Presentation by Aneesh Chopra for mHealth Israel, April 2022: Delivering on the Promise- How Open Data, APIs & Payment Reform will Fuel Value Based Care. A decade in the making: “The purpose of the Argonaut Project is to rapidly develop a first-generation FHIR-based API and Core Data Services specification to enable expanded information sharing for electronic health records” Sobering Performance on the Move to Value #1) Empower Consumers in Delivery Reform CMS includes consumer “gainsharing” payments in MLR calculations for smarter shopping as part of price transparency regs; National Academy of Medicine calls for a clear target on share of patients enrolled. #2) Optimize High Performing Networks. #3) Faster Feedback Loops. Transformation @ Pace of Trust Aneesh Chopra, former US Chief Technology Officer, Obama Administration Co-Founder & President, CareJourney, Author, Innovative State Bio: https://www.linkedin.com/in/apchopra

1. Aneesh Chopra
@aneeshchopra
Delivering on the Promise:
How Open Data, APIs & Payment Reform will Fuel Value Based Care

2. A Decade in the Making
Source: argonautproject.org; healthIT.gov; https://graphics.wsj.com/medicare-billing/;
“The purpose of the Argonaut Project is to
rapidly develop a first-generation FHIR-based
API and Core Data Services specification to
enable expanded information sharing for
electronic health records”

3. Sobering Performance on the Move to
Value
All data is from CY2020 except for Covid vaccine data which is from Q1-Q2 2021. Distressed Community Index (DCI) scores an aggregation of ZIP Code specific economic measures including local mean income,
employment rates, educational attainment, poverty rates, unoccupied habitable housing rates, and others. Based on the DCI scores we assigned each ZIP-Code a quintile ranging from lowest (1) to highest (5)
distress.
ZIP Quintile
Least Distressed 2 3 4 Most Distressed
ACO Enrolled 29.65% 28.47% 27.28% 26.14% 24.81%
ACO Enrolled Count 3,240,964 2,313,028 1,980,272 1,788,604 1,473,113
Total Benes 10,930,291 8,125,380 7,258,970 6,841,224 5,937,345
Zip code level mean proportion of eligible enrollees receiving recommended care
Flu shots (%) 44.02% 39.91% 36.07% 33.06% 29.01%
Annual wellness visits (%) 26.25% 23.89% 20.90% 18.67% 16.53%
Advanced care planning visits (%) 4.29% 4.40% 4.07% 4.20% 4.36%
Avoidable ED visits (%) 21.55% 23.98% 26.37% 28.38% 30.81%
Covid Vaccine (1+ shot) (%) 38.84% 35.70% 32.21% 29.78% 26.68%
Beneficiary Race (RTI) Full Dualor LIS
White Black Hispanic
Asian/Pacific
Islander
No Yes
ACO Enrolled 29.29% 22.40% 15.95% 16.57% 27.80% 23.84%
ACO Enrolled Count 9,253,646 825,229 452,514 219,863 9,207,368 1,856,041
Total Benes 31,590,178 3,684,170 2,837,260 1,326,762 33,124,496 7,785,492

4. #1) Empower Consumers in Delivery Reform
Consumers Can Aggregate Their Data
and Share with Those They Trust
Consumers Can Direct Their
Capitated Dollar
Source: https://nam.edu/wp-content/uploads/2021/05/CMMI_Expert-Panel-Overview_2021_5.19-F.pdf
CMS includes consumer “gainsharing” payments in MLR calculations for
smarter shopping as part of price transparency regs; National Academy of
Medicine calls for a clear target on share of patients enrolled

5. #2) Optimize High Performing Networks

6. #3) Faster Feedback Loops
https://www.whitehouse.gov/wp-content/uploads/2021/08/OMB-Report
-on-E013985-Implementation_508-Compliant-Secure-v1.1.pdf; Open
source app now available on GitHub; ResearchKitOnFHIR

7. Transformation @ Pace of Trust
Source: https://www.carinalliance.com/wp-content/uploads/2019/05/2019_CARIN_Code_of_Conduct_05082019.pdf;
whitehouse.gov