Health Information Exchange in Long-Term and Post-Acute Care Settings: Final Report. Notes

11/01/2015

  1. Devers, K., N. Lallemand, G. Ozanich, et al. 2015.Health information exchange in long-term and post-acute care settings: Conceptual framework. Commissioned by the Assistant Secretary for Planning and Evaluation. Freedman, V., and B. Spillman. 2014. Disability and care needs among older americans. Milbank Quarterly, 92(3): 509-41, doi:10.1111/1468-0009.12076. Stefanacci, R.G., and B.S. Spivack. 2014. Long-term care regulatory and practice changes: Impact on care, quality, and access. Annals of Long-Term Care, 22(11), http://www.annalsoflongtermcare.com/article/long-term-care-regulatory-and-practice-changes-impact-care-quality-and-access.

  2. Government Accountability Office. 2015. Nonfederal efforts to help achieve health information interoperability. GAO-15-817, http://www.gao.gov/assets/680/672585.pdf.

  3. Devers, K., N. Lallemand, G. Ozanich, et al. 2015.Health information exchange in long-term and post-acute care settings: Conceptual framework. Commissioned by the Assistant Secretary for Planning and Evaluation. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Pennsylvania site visiting findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation. Lallemand, N. , A. Napoles, K. Devers, et al. 2015. Minnesota site visit findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation.

  4. Includes both NHs and skilled nursing facilities (SNFs).

  5. American Health Care Association. 2015. Trends in nursing facility characteristics. http://www.ahcancal.org/research_data/trends_statistics/Documents/Trend_PVNF_FINALRPT_March2015.pdf.

  6. Administration on Aging, Administration for Community Living. 2012. A profile of Older Americans: 2012. U.S. Department of Health and Human Services. http://www.aoa.gov/Aging_Statistics/Profile/2012/docs/2012profile.pdf.

  7. Grady, PA. n.d. Advancing the health of our aging population: A lead role for nursing science. Nursing Outlook, 59(4): 207-209, Science Citation Index, EBSCOhost.

  8. CMS Claims Data, prepared by Health Dimensions Group 2013.

  9. Centers for Medicare and Medicaid Services. Home health quality initiative. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/index.html?redirect=/HomeHealthQualityInits/14_HHQIOASISUserManual.asp.

  10. Morley, M., S. Bogasky, B. Gage, et al. 2014. Medicare post-acute care episodes and payment bundling. Medicare and Medicaid Research Review, 4(1), https://www.cms.gov/mmrr/downloads/mmrr2014_004_01_b02.pdf.

  11. Resnick, H.E., B.B. Manard, R.I. Stone, and M. Alwan. 2009. Use of electronic information systems in nursing homes: United States, 2004. Journal of the American Medical Informatics Association, 16(2): 179-186, MEDLINE Complete, EBSCOhost.

  12. Office of the Assistant Secretary for Planning and Evaluation. 2014. Electronic health information exchange in LTPAC: Preparation, implementation, and impact. Request for Task Order/Proposal/Solicitation #14-233-SOL-00365.

  13. Office of the National Coordinator for Health Information Technology. 2014. A ten-year vision to achieve interoperable health IT infrastructure. Washington, DC: ONC. https://www.healthit.gov/system/files/ONC10yearInteroperabilityConceptPaper.pdf. Office of the National Coordinator for Health Information Technology. 2014. Draft interoperability roadmap. Washington, DC. https://www.healthit.gov/policy-researchers-implementers/draft-interoperability-roadmap.

  14. U.S. Department of Health and Human Services. 2015. Medicare and Medicaid programs; electronic health record incentive program--modifications to meaningful use in 2015 Through 2017. Proposed Rule, 42 CFR Part 495, 80(72), Part III, http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Modifications_MU_Rule.pdf. For the 2015-2017 new rule released October 6, 2015, see https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-06.html and https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-25595.pdf.

  15. Decker, S.L., E.W. Jamoom, and J.E. Sisk. 2012. Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems. Health Affairs, 31(5): 1108-1114.

  16. Yin, R.K. 1999. Enhancing the quality of case studies in health services research. Health Services Research, 34(5 Pt 2): 1209-1224.

  17. Flood, A.B., M. Fennell, K.J. Devers. 2012. Health reforms as examples of multilevel interventions in cancer care. JNCI Monographs, (44): 80-85, doi:10.1093/jncimonographs/lgs012.

  18. Minnesota Department of Health. 2015. Understanding the Minnesota interoperable electronic health record mandate. http://www.health.state.mn.us/e-health/hitimp/2015mandateguidance.pdf.

  19. Office of the National Coordinator for Health Information Technology. 2015. Health information exchange challenge grant program. HealthIT.gov. http://www.healthit.gov/providers-professionals/health-information-exchange-challenge-grant-program.

  20. Hogin, E., and J. Daniel. 2011. The many meaningful uses of health information technology. Health IT Buzz blog, HealthIT.gov. http://www.healthit.gov/buzz-blog/meaningful-use/meaningful-health-information-technology/.

  21. The of the National Coordinator for Health Information Technology. n.d. Beacon community program. HealthIT.gov. http://www.healthit.gov/policy-researchers-implementers/beacon-community-program.

  22. Stratis Health. 2014. HITPAC updated. Final Summary Report.

  23. Bryne, C., and M. Dougherty. 2013. Long-term and post-acute care providers engaged in health information exchange: Final report. Office of the Assistant Secretary for Planning and Evaluation. Available at https://aspe.hhs.gov/report/long-term-and-post-acute-care-providers-engaged-health-information-exchange-final-report. Harvell, J., M. Harr, E. Palena Hall, et al. 2012. Implementing health information exchange in the long-term and post-acute care community. Presentation, AHIMA Foundation. http://campus.ahima.org/audio/2012/RB121212.pdf.

  24. Stratis Health. 2013. Environmental scan of adoption and use of electronic health records and health information exchange in Minnesota skilled nursing facilities. Centers for Medicare and Medicaid Services, Special Innovation Project. http://www.stratishealth.org/documents/MN_Environmental_Scan_HITPAC.pdf.

  25. Centers for Medicare and Medicaid Services. 2013. CMS initiative to reduce avoidable hospitalizations among nursing facility residents. Fact Sheet. http://innovation.cms.gov/initiatives/rahnfr/.

  26. Centers for Medicare and Medicaid Services. 2015. State innovation models initiative: Model test awards round two. CMS.gov. http://cmswnmgteam.polldaddy.com/s/was-this-helpful?iframe=http%3A%2F%2Finnovation.cms.gov%2Finitiatives%2FState-Innovations-Model-Testing-Round-Two%2F&ft=1.

  27. Geisinger Health System. 2010. 2010 system report. http://www.geisinger.org/pages/newsroom/includes/pdf/ar10-111714.pdf.

  28. Ibid.  

  29. Office of the National Coordinator for Health Information Technology. 2015. 2015 edition final rule: Supporting care across the continuum. https://www.healthit.gov/system/files/2015editioncareacrosscontinuum_10615.pdf.

  30. Office of the National Coordinator for Health Information Technology. 2015. Community interoperability and health information exchange cooperative agreement program. HealthIT.gov. http://www.healthit.gov/newsroom/community-interoperability-and-health-information-exchange-cooperative-agreement-program.

  31. Office of the National Coordinator for Health Information Technology. 2014. State health information exchange cooperative agreement program. HealthIT.gov. http://www.healthit.gov/policy-researchers-implementers/state-health-information-exchange.

  32. Kern, L.M., A.B. Wilcox, J. Shapiro, et al. 2011. Community-based health information technology alliances: Potential predictors of early sustainability. American Journal of Managed Care, 17(4): 290-5.

  33. Ibid.  

  34. Health Management Associates. 2014. Colorado regional health information organization (CORHIO) program evaluation. Final Report.

  35. About Healthcare. About Kindred. http://www.kindredhealthcare.com/our-company/company-overview/.

  36. Office of the National Coordinator for Health Information Technology. 2015. HITECH act. HealthIT.gov. http://www.healthit.gov/policy-researchers-implementers/health-it-legislation.

  37. U.S. Department of Health and Human Services. 2012. Health information technology: Standards, implementation specifications, and certification criteria for electronic health record technology. Final Rule, 77 FR 54163. https://federalregister.gov/a/2012-20982.

  38. Mostashari, F. 2012. Meaningful use stage 2: What it means for interoperability.Health IT Buzz blog. http://www.healthit.gov/buzz-blog/meaningful-use/meaningful-use-stage-2/.

  39. Keystone Health Information Exchange. About us. http://www.keyhie.org/about_us/compliance.html.

  40. Minnesota Department of Health. 2015. Understanding the Minnesota interoperable electronic health record mandate. http://www.health.state.mn.us/e-health/hitimp/2015mandateguidance.pdf.

  41. Senate Finance Committee. 2014. The improving Medicare post-acute care transformation act of 2014. http://www.finance.senate.gov/imo/media/doc/IMPACT%20Summary.pdf.

  42. U.S. Department of Health and Human Services Press Office. 2015. HHS proposes to improve care and safety for nursing home residents. http://www.hhs.gov/news/press/2015pres/07/20150713d.html.

  43. Centers for Medicare and Medicaid Services. 2015. Medicare and Medicaid programs; reform of requirements for long-term care facilities. Proposed rule, 80 FR 55284. https://www.federalregister.gov/articles/2015/09/15/2015-23110/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities-reopening-of.

  44. Adler-Milstein, J., C.M. DesRoches, M.F. Furukawa, et al. 2014. More than half of US hospitals have at least a basic EHR, but stage 2 criteria remain challenging for most. Health Affairs; 33(9): 1664-1671. doi:10.1377/hlthaff.2014.0453.

  45. Ibid.  

  46. Furukawa, M.F., J. King, V. Patel, et al. 2014. Despite substantial progress in EHR adoption, health information exchange and patient engagement remain low in office settings. Health Affairs, doi:10.1377/hlthaff.2014.0445.

  47. Zamora, Z., B. McCall, L. Patel, et al. 2012. Implementation of a web-based system to improve the transitional care of older adults. Journal of Nursing Care Quality, 27(2): 182-9.

  48. Geisinger Health System. 2014. Transforming healthcare through continuous innovation. System Report. http://www.geisinger.org/pages/newsroom/includes/pdf/ar-final-2014.pdf.

  49. Minnesota Department of Health. 2015. Understanding the Minnesota interoperable electronic health record mandate. http://www.health.state.mn.us/e-health/hitimp/2015mandateguidance.pdf.

  50. Long-Term and Post-Acute Care (LTPAC) Health Information Technology (IT) Collaborative. 2012. A roadmap for health IT in long-term and post-acute care (LTPAC). http://www.ltpachealthit.org/system/files/LTPAC_HealthIT_Roadmap_2012-2014%28Final%29.pdf. Office of the National Coordinator for Health Information Technology. 2012. Long-term and post-acute care (LTPAC) roundtable summary report of findings." http://www.healthit.gov/system/files/pdf/LTPACroundtablesummary.pdf.

  51. Mertz, K., and W. Russell. 2013. Improving transitions of care in LTPAC: An update from the theme 2 Challenge Grant awardees. HealthIT.gov. http://www.healthit.gov/system/files/challengegrantslessonslearnedltpac_paper.pdf.

  52. Health Management Associates. 2014. Colorado regional health information organization (CORHIO) program evaluation. Final Report.

  53. Hustey, F.M., and R.M. Palmer. 2012. Original study: Implementing an internet-based communication network for use during skilled nursing facility to emergency department care transitions: Challenges and opportunities for improvement. Journal of the American Medical Directors Association, 13: 249-53.

  54. Bresnick, J. 2014. HIMSS: Sustainability top of mind for RECs as funding dries up. EHR Intelligence. https://ehrintelligence.com/news/himss-sustainability-top-of-mind-for-recs-as-funding-dries-up.

  55. Office of the National Coordinator for Health Information Technology. Care coordination tool for transition to long-term and post-acute care. http://www.healthit.gov/system/files/nlc_ltpac_carecoordinationtool.pdf.

  56. LeadingAge. 2015. Electronic health record adoption and health information exchange among long-term and post-acute care providers: A survey of LeadingAge New York members. http://www.leadingageny.org/linkservid/2E102FA3-007E-0553-F50E1E2BB975E3DC/showMeta/0/.

  57. Minnesota Department of Health. 2012. MN e-health report: Nursing homes adoption and use of EHRs and exchange of health information. http://www.health.state.mn.us/e-health/summaries/reportnursehome2011.pdf.

  58. LeadingAge. 2015. Electronic health record adoption and health information exchange among long-term and post-acute care providers: A survey of LeadingAge New York members. http://www.leadingageny.org/linkservid/2E102FA3-007E-0553-F50E1E2BB975E3DC/showMeta/0/.

  59. Private correspondence with Varro Health on September 25, 2015.

  60. Health Level Seven Special Committee. 2015. FHIR infrastructure. http://www.hl7.org/Special/committees/fiwg/overview.cfm.

  61. Stratis Health. 2014. HITPAC updated. Final Summary Report.

  62. Yeager, V.A., D. Walker, E. Cole, et al. 2014. Factors related to health information exchange participation and use." Journal of Medical Systems 38(8): 78, MEDLINE Complete, EBSCOhost. Dullabh, P., J. Adler-Milstein, H. Hovey, et al. 2014. Key challenges to enabling health information exchange and how states can help. FinalReport, Office of the National Coordinator for Health Information Technology. https://www.healthit.gov/system/files/state_hie_evaluation_stakeholder_discussions.pdf. Blavin, F.E., A. Shah, N. Cafarella Lallemand, et al. 2014. How local context affects providers' adoption and use of interoperable health information technology: Case study evidence from four communities in 2013 (Round Two). Issue Brief, Urban Institute. http://www.urban.org/UploadedPDF/413251-How-Local-Context-Affects-Providers-Adoption-and-Use-of-Interoperable-HIT-2013.pdf. Devers, K.J., A. Shah, and F. Blavin. 2014. How local context affects providers' adoption and use of interoperable health information technology: Case study evidence from four communities in 2012 (Round One). Issue Brief, Urban Institute. http://www.urban.org/research/publication/how-local-context-affects-providers-adoption-and-use-interoperable-health-information-technology.

  63. Stratis Health. 2014. HITPAC updated. Final Summary Report.

  64. Ibid.  

  65. Office of the National Coordinator for Health Information Technology. 2015. Health information exchange challenge grant program. HealthIT.gov. http://www.healthit.gov/providers-professionals/health-information-exchange-challenge-grant-program.

  66. Ibid.  

  67. Centers for Medicare and Medicaid Services. 2015. State innovation models initiative: Model test awards round two. CMS.gov. http://cmswnmgteam.polldaddy.com/s/was-this-helpful?iframe=http%3A%2F%2Finnovation.cms.gov%2Finitiatives%2FState-Innovations-Model-Testing-Round-Two%2F&ft=1.

  68. Shapiro, J.S. (2007). Evaluating public health uses of health information exchange.Journal of Biomedical Informatics, 40: S46-S49. Shapiro, J.S., F. Mostashari, G. Hripcsak, N. Soulakis, and G. Kuperman. 2011. Using health information exchange to improve public health. American Journal of Public Health, 101(4): 616-623, doi:10.2105/AJPH.2008.158980.

  69. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Pennsylvania site visiting findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Minnesota site visit findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation.

  70. Berenson, R., and R. Burton. 2012. Health policy brief: Next steps for ACOs. Health Affairs. Burns, L., and M. Pauly. 2012. Accountable care organizations may have difficulty avoiding the failures of integrated care networks of the 1990s. Health Affairs, 31: 2407-2416.

  71. Pham, H., J. Pilotte, R. Rajkumar, et al. 2015. Medicare's vision for delivery-system reform--The role of ACOs. New England Journal of Medicine, 373(11): 987-990.

  72. Core partners are identified as part of the ACO in its application to CMS or share in the costs of the ACO.

  73. Based upon the site visits and interviews, there is market segmentation between long-term care facilities and HHAs in terms of the types of technology adopted and their use for data exchange. HHAs appear more likely to be using a module from a certified EHR vendor than a NH or SNF. This is likely due to either the HHA being owned by a hospital system or having a close hospital system affiliation.

  74. Functional relationships are those that the ACO has with providers that are not core partners that facilitate management of beneficiaries across settings. They typically include data sharing agreements and adoption of common protocols.

  75. L&M Policy Research. 2015. Evaluation of CMMI accountable care organization initiatives: Pioneer ACO evaluation findings from performance years one and two. Centers for Medicare and Medicaid Services. http://innovation.cms.gov/Files/reports/PioneerACOEvalRpt2.pdf.

  76. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Pennsylvania site visiting findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Minnesota site visit findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation.

  77. For example, see http://www.resdac.org/cms-data/files/ssp-aco-provider-level-rif/data-documentation.

  78. Scicchitano, E. 2014. Geisinger, SUN home health to "integrate". Newsitem.com. http://newsitem.com/news/geisinger-sun-home-health-to-integrate-1.1669782.

  79. Colorado Department of Health Care Policy and Financing. 2014. Accountable care collaborative (ACC): Medicare-Medicaid program. https://www.colorado.gov/pacific/hcpf/accountable-care-collaborative-acc-medicare-medicaid-program. Musumeci, Marybeth. 2015. Financial and administrative alignment demonstrations for dual eligible beneficiaries compared: States with memoranda of understanding approved by CMS. Kaiser Family Foundation. http://kff.org/medicaid/issue-brief/financial-and-administrative-alignment-demonstrations-for-dual-eligible-beneficiaries-compared-states-with-memoranda-of-understanding-approved-by-cms/.

  80. See https://www.comedprice.org/#/home.

  81. Administration on Aging, Administration for Community Living. 2012. A profile of Older Americans: 2012. U.S. Department of Health and Human Services. http://www.aoa.gov/Aging_Statistics/Profile/2012/docs/2012profile.pdf.

  82. Devers, K., N. Lallemand, G. Ozanich, et al. 2015. Health information exchange in long-term and post-acute care settings: Conceptual framework. HHS Office of the Assistant Secretary for Planning and Evaluation. Freedman, V., and B. Spillman. 2014. Disability and care needs among older americans. Milbank Quarterly, 92(3): 509-41, doi:10.1111/1468-0009.12076. Stefanacci, R.G., and B.S. Spivack. 2014. Long-term care regulatory and practice changes: Impact on care, quality, and access. Annals of Long-Term Care, 22(11), http://www.annalsoflongtermcare.com/article/long-term-care-regulatory-and-practice-changes-impact-care-quality-and-access.

  83. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Pennsylvania site visiting findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Minnesota site visit findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation.

  84. Blumenthal, D. 2010. Launching HITECH. New England Journal of Medicine, 362(5): 382-385.

  85. Ibid.  

  86. An introduction to the Medicaid EHR incentive program for eligible professionals. https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/ehr_medicaid_guide_remediated_2012.pdf. Eligible providers are physicians (primarily doctors of medicine and doctors of osteopathy), nurse practitioners, certified nurse-midwives, dentists, physician assistants who furnish services in a federally qualified Health Center or Rural Health Clinic that is led by a physician assistant, and in some states optometrists.

  87. Spillman, B.C., E.H. Allen, and A. Spencer. 2015. Evaluation of the Medicaid health home option for beneficiaries with chronic conditions: Provider experiences with implementation, service delivery, and health information technology, final annual report: Year 3. HHS Office of the Assistant Secretary of Planning and Evaluation. https://aspe.hhs.gov/basic-report/evaluation-medicaid-health-home-option-beneficiaries-chronic-conditions-annual-report-year-three

  88. Senate Finance Committee. 2014. The improving Medicare post-acute care transformation act of 2014. http://www.finance.senate.gov/imo/media/doc/IMPACT%20Summary.pdf.

  89. Stratis Health. 2014. Progress in cross-setting health information exchange in Minnesota. http://www.stratishealth.org/pubs/qualityupdate/sp14/HIE.html.

  90. CASPER contains information on NF, HHA, and hospice provider characteristics, as well as citations for substandard care, and quality measures and is used in production of CMS's Nursing Home and Home Health Compare. It is a compilation of all the data elements collected during the inspection survey conducted for the purpose of certification for participation in CMS programs.

  91. An alternative approach would be from the provider perspective. The power of such an approach depends on the number of providers included, not the number of individuals served by those providers. See, for example, Peikes, D., S. Dale, E. Lundquist, J. Genevro, and D. Meyers. 2011. Building the evidence base for the medical home: What sample and sample size do studies need? White Paper, Mathematica Policy Research, Contract No. HHSA290200900019I TO2, AHRQ Publication No. 11-0100-EF. Rockville, MD: Agency for Healthcare Research and Quality. Because our interest is in evaluating patient outcomes in the presence and absence of health information exchange, not a particular model, we focus on an individual level.

  92. Shapiro, J.S. (2007). Evaluating public health uses of health information exchange.Journal of Biomedical Informatics, 40: S46-S49. Shapiro, J.S., F. Mostashari, G. Hripcsak, N. Soulakis, and G. Kuperman. 2011. Using health information exchange to improve public health. American Journal of Public Health, 101(4): 616-623, doi:10.2105/AJPH.2008.158980.

  93. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Pennsylvania site visiting findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Minnesota site visit findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation.

  94. Devers, K., N. Lallemand, G. Ozanich, et al. 2015. Health information exchange in long-term and post-acute care settings: Conceptual framework. HHS Office of the Assistant Secretary for Planning and Evaluation.

  95. Minnesota Department of Health, Office of Health Information Technology. 2015. Understanding the Minnesota interoperable electronic health mandate. http://www.health.state.mn.us/e-health/hitimp/2015mandateguidance.pdf.

  96. Minnesota Department of Health, Office of Health Information Technology. 2015. Understanding the Minnesota interoperable electronic health mandate. http://www.health.state.mn.us/e-health/hitimp/2015mandateguidance.pdf.

  97. General Accounting Office. 2014. Medicare advantage: CMS should fully develop plans for encounter data and assess data quality before use. http://www.gao.gov/assets/670/665142.pdf.

  98. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Minnesota site visit findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation.

  99. Minnesota Department of Health. 2015. All payer claims database--Overview. http://www.health.state.mn.us/healthreform/allpayer/.

  100. Berenson, R., and R. Burton. 2012. Health policy brief: Next steps for ACOs. Health Affairs. Burns, L., and M. Pauly. 2012. Accountable care organizations may have difficulty avoiding the failures of integrated care networks of the 1990s. Health Affairs, 31: 2407-2416.

  101. Pham, H., J. Pilotte, R. Rajkumar, et al. 2015. Medicare's vision for delivery-system reform--The role of ACOs. New England Journal of Medicine, 373(11): 987-990.

  102. Core partners are identified as part of the ACO in its application to CMS or share in the costs of the ACO.

  103. Based upon the site visits and interviews, there is market segmentation between long-term care facilities and HHAs in terms of the types of technology adopted and their use for data exchange. HHAs appear more likely to be using a module from a certified EHR vendor than a NH or SNF. This is likely due to either the HHA being owned by a hospital system or having a close hospital system affiliation.

  104. Functional relationships are those that the ACO has with providers that are not core partners that facilitate management of beneficiaries across settings. They typically include data sharing agreements and adoption of common protocols.

  105. L&M Policy Research. 2015. Evaluation of CMMI accountable care organization initiatives: Pioneer ACO evaluation findings from performance years one and two. Centers for Medicare and Medicaid Services. http://innovation.cms.gov/Files/reports/PioneerACOEvalRpt2.pdf.

  106. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Pennsylvania site visiting findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation. Lallemand, N., A. Napoles, K. Devers, et al. 2015. Minnesota site visit findings. Memorandum commissioned by the Assistant Secretary for Planning and Evaluation.

  107. For see http://www.resdac.org/cms-data/files/ssp-aco-provider-level-rif/data-documentation.

  108. Scicchitano, E. 2014. Geisinger, SUN home health to "integrate". Newsitem.com. http://newsitem.com/news/geisinger-sun-home-health-to-integrate-1.1669782.

  109. Colorado Department of Health Care Policy and Financing. 2014. Accountable care collaborative (ACC): Medicare-Medicaid program. https://www.colorado.gov/pacific/hcpf/accountable-care-collaborative-acc-medicare-medicaid-program. Musumeci, Marybeth. 2015. Financial and administrative alignment demonstrations for dual eligible beneficiaries compared: States with memoranda of understanding approved by CMS. Kaiser Family Foundation. http://kff.org/medicaid/issue-brief/financial-and-administrative-alignment-demonstrations-for-dual-eligible-beneficiaries-compared-states-with-memoranda-of-understanding-approved-by-cms/.

  110. See https://www.comedprice.org/#/home.

  111. Centers for Medicare and Medicaid Services. 2014. IMPACT Act of 2014 and cross setting measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014-and-Cross-Setting-Measures.html. Freedman, V.A., and B.C. Spillman. 2014. The residential continuum from home to nursing home: Size, characteristics and unmet needs of older adults. Journal of Gerontology: Social Sciences, 69(Suppl 1): S42-S50, doi:10.1093/geronb/gbu120.

  112. ACTION III is a contract mechanism AHRQ uses to support field-based delivery system research. The Urban Institute is a subcontractor to multiple prime organizations on this funding vehicle. For additional information on ACTION III, see http://www.ahrq.gov/research/findings/factsheets/translating/action3/index.html.

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