supreme Court decisions in the 1970s and 1980s suggested that justices were open to exploring limits on what Washington could force states to do, based on congressional spending power, but nothing much came of those cases. And the court said as far back as the 1930s that it didn't want to wade into the murky waters of defining what might constitute coercion because that would result in "endless difficulties."

On the other hand, nothing in the court's opinion suggested that it views Medicaid as unique because of its size.

Other federal rules also put lots of money at risk. The government places numerous strings on education dollars, for instance. Those may not make up a huge percentage of any state's spending, but federal grant money dominates the budgets of some school districts, which might be encouraged to sue when presented with strictures they don't like.

The Civil Rights Act, meanwhile, threatens to cut off all federal dollars from any entity that discriminates on the basis of race or gender.

It's also unclear whether the court's decision opens the door for states and localities to challenge existing rules, or only new ones.

"The Supreme Court knows that this decision is going to result in some federal rules being ruled unconstitutional by some judges and maybe even upheld by some circuit courts," says Galle, the Boston College law professor. "They know that."

Self-fulfilling media narratives

How did one Supreme Court Justice � Chief Justice John Roberts � end up with the power to decide the fate of the Affordable Care Act? Blogger Maggie Mahar says we should look to the media for the answer.

Note to readers: I welcome reader comments and questions, and will try my best to reply in a timely manner. I ask only that you do your part to keep our discussion both reasoned and polite. � MM

Personally, I am delighted that Chief Justice Roberts voted to uphold the Affordable Care Act. But, I am troubled that the fate of U.S. healthcare turned on one man's opinion. This is not how things are supposed to work in a democracy.

Healthcare represents 16 percent of our economy. It touches all of our lives. If we don't like the laws our elected representatives pass, we can vote them out of office. The Supreme Court, on the other hand, doesn't have to worry whether its decisions reflect the will of the people. The Justices are appointed for life. This is why they are not charged with setting public policy.

How then, did the Court wind up with the power to affirm or overturn the ACA?

The media shapes our expectations

As I suggested when oral arguments began back in March, a "media narrative" drove the case to the Court � a fiction that caught on, in the press, on television, and in the blogosphere, where it began to take on a reality of its own. A handful of "state attorneys general and governors" saw "a political opportunity" and floated the idea that the law might be unconstitutional. The media picked up the story, repeated the heated rhetoric, and "fanned the flames … Before long, what constitutional experts thought was a non-story became a Supreme Court case."

These media narratives are based on what "that those in power and in the media have concluded is likely to happen," observes Lyle Denniston, known by some as the Dean of Supreme Court reporters.

Writing on Scotusblog.com, he observes: "One ‘narrative' about the health care law began building up in Washington, and perhaps beyond, right after the Supreme Court held its hearings in late March. The mandate, it was said, was going to be struck down, the government's lawyer had blown it, and the President was going to be deeply wounded politically over the loss of his treasured domestic initiative." Some media outlets were so persuaded by their own myth-making that initially, they reported that the Court had ruled against reform!

Denniston explains that once the story goes viral, the conventional wisdom is then repeated, over and over, until "often, it seems, such ‘narratives' become self-fulfilling."

He then points a "currently prevailing ‘narrative' that most of the country is stubbornly committed to the Tea Party's wish to limit the power of the federal government." The facts contradict the fiction: Tea Party Candidates have been "losing steam" in recent elections.

In April, a WashingtonPost/ABC poll revealed that support for the Tea Party among young adults had plunged to 31 percent � down from 52 percent in the fall 2011. Half of those polled said that the more they heard about the Tea Party, the less they liked it.

Tea Partiers claims that the Court's decision invigorated its base, but offer little evidence. As I reported onHealthBeat last week, polling suggested that the ruling lifted support for reform among Independents, while having little effect on Republicans.

Media props up Governors' threat to thwart ACA

Nevertheless, belief in the Tea Party' grip on the country is now leading many to suggest that because far- right conservatives "hate the poor," some states will turn down federal funding to expand Medicaid.

I doubt it. The money is too good. The Federal government would cover the entire cost for the first three years, 90 percent thereafter. Over eight years (2014-22) the Center on Budget Policy and Priorities calculates that state spending on Medicaid spending would increase by only 2.8 percent.

Moreover, as former CBO director Peter Orzag pointed out�yesterday on Bloomberg,�Medicaid expansion will reduce others state costs: "As the number of uninsured decreases, so does the cost of uncompensated care. In 2008, state and local governments paid roughly 20 percent of the hospital costs for uninsured people, according to an Urban Institute Study."

Tea Party Governors may threaten to opt out, but The Incidental Economist's Aaron Carroll observes they will "face enormous pressure from doctors, hospitals, pharma, etc." who now provide billions of dollars worth of uncompensated care. "They have pretty good lobbying groups," he adds."

And Medicaid dollars would translate into new jobs for hospital and lab workers � something state legislators cannot ignore.

But "that won't stop the media from breathlessly covering the [governors'] threats as reality" Carroll notes. "The ‘battle' will likely sell a lot of advertising." There, he puts his finger on why even moderate to liberal publications repeat the conservatives' fictions: the image of a governor shaking his fist at Washington sells newspapers.

Keep in mind these governors are not all-powerful. State legislatures will have a say. And, while the Tea Party Tide swept many candidates into office in 2010, some will be swept out in coming elections.

Commenting on upcoming gubernatorial races, healthcare economist Len Nichols recently toldKaiser Health News "Medicaid will be an issue anywhere Democrats have a chance to win," He named West Virginia, North Carolina, Washington state and possibly Missouri."

Next: How the Court's decision buys time for health reform.

New imaging management solution eyes orthopedics

CHICAGO – A new comprehensive imaging solution is now available for orthopedics. Merge Healthcare officials announced Thursday the release of Merge OrthoPACS, an imaging management and digital templating solution that allows orthopedic surgeons and specialists to securely access images taken from virtually any location. 

Officials say the technology provides real-time study list updates, which ultimately delivers faster results to physicians. Physicians can also access archived images from their iPhones, iPads and other mobile devices with no software download required. 

"Merge's OrthoPACS solution successfully demonstrates our large investment and commitment to the orthopedic market," said Jeff Surges, CEO of Merge Healthcare. "We've combined new and innovative functionality with proven underlying technology to deliver a truly unified orthopedic-specific PACS solution. Additionally, we're excited to now offer OrthoPACS in a subscription model that will address clients' requirements for pricing that more closely aligns with their long-term operating plans."

"We've already begun upgrading our practice to Merge OrthoPACS," said Bradley Dick, chief information officer at Resurgens Orthopaedics, Georgia's largest orthopedic practice. "With Merge OrthoPACS, we'll migrate from a legacy product to true DICOM archive technology which will make it easier to share and manage images across our 21 offices in metro Atlanta."

Merge officials say orthopedic surgeons will find that the new solution integrates into and enhances their current workflow. For example:

Orthopedic-specific workflows are built into Merge OrthoPACS, from clinic use to the operating room.The Merge OrthoPACS zero-footprint client viewer can be the sole viewer for an orthopedic practice, meaning that reading images will be no different whether a surgeon reads from their workstation or any mobile device. The Merge OrthoPACS viewer also provides access to pre-surgical templating, including advanced measurements and automated hip templating. 

More Answers To Your Questions About The Health Care Law

Adam Cole/NPR

The Affordable Care Act remains pretty much intact after its review by the Supreme Court. So what's in it anyway?

Now that the Supreme Court has upheld almost all of the Affordable Care Act, many Americans are scrambling to remember � or learn for the first time � what's in the law and how it works.

We asked for questions from our audiences online and on air. Here's are some, edited for clarity and length, and the answers:

 

Q: Will the penalty for not having health insurance affect people at all income levels, or will low-income people be spared?

A: The short answer is no, if you can't afford insurance you don't have to buy it.

Here is the slightly longer answer.

For starters, if you don't earn enough to have to file a federal tax return, you're exempt. In 2010 that was $9,350 for an individual, or $18,700 for a married couple.

You're also exempt if you would have to pay more than 8 percent of your household's income for health insurance, after whatever help you might get from an employer or subsidies from the federal government.

Q: If someone is only insured for six or seven months a year, will there still be a fine?

A: Possibly, but it would be prorated for only the months you didn't have insurance.

There is one exception. There's no penalty in the law for a single gap of less than three months in a year. That's because many employers impose a waiting period. There's also a separate provision in the health law that forbids employers from imposing waiting periods of longer than three months. So no one will have to pay a penalty specifically because a new employer makes them wait to qualify for coverage.

Q: I understand that businesses above a certain size have to provide a health care insurance option, but do they have to pay for it? Does the law require a certain contribution from the employer, or can the employer make the employees just pay, say, 99 percent of the premiums?

A: This is where the law seems a little bit tricky. It doesn't stipulate how much of the premiums employers have to pay, but it does say that overall, employers with more than 50 workers have to provide a plan that covers 60 percent of the covered expenses for a typical population. And that plan can't cost more than 9.5 percent of family income.

Q: How does the law affect Medicare recipients? I heard it cuts billions of dollars from the program. Does it have other effects?

A: Let's take these one at a time. Yes, the law does reduce Medicare spending by roughly $500 billion less than it would have been without the law. That's over 10 years, by the way, and Medicare will cost a little under $500 billion this year. But none of that comes out of benefits guaranteed under the law.

The biggest single chunk comes from reducing what had been overpayments to private HMOs and other health plans that serve about 20 percent of Medicare patients.

The next biggest chunk comes from hospitals and other providers of health care that hope to get that money back because more people will have insurance.

As to other changes to Medicare, there are actually some new benefits. The doughnut hole, that gap in coverage for prescription drugs, is being gradually closed. And Medicare patients are now getting new preventive screenings, like mammograms, without having to pay a deductible.

Q: My son lives overseas, where he is covered by the national health insurance plan. As an American citizen, would he be required to pay the fee for not being covered under an American plan?

A: No, only residents of the U.S. and its territories are subject to the insurance requirements.

Q: I am a veteran getting my medical care from Veterans Affairs. Am I correct that this counts as having insurance, when it comes to the requirement that everyone be covered or pay a penalty?

A: Yes, the VA counts. So does TRICARE and other military health plans. In fact, just about all government health care program, including Medicare and Medicaid, count as well. That's why the Urban Institute estimates that come 2014, only about 7 million people out of the U.S. population of well over 300 million will have to either purchase insurance or be subject to paying the penalty.

Q: If my current insurance policy does not meet the minimum requirements in the Affordable Care Act, and my insurer must raise the standards of my policy, can my insurer raise the premiums I pay?

A: In a word, yes. That was part of the goal of the law, not just to get people without insurance to have it, but to get people with what was considered substandard insurance up to par. This is controversial, and it's the part that leads to claims that the government is interfering in the private insurance market, which in this case it is. But it's in the law because Congress heard about lots and lots and lots of cases where people who had insurance nevertheless ended up bankrupt because the insurance didn't cover what they thought it did. So will this make healthy people who have to spend more unhappy? Yes. But will it protect people better when they do get sick? Yes, it will do that, too. And will the arguments about it continue? Yes, undoubtedly.

States Pushing Medicaid Ruling to Cut Rolls Immediately

It’s true that states could, after 2014, reduce their Medicaid rolls without the potential consequences of losing their entire federal share of funding. But some states aren’t waiting until 2014.

The court, which upheld most of the law, struck down penalties for states choosing not to expand Medicaid. A few states are also trying to go farther, arguing that the ruling justifies cuts to their existing programs.

Within hours of the Supreme Court’s ruling on June 28, lawyers in the Maine attorney general’s office began preparing a legal argument to allow health officials to strike more than 20,000 Medicaid recipients from the state’s rolls�including 19- and 20-year-olds�beginning in October to save $10 million by next July.

“We think we’re on solid legal ground,” Attorney General William Schneider said in an interview. “We’re going to reduce eligibility back to the base levels in a couple of areas,” he said. Maine, like some other states eyeing cuts, earlier expanded its Medicaid program beyond national requirements.

Other states, including Wisconsin and Alabama, are expected to follow Maine’s lead, though there is disagreement over whether the high court gave the states such leeway. That could lead to battles between states and the federal government that could drag the health law back to the courts. New Jersey and Indiana also said they were evaluating the decision and did not rule out challenging the requirements.

This looks to me like an expansion of what the Court actually said. The Court’s ruling specifically regarded tying the Medicaid expansion to the initial program funding as unconstitutional. If the cuts contemplated now started before the expansion, that seems to fall under the same maintenance of effort rules that remain in place until 2014. This will take further litigation and a new ruling to figure out.

But it does show that states view the Medicaid program as something to raid, not something to nurture. They want to push the limits of the ruling to make as many cuts as possible. So suggestions that red state governors will not be able to pass up a “good deal” like the Medicaid expansion doesn’t match with this reality.

Meanwhile, given these statistics out of Texas, it’s not clear whether an expansion will really result in an expansion.

The number of Texas doctors willing to accept government-funded health insurance plans for the poor and the elderly is dropping dramatically amid complaints about low pay and red tape, showed a survey by the Texas Medical Association provided to The Associated Press on Sunday before its Monday release.

Only 31 percent of Texas doctors said they were accepting new patients who rely on Medicaid, the health insurance program for the poor and disabled. In 2010, the last time the survey was taken, 42 percent of doctors accepted new Medicaid patients. In 2000, that number was 67 percent.

Texas doesn’t have enough primary-care doctors to serve the size of the state or its rapid population growth. The doctors’ reluctance to take on new Medicaid patients comes at a bad time, since the new federal health care law proposes adding 6 million additional people to the Texas Medicaid rolls with the intent of ensuring every U.S. citizen has access to health insurance. The state ranks last in the nation in terms of percentage of people insured, with 27 percent of Texans without any kind of insurance, according to a March Gallup poll.

Obviously, having health insurance coverage that 31% of doctors will honor is better than having no coverage at all. But geographic distribution matters here. Texas is a big place, and a low-income resident, on the off chance that the state expands its Medicaid coverage, may not be able to find a doctor for many miles. The primary-care doctor problem is central to this debate. States predisposed to reject the expansion will justify it by saying they don’t have the resources to accommodate all these new eligible patients on the Medicaid rolls.

Calling all innovators: Health 2.0 contest makes eHealth a priority

SAN FRANCISCO – On Wednesday, officials at the Office of the National Coordinator for Health Information Technology (ONC) and Health 2.0 announced the launch of a collaborative venture that aims to spur health information technology innovation among software developers. 

The Investing in Innovation (i2) Initiative competition seeks to foster the use of technology to drive improved health outcomes, officials say, driving patient participation in their own health and wellness data.  

The Health 2.0 Developer Challenge program is now accepting submissions for the new competition, the SMART-Indivo App Challenge. SMART (Substitutable Medical Apps, Reusable Technologies) is one of four Strategic Health IT Advanced Research Projects (SHARP) funded by the ONC. 

A healthcare system adapting to the effects of an aging population, growing expenditures and a diminishing primary care workforce needs the support of a flexible information infrastructure, officials say, which will ultimately facilitate innovation in wellness, health care and public health.

The SMART API challenge is a multidisciplinary call to IT innovators and software developers to create an Indivo application that provides value to patients using data delivered through the SMART API and its Indivo-specific extensions. The app will be either an HTML5 Web app or an iOS app that runs against the Indivo Developer Sandbox, where it can access patient demographics, medications, laboratory tests and diagnoses using Web standards.

Developers could, for example, build a medication manager, a health risk detector, a patient-friendly laboratory visualization tool or an app that integrates external data sources with patient records in real-time.

Officials say submissions will be evaluated on five parameters. These include: usefulness to patients, importance to clinical medicine or public health, interface and presentation, use of the Indivo and SMART APIs, and creative use of data from the sandbox and, optionally, from open health data sources. A review panel consisting of technical experts will evaluate the submissions.

Submissions are due on September 28, 2012. Prizes total $13,000, with the first place team awarded $10,000. The first place winner will also present the winning solution at a national conference. For more details visit the SMART-Indivo App Challenge website.

"Health 2.0 is excited to be launching this new challenge," said Indu Subaiya, CEO and co-chair of Health 2.0. "The SMART-Indivo App Challenge is an interesting competition that embraces key Health 2.0 themes, including modularity, scalability and interoperability. Applications developed for this challenge will help individuals to manage their health and wellness information across a range of healthcare settings."

NYeC's 'public utility' model works well for regional HIEs

NEW YORK – In the second half of 2011, the New York eHealth Collaborative (NYeC) shifted its role from a policy convener to a service provider that runs the health information exchange (HIE) infrastructure for the local HIEs and regional health information organizations (RHIOs) like a public utility. That shift was the "biggest necessary change" that is propelling the Statewide Health Information Network of New York (SHIN-NY) forward, according to Irene Koch, executive director of the Brooklyn Health Information Exchange (BHIX).

"Instead of allowing SHIN-NY to develop organically through just policy and have the RHIOs maintain their infrastructure independently, NYeC being able to offer a centralized, efficient model made a lot of sense to those of us who have patients who can really benefit from a deeper, more integrated system," Koch said.

While BHIX has a lot of data and value, it sits in New York City and serves a population that can easily access multiple HIEs and RHIOs. "The data needs to travel across a wider geography than just any one borough or region can achieve right now," Koch explained. Also, despite the handful of RHIOs in New York City, there's still a lot of fragmentation in terms of provider affiliation with different RHIOs, which impacts data flow. For example, some providers in Queens may have data flowing in BHIX, or some Brooklyn providers may have data flowing in another RHIO.

"It was always important for us to move along the path toward inter-regional interoperability. For us, we want to be right at the lead for that," Koch said. BHIX is indeed at the forefront in NYeC's first step toward connecting New York State, as one of the first three RHIOs (along with e-Health Network of Long Island and THINC) in the downstate region to participate in the SHIN-NY. Part of BHIX’s decision to participate was predicated on NYeC being able to combine and take over the infrastructure, which includes financing the operation of the infrastructure. Once more RHIOs come on board, SHIN-NY would evolve to a collective business model. Taking this step furthers BHIX’s mission to deliver a product at better price points in order to benefit its members, Koch said.

"We knew from the start that things had to be flexible and that things would evolve," she said. "We're so pleased that the work we’ve done over these past several years is the kind of flexible infrastructure that will form a key component of the SHIN-NY going forward and we're very pleased at the same time to be among the first to partake from that and get the benefit of what shared data will mean for our providers and their patients."

On the technical side, BHIX is consulting with NYeC to assist the organization in the transition to maintain the infrastructure and to share best practices and lessons learned. BHIX's infrastructure, which combines InterSystems HealthShare and IBM Initiate software, and internally built applications on top of the software within a privacy framework, is forming the reference implementation for the SHIN-NY. "NYeC is looking to us to help them understand and help them take over and run what we've built to support the entire SHIN-NY," Koch said. As RHIOs and newly formed local HIEs join SHIN-NY, having the reference implementation in place will allow for interoperability more quickly. At the same time, as NYeC builds on the infrastructure and makes it available for supporting interoperability with many different RHIOs, BHIX will have flexibility to do innovative projects with its stakeholders.

The RHIO is continuing its patient and community education about the benefits of HIE, as well as growing its membership through the build-out of connections and interfaces to new providers and discussions with payers regarding both support for the exchange and new reimbursement models such as Medicaid health homes and accountable care organizations. "This is what health information exchange was made for," she said.

When BHIX was established, the focus was on aggregating data to deliver patient-centric views for care coordination. HIE is now being used to support new reimbursement models that are looking to coordinate care across organizations. Maimonides Medical Center in Brooklyn, a BHIX participant, is an early leader in this area, using HIE features as a tool for coordinating care. For example, event notifications – ED admissions, discharges and so on – are being sent in real time to care coordinators who are responsible for tracking and managing a panel of patients with mental health issues so they can follow up in a timely manner.

For the Maimonides project, BHIX is expanding those event notifications to a broader panel of patients who are suffering from schizophrenia and bipolar disorders. "These event notifications are just the tip of the iceberg," Koch said. "We can trigger alerts for abnormal lab values for a particular panel of patients and really help these care coordinators get the information that they need at the right time so that they’re able to follow up more efficiently."

BHIX is also involved in New York State’s Medicaid Health Homes program. The RHIO got a head start, getting some functionalities live, thanks to Brooklyn being named to begin in the early round and Maimonides being named one of the four health home provider leads in Brooklyn. "As they refine and grow their clinical and technical program, we will support them every step of the way," Koch said.

Premier makes big connect with big data

CHARLOTTE, NC – The Premier healthcare alliance will connect more than 100,000 healthcare provides in what Premier calls the world’s largest healthcare community to share knowledge, data, best practices and decision support.

The alliance’s PremierConnect technology platform will make it possible for clinicians, supply chain leaders, hospital executives and other healthcare providers nationwide to connect as one in communities of common interest, officials say.

[See also: Premier to bring meaning to disparate data]

Premier, which describes itself as a performance improvement alliance, includes more than 2,600 U.S. hospitals and 84,000-plus other healthcare sites.

PremierConnect will connect data, knowledge and people in ways that support evolving care delivery models and accelerate the pace of performance improvement, say Premier officials. The virtual community allows alliance members to instantly share knowledge, data and strategies based on thousands of patient outcomes that can be used to benefit treatment anywhere, an ability that has been a missing link in care delivery to date.

"Health systems today need an integrated look into utilization, costs, efficiency and quality," said Michael D. Connelly, president and CEO of Catholic Health Partners. "With this information we can further build out the predictive capabilities that will help us find opportunities and enact corrective actions before they affect patients. This initiative is a critical foundational piece to our mission and the mission of the Premier alliance to improve the health of our communities."

[See also: Premier comparative effectiveness program seeking applicants]

PremierConnect supports new ways to deliver care that are required by health reform, including accountable care organizations (ACOs), which emphasize more clinical integration and healthier outcomes. Individual health systems can use it to connect care across all of their sites – hospitals, physician offices, outpatient clinics and more. These population analytic capabilities provide insight into how to manage populations for improved outcomes.

"Leaders of healthcare systems will be able to easily make data-driven, evidence-based decisions that improve performance while making their communities healthier places to live,” said Premier President and CEO Susan DeVore. “They'll know which patients are driving undesirable outcomes, which physicians have the highest costs or the poorest performance, and why these scenarios are occurring.

"Patients will have confidence that their care is based on proven innovations and best practices from top-performing clinical leaders nationwide," DeVore added. "And their providers will understand everything about their care – what drugs they're taking or allergic to, what procedures they've had recently and more."

PremierConnect will integrate Premier's clinical, financial and operational comparative databases, containing one in four patient admissions and close to $43 billion in annual purchasing data. This information is updated every 30 days to ensure it is current. It will also continuously integrate real-time electronic health record data from over 325 hospitals. Premier's quality, safety, labor and supply chain applications will be easily accessible in PremierConnect, helping providers make decisions based on a combination of quality, safety and cost information – not each individually.

"What we've built mirrors what we're trying to do in healthcare – build a system that is coordinated and integrated, where communication is dramatically improved and we aren't unnecessarily repeating work," said Keith J. Figlioli, Premier's senior vice president of healthcare informatics. "It will help eliminate unnecessary care that can compromise safety and add to already expensive bills for both consumers and health systems. It's a new, better approach to care delivery, with a truly efficient way to treat patients and keep people healthy."

PremierConnect is powered by IBM information management, business analytics, enterprise content management, social business, Rational, Tivoli and WebSphere software, as well as IBM Power Systems hardware to provide insights from vast amounts of data.

[See also: Premier develops industry IT standards for ACOs]

Ashley-Care: Health Care Coverage Without Stress for a Young Adult

Today, 3.1 million people are newly insured thanks to a provision in the law that enables young adults to stay on their parents� health care plans. Ashley Drew is one of them. Ashley, a young woman from Scarborough, Maine, was born with Cystic Fibrosis, a life-threatening chronic disease. She spends a lot of time in hospitals getting special IV antibiotics, respiratory therapy and physical therapy to clear her lungs and fight infections. One month in the intensive care unit cost her about $144,000; her last stay was for three months.

Ashley was diagnosed with end-stage lung disease and waited on two transplant lists for more than 500 days. She recently successfully underwent a double lung transplant.

Because of the health care law, the Affordable Care Act, young adults under the age of 26 may be able to stay on their parents� health insurance, and for Ashley, this has made all the difference. Staying on her parents� insurance allowed her to pursue her education to become a music teacher and to study instrumental conducting � at a pace she could handle with her health condition � and not worry about how to make sure she had coverage.�

�The fact that the Affordable Care Act is in effect, it�s amazing, because it�s horrible to have to worry and stress about your health and, in my case, something that everyone takes for granted: breathing,� Ashley says. �Everyone deserves to breathe, but unfortunately without health insurance that�s not a reality for some people.�

Without the security that staying on her parents� insurance plan provides, Ashley says she would be spending all her time trying to figure out how to come up with the money for her treatment.

Ashley believes the benefits under the law are important for people who don�t have her immediate health concerns as well. �I think the Affordable Care Act brings peace of mind to people all over this country because you don�t know when something�s going to happen,� she says. �Just to know that you have health insurance � You�re not going to lose your car and you�re not going to end up homeless because you got sick.�

UPMC data exchange technology seeks to spur supply chain efficiencies

PITTSBURGH – Prodigo Solutions, a unit of UPMC, has launched ProdigoXchange, an e-commerce platform that aims to lower costs and improve efficiency throughout the healthcare supply chain.

Powered by technology licensed from Ontario-based Toreion Corp., the exchange enables providers to electronically connect with vendors, improving contract compliance and replacing more costly alternative exchanges, officials say.

The initial users of ProdigoXchange – Pittsburgh-based UPMC and Evergreen Hospital Medical Center in Kirkland, Wash. – have already seen savings from the platform, with improved efficiency for end users and increased audit compliance.

"We are providing our end users with a product that is easy to use and adaptable to their requirements, and we have increased our audit compliance because of the system’s transparency and detailed reporting capabilities," said Max Rothwell, an analyst at Evergreen.

In addition to ProdigoXChange, Evergreen implemented the full suite of Prodigo Solutions’ managed services, including ProdigoMarketplace, a hosted solution that connects buyers and sellers in a virtual supplier network, and ProdigoBuyer, which automates and streamlines the requisition creation, submission and approval process.

Based on the efficiencies achieved at UPMC by applying Toreion’s technology to supply chain automation, Toreion and Prodigo Solutions have entered into a partnership that seeks to provide similar benefits to other providers.

"This flexible platform that Prodigo Solutions now offers to the broad commercial marketplace makes it easy and cost-effective for suppliers to do business with us electronically, and it allows them to avoid the high costs of using an alternative exchange," said David A. Hargraves, vice president of clinical supply chain at UPMC. "With ProdigoXchange, we are proving that electronic data exchange in healthcare should be viewed and priced as a commodity, as it is in other established industries, so that we can lower the cost of delivering high-quality healthcare."
 

Woman Charged In Death Of Fetus Is Out Of Jail

Enlarge Indianapolis Metropolitan Police Dept./AP

Bei Bei Shuai, seen in a file photo, was charged with murder in the Jan. 2, 2011, death of her 3-day-old daughter Angel Shuai, after eating rat poison.

Indianapolis Metropolitan Police Dept./AP

Bei Bei Shuai, seen in a file photo, was charged with murder in the Jan. 2, 2011, death of her 3-day-old daughter Angel Shuai, after eating rat poison.

Bei Bei Shuai is out of jail for the first time since March 2011.

Shuai, a Chinese immigrant who lives in Indiana, is still facing charges of murder and feticide following a failed suicide attempt in December 2010, when she was 33 weeks pregnant.

She was released today after posting a $5,000 bond.

A trial is set for Dec. 2, Emma Ketteringham, one of her lawyers, told Shots. A judge ordered Shuai to wear a GPS tracking device, which could cost $2,500 if she's required to wear until the trial begins, Kettingham said.

Previously Woman Who Tried To Commit Suicide While Pregnant Gets Bail May 18, 2012

Shuai's case has galvanized women's groups across the country. They say that if she is convicted, it could set a precedent for further prosecutions on pregnant women for behaviors that could potentially endanger their fetuses.

Earlier this month, the Indiana Supreme Court refused to review a lower court ruling allowing the case against Shuai to go forward.

Shuai was charged after she was abandoned by the father of her baby, left a suicide note, and ingested rat poison.

She was saved and the baby, a girl, was born, but died three days later in her arms.

She is being prosecuted underlaws originally intended to punish third parties who attack pregnant women and injure or kill fetuses.

Calif. Runs With Health Law Without Waiting On Supreme Court

Enlarge iStockphoto.com

California lawmakers have been introducing legislation that would replicate key pieces of the federal law, including bills defining benefits and guaranteeing coverage to people with pre-existing conditions.

iStockphoto.com

California lawmakers have been introducing legislation that would replicate key pieces of the federal law, including bills defining benefits and guaranteeing coverage to people with pre-existing conditions.

Many states have done nothing to implement the health overhaul law, saying they'll wait to see how the Supreme Court rules.

Not California.

The country's most populous state got out in front first on implementing the law, and it hasn't slowed down in recent weeks as the rest of the country waits to hear from the high court.

"California has been moving ahead 100 percent assuming it will upheld," says Peter Lee, who left his Washington job as a health policy official in the Obama administration to lead California's Health Benefit Exchange. "We [aren't] doing anything in the way of contingency planning because it makes no sense to plan for what seems like an outer bounds of possibility, and rather, we've got a big job to do to get ready to cover what will be millions of Californians in 18 months."

 

Lee has a staff of 36 that is working feverishly to be ready � and he is optimistic about the exchange's future in California even if the court overturns the requirement that most people buy insurance. He argues that the tax subsidies to allow some people to buy insurance will be enough to entice customers to buy their insurance in the online marketplace his agency is setting up.

"The reason the exchange is going to have � we project � over 2 million people in it after a few years, [has] very little to do with the [individual] mandate," Lee says. "We're a place where people can get subsidies for care, and can make informed choices."

Without the requirement that everyone buy insurance, known as the individual mandate, Lee estimates that the exchange would lose a few hundred thousand people; it would still be a viable marketplace for California, however.

But Patrick Johnston, president and CEO of the California Association of Health Plans, says the federal law wouldn't work without the mandate.

"We need to have a group of people that is big enough and has enough people who for the most part are healthy to make sure that the insurance costs will be shared and not high," Johnston said. "States that decided to say 'Everybody gets insurance at the same price but you can buy it whenever you want,' found that prices just went way up and people dropped out."

Still, on the legislative side, California lawmakers have been introducing legislation that would replicate key pieces of the federal law, including bills defining standard health benefits and guaranteeing coverage to people with pre-existing conditions.

"I'm going to remain fully committed to figuring out how do we preserve and protect what was the vision of President Obama, to replicate that in California by any means necessary," says Assemblyman Bill Monning, chairman of the state assembly's health committee. "We will figure out how to do it."

Monning and his counterpart state Sen. Ed Hernandez, a Democrat, hesitate to say they'd propose a state health insurance mandate, without knowing the court decision. But Hernandez says he would author a bill that would "start the discussion" about compelling people into the market. Hernandez worries, though, that funding a new state marketplace without federal help would be difficult.

"The state just doesn't have any money," he said. "My biggest fear and concern is if we lose the federal subsidies, I just don't know how we can make it ... work."

Republican Assemblyman Dan Logue is a fierce opponent of the health law. He thinks the Democratic majority in California would succeed in passing a state mandate if the federal one goes down. But if a state mandate were proposed, he would take it to the voters.

"I think once they realize the dynamics and the cost and how it would put California at risk financially with the rest of the country, that it would go down in flames easily," Logue said.

Lee of the health exchange says he isn't losing any sleep over the thought of the mandate being thrown out . "I've seen community groups, I've seen hospitals, I've seen health plans, I've seen the business community, not throwing rocks at our effort but, rather, joining in to make this thing work," he says.

Despite Lee's optimism, a recent survey by the Public Policy Institute of California showed 63 percent of Californians were against the mandate.

This story is part of a project with the Capital Public Radio, NPR and Kaiser Health News.

Finally, A Map Of All The Microbes On Your Body

Enlarge Ayodhya Ouditt/NPR

Ayodhya Ouditt/NPR

Scientists Wednesday unveiled the first catalog of the bacteria, viruses and other microorganisms that populate every nook and cranny of the human body.

Researchers hope the advance marks an important step towards understanding how microbes help make humans human.

The human body contains about 100 trillion cells, but only maybe one in 10 of those cells is actually � human. The rest are from bacteria, viruses and other microorganisms.

"The human we see in the mirror is made up of more microbes than human," said Lita Proctor of the National Institutes of Health, who's leading the Human Microbiome Project.

 

"The definition of a human microbiome is all the microbial microbes that live in and on our bodies but also all the genes � all the metabolic capabilities they bring to supporting human health," she said.

These microbes aren't just along for the ride. They're there for a reason. We have a symbiotic relationship with them � we give them a place to live, and they help keep us alive.

"They belong in and on our bodies; they help support our health; they help digest our food and provide many kinds of protective mechanisms for human health," Protor said.

Microbes extract vitamins and other nutrients we need to survive, teach our immune systems how to recognize dangerous invaders and even produce helpful anti-inflammatory compounds and chemicals that fight off other bugs that could make us sick.

"These microbes are part of our evolution. As far as we can tell, they are very important in human health and probably very important in human disease as well," said Martin Blaser of New York University.

These bugs generally don't make us sick. But when we disrupt the delicate ecosystems they carefully construct in different parts of our bodies, scientists think that can make us sick.

"There can be a disturbance in the immune system. There can become some kind of imbalance. And then you can get a microorganism which, under normal circumstances, lives in a benign way and can become a disease-bearing organism," Proctor said.

Taking too many antibiotics, our obsession with cleanliness and even maybe the increase in babies being delivered by Caesarean section may disrupt the normal microbiome, she said.

So the idea behind the micobiome project was to get the first map of what a normal, healthy microbiome looks like.

More than 200 scientists spent five years analyzing samples from more than 200 healthy adults. The samples came from 18 different places on their bodies, including their mouths, noses, guts, behind each ear and inside each elbow.

"This is the only study to date anywhere in the world where peoples' microbiomes across a human body were sampled and analyzed. Here was an effort to really investigate the full landscape, if you will, of the human microbiome across the body," Proctor said.

Scientists identified some 10,000 species of microbes, including many never seen before, according to the first wave of results, which are being published in 16 papers in the journals Nature and PLoS.

"This is like going into uncharted territory � going into a forest and finding a new species of butterfly or new type of mammal or something like that � a new kind of bird," said George Weinstock of Washington University in St. Louis.

Those 10,000 or so species have more than 8 million genes, which is more than 300 times the number of human genes.

And scientists found some very interesting things when comparing microbiomes.

"People were very different from each other, but skin was more like skin and gut was more like gut. So the composition of microbes and the kinds of genes that they have are very much habitat-specific," Proctor said.

Now that scientists have an idea of what a healthy microbiome looks like, they can start to explore this super-organism � this complex mishmash of human and microbial cells.

"How do they talk to our human cells? And how do human cells talk back to them? Because it's really a concert that they're playing together, and that's what makes us who we are," Weinstock said.

Scientists have already discovered some intriguing clues. For example, the microbes in a pregnant woman's birth canal start to change just before she gives birth. Scientists think that's so their babies are born with just the right microbiome they'll need to live long, healthy lives.

HHS to dig deeper for better decisions

WASHINGTON – For San Francisco-based Archimedes, a company named for a Greek mathematician of antiquity, it’s all about data, math, computing and healthcare modeling. The 20-year-old company deals in information – of the quantitative type. And now it will bring its high-powered analytics skills to bear for the Department of Health and Human Services.

Under a contract with HHS announced last month, Archimedes will dig into large quantities of data to provide several HHS agencies the ability to evaluate the effectiveness of specific health interventions more quickly and more accurately. HHS officials say it signals "a new era of medical decision-making."

The technology will enable the agencies to research, analyze and evaluate the effects of specific healthcare interventions more quickly and accurately, Archimedes executives say.

The company bills the Archimedes Model, developed initially with support from Kaiser Permanente, as “the most advanced mathematical modeling tool available to answer complex questions on health and healthcare.”

Under the contract, HHS will make a new Web-based interface called the Archimedes Healthcare Simulator (ARCHeS) available to its agencies, including the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ), the National Heart, Lung & Blood Institute and the Food & Drug Administration (FDA).

A $15.6 million grant from the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio in 2007 supported the creation of ARCHeS, which makes the Archimedes Model more accessible and affordable for public policymakers and nonprofit users.

“When we initially made this grant, I said that the development of ARCHeS would usher in a new era in medical decision-making that we believe has the potential to transform health and healthcare,” said Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation. “By getting ARCHeS in the hands of HHS and all of its agencies, we’ve taken a very big step toward realizing that potential. Our goal has always been to create access to this innovation for the public policymakers and researchers best positioned to use it to inform decisions that will improve health and healthcare for all Americans. We now see that happening.”

“The quality and cost of healthcare are determined by decisions made by policymakers, physicians and others. To make those decisions wisely, decision makers need to know the consequences of the different options they face,” said David Eddy, MD, founder and chief medical officer of Archimedes. “For a high proportion of decisions, the only feasible way to get the needed information is to use mathematical models that integrate existing evidence, and are validated against evidence.

In his view, the contract with HHS will put the analytical power of advanced healthcare modeling on the desks of decision makers in the federal government.

“By combining this tool with their own insights and experience, decision makers will be able to understand much better the effects of different policies, and be able to design policies that achieve the twin goals of improving quality and controlling costs,” said Eddy.

In one of a number of analyses already performed by Archimedes, Kaiser Permanente used forecasts from the model as the impetus to launch a program to provide a bundle of aspirin, lovastatin (a cholesterol-lowering drug), and lisinopril (a blood pressure-reducing drug), to high-risk members. This analysis was used in informing the implementation of Kaiser Permanente’s ALL/PHASE program. The result was a more than 60 percent reduction in heart attacks and strokes over a two-year period.

As a result of HITECH Act and the Patient Protection and Affordable Care Act, the use of modeling and simulation platforms is in high demand for policymakers and researchers. Both of these laws include new requirements for use of data in the design of health benefits; comparative effectiveness of quality, cost, and outcomes; and evaluation of population health efforts.

In March, the federal government launched a research initiative in big data computing for a number of agencies, including the National Institutes of Health.

"The federal government sees a growing need across all of its agencies for innovative resources to aid in research, policy analysis and evaluation,” said U.S. Chief Technology Officer Todd Park. "We’re excited that ARCHeS will now be available to staff across the Department of Health and Human Services. It gives us an important new tool to analyze a wide variety of health policy questions and quickly compare different scenarios and outcomes.”