The Federal Trade Commission and Department of Justice issued a joint statement about how the agencies will enforce U.S. antitrust laws in regard to new Accountable Care Organizations – groups of health care providers that will be collaborating under the Affordable Care Act of 2010 to improve health care quality and reduce costs.

The joint proposed Policy Statement solicits public comment on the antitrust agencies’ proposed guidance to ensure that newly formed collaborative care organizations, known as ACOs, can innovate to serve Medicare beneficiaries and patients with private health insurance, without raising competitive concerns. The proposed Policy Statement would create an antitrust “safety zone” for certain ACOs and establish expedited antitrust reviews for others.

“The Administration has led an unprecedented, collaborative effort among all of the agencies responsible for developing guidance for ACOs,” said FTC Chairman Jon Leibowitz. “This guidance will help ensure that ACOs meet their goals of improving quality and lowering costs while minimizing the regulatory burden on health care providers.”

The 2010 Act encourages health care providers to form integrated organizations to jointly offer services in order to reduce costs and improve the quality of patient care in the United States. The goal of these joint provider organizations – ACOs – is to better coordinate care, leading to efficiencies and cost savings for consumers. Under the Act, ACOs will serve fee-for-service beneficiaries through Medicare’s Shared Savings Program and must sign up with the Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) to participate in the program for at least three years, starting January 1, 2012.

The FTC and DOJ recognize that ACOs may generate opportunities for health care providers to innovate in both the Medicare and commercial markets to achieve the cost savings Congress intended when establishing the Shared Savings Program. At the same time, however, the agencies also understand that collaborations among competitors – as will occur through the formation of ACOs – may raise concerns about competition. The FTC and DOJ have jointly developed the proposed antitrust Policy Statement to coordinate competition analysis with CMS’s review of ACO applications, to ensure the newly formed organizations do not lead to reduced competition and higher prices for consumers.

The joint Policy Statement is intended to ensure that health care providers have the antitrust guidance they need to form procompetitive ACOs. It describes: 1) the ACOs to which it will apply; 2) when the FTC and DOJ will apply particular antitrust analyses to those ACOs; 3) an antitrust safety zone for certain ACOs; 4) the CMS-mandated antitrust review process for certain other ACOs; and 5) options for ACOs to gain additional antitrust clarity if they fall outside the safety zone but below the CMS-mandated antitrust threshold.

As described in the Policy Statement, the FTC and DOJ will evaluate applicants that meet CMS eligibility criteria for the Shared Savings Program based on the ACOs share of services in each participant’s Primary Service Area, or PSA. ACOs with high PSA shares may pose a higher risk of being anticompetitive and also may reduce quality, innovation, and choice for both Medicare and commercial patients. High PSA shares may reduce the ability of competing ACOs to form, and could allow an ACO to raise prices charged to commercial health plans above competitive levels.

Depending on an ACO’s range of PSA shares, CMS may mandate, or an ACO may choose to seek, an expedited antitrust review. An ACO will submit its request for expedited review to both the FTC and DOJ, and the agencies will determine which of the two will review the request. The FTC and DOJ have committed to a 90-day expedited review of ACOs that are subject to mandatory review, or that seek expedited review, once all required documents and information have been received. The FTC and DOJ will establish a Joint ACO Working Group to collaborate and discuss issues arising out of ACO reviews. This process will allow ACOs to rely on the expertise of both agencies and will ensure efficient, cooperative, and expeditious reviews.

The FTC and DOJ are accepting public comment on the proposed Policy Statement through May 31, 2011. The agencies are seeking comments from health care providers, payers, consumers, antitrust practitioners, and other stakeholders on issues including:

• Whether, and if so why, the guidance in the proposed Policy Statement should be changed in any respect;
• Whether other data sources exist that ACO applicants could use to determine relevant PSA shares for: 1) physician services rarely used by Medicare beneficiaries (e.g., pediatrics, obstetrics); and 2) inpatient hospital services located in states where all-payer hospital discharge data are unavailable; and
• Whether providing the documents and information required to obtain an expedited antitrust review will present an undue burden on ACO applicants.

Comments can be submitted electronically here. The Federal Register notice announcing the proposed Policy Statement contains information on submitting comments via mail, and can be found here. The proposed Policy Statement can be found here and as a link to this press release on the FTC’s website.

The Commission vote approving the proposed Policy Statement and related Federal Register notice was 4-1. Commissioner J. Thomas Rosch dissented. He generally agrees with the analytical framework described in the proposed Policy Statement but dissents because of the statement’s suggestion that the formation of ACOs will be reviewed by both the FTC and the DOJ. Commissioner Rosch believes that responsibility for reviewing the formation of ACOs should remain with the Commission because: 1) the Antitrust Division currently has far less expertise or experience than the Commission in reviewing the formation of ACOs or applying the antitrust laws to them; and 2) the Antitrust Division is more susceptible than the Commission, an independent agency, to lobbying and other political pressure. In his view, the evaluation of some ACOs by the Antitrust Division represents a victory for physicians and hospitals – as well as their lobbyists and political supporters – which have opposed Commission review and antitrust enforcement of clinically-integrated health care providers.

The FTC’s Bureau of Competition works with the Bureau of Economics to investigate alleged anticompetitive business practices and, when appropriate, recommends that the Commission take law enforcement action. To inform the Bureau about particular business practices, call 202-326-3300, send an e-mail to antitrust@ftc.gov, or write to the Office of Policy and Coordination, Room 394, Bureau of Competition, Federal Trade Commission, 600 Pennsylvania Ave, N.W., Washington, DC 20580. To learn more about the Bureau of Competition, read “Competition Counts” at http://www.ftc.gov/competitioncounts.

 

Proposal for Accountable Care Organizations will help
better coordinate care, lower costs 

The U.S. Department of Health and Human Services (HHS) today released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).  ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower health care costs while meeting performance standards on quality of care and putting patients first.  Patient and provider participation in an ACO is purely voluntary.

The proposed new rules will help doctors, hospitals, and other providers form ACOs and are now available for public comment.  HHS also announced it will hold a series of open-door forums and listening sessions during the comment period to help the public understand what the Centers for Medicare & Medicaid Services (CMS), the agency administering the ACO program, is proposing to do and to ensure that the public understands how to participate in the formal comment process.

“The Affordable Care Act is putting patients and their doctors in control of their health care,” said HHS Secretary Kathleen Sebelius.  “For too long, it has been too difficult for health care providers to work together to coordinate and improve the care their patients receive. That has real consequences: patients have gaps in their care, receive duplicative care, or are at increased risk of suffering from medical mistakes.  Accountable Care Organizations will improve coordination and communication among doctors and hospitals, improve the quality of the care their patients receive, and help lower costs.”

By focusing on the needs of patients and linking payment rewards to outcomes, this delivery system reform, as part of the Affordable Care Act, will help improve the health of individuals and communities while saving as much as $960 million over three years for the Medicare program. 

Under the proposal, ACOs – teams of doctors, hospitals, and other health care providers and suppliers working together – would coordinate and improve care for patients with Original Medicare (that is, who are not in Medicare Advantage private health plans). To share in savings, ACOs would meet quality standards in five key areas:

• Patient/caregiver care experiences
• Care coordination
• Patient safety
• Preventive health
• At-risk population/frail elderly health.

The proposed rules also include strong protections to ensure patients do not have their care choices limited by an ACO.

If ACOs save money by getting beneficiaries the right care at the right time – for example, by improving access to primary care so that patients can avoid a trip to the emergency room – the ACO can share in those savings with Medicare.  ACOs that do not meet quality standards cannot share in program savings, and over time, those who do not generate savings can be held accountable.  The new program will be established on January 1, 2012.  Before the rule is finalized, CMS will review all comments from the public and may make changes to its proposals based on those comments.

“An ACO will be rewarded for providing better care and investing in the health and lives of patients,” said Donald M. Berwick, M.D., CMS Administrator.  “ACOs are not just a new way to pay for care but a new model for the organization and delivery of care.”

CMS has worked closely with other federal agencies, including the Department of Health and Human Services Office of Inspector General (OIG), the Department of Justice (DOJ), the Federal Trade Commission (FTC), and Internal Revenue Service (IRS) to ensure that providers and suppliers have the clear and practical guidance they need to form ACOs without running afoul of the fraud and abuse, antitrust, and tax laws. Concurrently with the publication of this proposed rule, the following documents have been issued: a joint CMS and OIG notice and solicitation of public comments on potential waivers of certain fraud and abuse laws in connection with the Medicare Shared Savings Program; a joint FTC and DOJ proposed antitrust policy statement; and an IRS notice requesting comments regarding the need for additional tax guidance for tax-exempt organizations, including tax-exempt hospitals, participating in the Medicare Shared Savings Program.

The proposed rules are just one piece of a broader effort by the Obama Administration to improve the quality of health care for all Americans.  On March 21, HHS announced the first-ever National Quality Strategy, which will serve as a tool to better coordinate quality initiatives between public and private partners.  In addition, the Affordable Care Act established a new Center for Medicare and Medicaid Innovation that will test innovative care and service delivery models.  CMS is currently exploring how the Innovation Center will test alternative payment models for ACOs. 

Here is the proposed rule:

 

An emphasis on improved quality is restructuring the way health care is delivered, measured and paid for. These transformational elements of the patient centered medical home are the focus of three new resources unveiled today at the Patient-Centered Primary Care Collaborative’s Stakeholders’ Meeting in Washington, DC.

“The Stakeholders’ Meeting convenes the nation’s top thought leaders to share guidelines, cutting-edge ideas and proven practices for expanding the impact of the medical home. All three of these resources provide more than a mile-high overview—they offer detailed examples of how the medical home is improving care delivery, enhancing how health benefits are structured and rewarding physicians for patient-centered care,” said Edwina Rogers, executive director of the Patient-Centered Primary Care Collaborative (PCPCC). “The PCPCC is dedicated to expanding the impact of the medical home. These resources are developed to meet just-in-time needs of stakeholders for rapid advancement of the medical home.”

“Practices in the Spotlight: The Medical Home and Diabetes Care” lays out the intersecting quality priorities of structured, high-value diabetes care management and the principles of the medical home. The report provides an overview of the issue and provides 10 case examples from across the country of expert practices that have adopted the medical home principles in their care programs for diabetes patients. “Practices in the Spotlight,” written by Health2 Resources on behalf of the PCPCC, is a resource for health care practitioners to see how diabetes interventions are taking hold in the medical home context, and how to apply them in their own practices. This resource is supported by funding from Novo-Nordisk. To download the report, go to http://www.pcpcc.net/guide/medical-home-and-diabetes-care

“Patient-Centered Medical Home: Performance Metrics for Employers” was primarily written by Bruce Sherman, MD, FCCP, FACOEM, consulting corporate medical director for the Whirlpool Corporation, in collaboration with his co-chairs of the PCPCC’s Center for Employer Engagement Center. This resource for employers puts forward a set of health and productivity metrics that can be used by employers and their supplier partners to gain a comprehensive understanding of the value of health, and then to compare the outcomes of programs based on the concept of the patient-centered medical home from employer to employer. It includes a description of metrics categories used by employers, a business-oriented timeline for understanding those metrics, and eight detailed case studies that demonstrate the effective use of the medical home in benefit design. To download the report, go to
http://www.pcpcc.net/guide/metrics-for-employers

The third resource is a payment rate brief authored by Michael Bailit, president, Bailit Health Purchasing, LLC on behalf of the PCPCC. Although the PCMH is taking hold in dozens of demonstration projects across the nation, there is a wide range of payment methodologies and rate arrangements with providers within those projects. This brief provides a detailed look at the payment arrangements and dollar value of a sample of 12 PCMH initiatives that represent a diverse mix of initiatives, including those involving a single commercial payer, multiple payers and a state Medicaid agency acting alone. The brief is a reference for primary care practices and payers interested in creating new PCMH initiatives, or to refine existing ones. To download the brief, go to http://www.pcpcc.net/guide/payment-rate-brief

An additional report, written by Health2 Resources and co-sponsored by the PCPCC, The Commonwealth Fund and the Dartmouth Institute for Health Policy and Clinical Practice with report funding from the Milbank Memorial Fund, will also be unveiled at the March 30 meeting. “Better to Best: Value-Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations” is a report summarizing the presentations, discussion and resulting consensus statements of a meeting of high-level health care stakeholders that took place Sept. 8, 2010. Four value-driving elements that are central to the advance of health care transformation--access, care coordination, health information technology and payment reform—are brought into focus and enhanced by action steps designed to drive them forward within medical homes and accountable care organizations. To download the report, go to http://www.pcpcc.net/guide/better_to_best

The PCPCC is a coalition of more than 700 organizations representing the nation’s business leaders, consumers, primary care physicians and other health care stakeholders with the shared goal of advancing adoption of the patient centered medical home (PCMH) across the nation. The theme for today’s meeting, “A Foundation for Transformation and Reform,” speaks to the centrality of primary care in models that are expanding, such as the medical home, as well as emerging models such as accountable care organizations.

For a complete agenda or for more information about the PCPCC Stakeholders’ Working Meeting, go to http://pcpcc.net/event/meeting/3-30-2011

 

 

 

 

 

 

 

The Office of the National Coordinator for Health Information Technology (ONC) today announced an open public comment period on the Federal Health IT Strategic Plan: 2011-2015 (“the Plan”). The Plan reflects ONC’s strategy, developed in collaboration with other federal partners, over the next five years for realizing Congress and the Administration’s health IT agenda.

“Meaningful use provides an opportunity to bring electronic health information to life in the care of patients and power an information-driven health care system that is capable of never before imagined levels of performance.”

Despite evidence of the benefits of the use of health IT, today only 25-percent of physician offices and 15-percent of hospitals take advantage of electronic health records (EHRs). Two major pieces of legislation, enacted over the past two years, are dramatically changing the health IT landscape and providing an opportunity to modernize the way care is delivered and improve the health of all Americans – the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Affordable Care Act. The Plan, originally published in 2008, is being updated to reflect the significant impact of these two pieces of legislation.

The Plan begins in 2011, when it became possible for eligible professionals and eligible hospitals that demonstrate “meaningful use” of certified electronic health record (EHR) technology to receive incentive payments under the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs as authorized by the HITECH Act.

“We’ve entered a new era in health care, the era of meaningful use,” said David Blumenthal, M.D., M.P.P., national coordinator for health information technology. “Meaningful use provides an opportunity to bring electronic health information to life in the care of patients and power an information-driven health care system that is capable of never before imagined levels of performance.”

The Plan describes how ONC will work collaboratively with its federal partners and the private sector to usher in a new era of meaningful use that will allow the health care system to harness the power of health IT to bring information to bear in new ways to improve care and transform the health care system.

Building on meaningful use, the Plan also addresses how ONC and its federal partners will increase protections to ensure that electronic health information is kept private and secure, empower individuals with access to their electronic health information, and enhance the ability to study care delivery and payment systems.

Over the past year, ONC has worked closely with its federal partners and the private sector (through the HIT Policy Committee, a Federal Advisory Committee) to update the Plan. ONC welcomes the public to submit comments on the Plan through April 22, 2011, in order to better inform its strategy.

To read the draft, Federal Health IT Strategic Plan: 2011 – 2015, and submit comments, please visit: http://healthit.gov/buzz-blog/.

 

 

Clinical practice guidelines and systematic reviews of the evidence base for health care services are supposed to offer health care providers, patients, and organizations authoritative guidance on the comparable pros and cons of various care options, but too often they are of uncertain or poor quality.  There are no universally accepted standards for developing systematic reviews and clinical practice guidelines, leading to variability in the handling of conflicts of interest, appraisals of evidence, and the rigor of the evaluations.  Two new reports from the Institute of Medicine recommend standards to enhance the quality and reliability of these important tools for informing health care decisions (see illustration).

 

Clinical Practice Guidelines We Can Trust recommends eight standards to ensure the objective, transparent development of trustworthy guidelines.  Several problems hinder providers' and others' ability to determine which among thousands of sometimes competing guidelines offer reliable clinical recommendations.  Finding What Works in Health Care: Standards for Systematic Reviews recommends 21 standards to ensure objective, transparent, and scientifically valid reviews.  Poor quality reviews can lead clinicians to the wrong conclusions and ultimately to inappropriate treatment decisions. 

 

"These standards are necessary given that there is little documentation to judge the quality and reliability of many of the existing clinical practice guidelines," said Sheldon Greenfield, Donald Bren Professor of Medicine and executive director, Health Policy Research Institute, University of California, Irvine, and chair of the committee on guidelines.  "Practice guidelines provide valuable data and guidance that not only inform individual decisions about care but ultimately could also improve overall health care quality and outcomes." 

 

"This report presents the 'gold standard' to which those who conduct systematic reviews should aspire to achieve the most reliable and useful products," said Alfred O. Berg, professor of family medicine, University of Washington School of Medicine, Seattle, and chair of the committee that wrote the report on systematic reviews.  "We recognize that it will take an investment of resources and time to achieve such high standards, but they should be adopted to minimize the chances that important health decisions are based on information that may be biased or erroneous."

 

To prevent actual or perceived conflicts of interest from eroding trust in clinical practice guidelines, members of guideline development groups should not have intellectual, institutional, financial, or other forms of conflicts whenever possible, says the guidelines report.  However, if a group cannot perform its work without conflicted individuals, they should make up only a minority of the members.  Those who fund guideline development work should have no role in the development process.  Similarly, individuals with clear financial conflicts of interest as well as those with professional or intellectual biases that would lessen an evaluation's credibility should be excluded from the teams that conduct systematic reviews, the report on reviews says.   

 

Getting input from consumers, health professionals, insurers, and other intended users can boost the quality of reviews and guidelines and make them more relevant.  Guideline development groups should include a current or former patient and a patient advocate or representative of a consumer organization.  Systematic reviews should include a method to collect information from individuals with relevant perspectives and expertise.  Individuals providing input should publicly acknowledge their potential biases and conflicts and be excluded from the process if their participation would diminish the evaluation’s credibility.

 

People expect clinical practice guidelines to provide an accurate, fair account of the potential benefits and harms of various health care options and they expect systematic reviews to provide a complete picture of all that is known about an intervention.  Because guideline developers often have to make subjective judgments about evidence, especially when it is low-quality or limited, they should explicitly describe the part that value judgments, theory, or clinical experience played in their recommendations, the guidelines report says.  They should explain the reasoning underlying each recommendation they make, including their assessment of the quality, completeness, and consistency of the available evidence.  Teams conducting systematic reviews should not limit their evaluations to the published literature or large databases because negative findings sometimes go unpublished and these tools provide only a partial picture of the evidence, the report on reviews says.  Reviewers should seek out relevant unpublished information.  And they should clearly describe the team's methodology, selection criteria, and assessment of the evidence, including what remains unknown about the topic. 

 

The studies were requested by Congress and sponsored by the U.S. Department of Health and Human Services.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  For more information, visit http://national-academies.org or http://iom.edu.  Committee rosters follow.

 

Contacts: 

Christine Stencel, Senior Media Relations Officer

Luwam Yeibio, Media Relations Assistant

Office of News and Public Information

202-334-2138; e-mail news@nas.edu

 

Additional resources:

Report Brief for Practice Guidelines

Report Brief for Systematic Reviews

Illustration

Practice Guidelines Website

Systematic Reviews Website

 

___________________________________________________________________________________________

Pre-publication copies of Finding What Works in Health Care: Standards for Systematic Reviews and Clinical Practice Guidelines We Can Trust are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu.  Additional information is available at http://www.iom.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above). 

 

#       #       #

 

INSTITUTE OF MEDICINE

Board on Health Care Services

 

Committee on Standards for Developing Trustworthy Clinical Practice Guidelines

 

Sheldon Greenfield, M.D. (chair)

Donald Bren Professor of Medicine

and Executive Director

Health Policy Research Institute

University of California

Irvine

 

Earl P. Steinberg, M.D., M.A. (vice chair)

Senior Vice President of Clinical Strategy, Quality, and Outcomes

WellPoint Inc., and

President and CEO

Resolution Health Inc.

Columbia, Md.

 

Andrew Auerbach, M.D.,

M.P.H.

Associate Professor of Medicine in

Residence

School of Medicine

University of California

San Francisco

Jerry Avorn, M.D.

Professor of Medicine

Harvard Medical School, and

Chief

Division of Pharmacoepidemiology 

and Pharmaconomics

Brigham and Women’s Hospital Boston

 

Robert S. Galvin, M.D.

CEO

Equity Healthcare, and

Executive Director

Corporate Private Equity

The Blackstone Group

New York City

 

Raymond J. Gibbons, M.D.

Consultant in Cardiovascular Disease and Internal Medicine

Mayo Clinic

Rochester, Minn.

 

Joseph Lau, M.D.

Director

Evidence-Based Practice Center

Tufts Medical Center

Boston

 

Monica Morrow, M.D.

Chief of Breast Service and Anne Burnett Windfohr Chair of Clinical Oncology

Memorial Sloan-Kettering Cancer Center, and

Professor of Surgery

Weill Medical College

Cornell University

New York City

 

Cynthia Mulrow, M.D.

Senior Deputy Editor

Annals of Internal Medicine

American College of Physicians

San Antonio

 

Arnold J. Rosoff, J.D. 

Professor of Legal Studies and Health Care Management

The Wharton School;

Professor of Family Medicine and Community Health

School of Medicine; and

Senior Fellow

Leonard Davis Institute of Health Economics

University of Pennsylvania

Philadelphia

 

John Santa, M.D., M.P.H.

Director

Consumer Reports Health Ratings   

Center

Yonkers, N.Y.

 

Richard N. Shiffman, M.D., M.C.I.S.

Professor of Pediatrics

Yale School of Medicine

New Haven, Conn.

 

Wally R. Smith, M.D.

Professor and Chair

Division of Quality Health Care, and

Scientific Director

Center on Health Disparities

Virginia Commonwealth University

Richmond

 

Walter F. Stewart, Ph.D., M.P.H.

Associate Chief Research Officer

Center for Health Research

Geisinger Health System

Danville, Pa.

 

Ellen L. Stovall, B.A.

Senior Health Policy Adviser

National Coalition for Cancer Survivorship

Silver Spring, Md.

 

Brian L. Strom, M.D., M.P.H.

Chair and Professor

Department of Biostatistics and  

Epidemiology

University of Pennsylvania

Philadelphia

 

Marita G. Titler, Ph.D., R.N.

Associate Dean

Office of Practice and Clinical   

Scholarship

School of Nursing

University of Michigan

Ann Arbor

 

STAFF

 

Robin Graham, Ph.D., M.P.H.

Study Director

 

 

INSTITUTE OF MEDICINE

Board on Health Care Services

 

Committee on Standards for Systematic Review of Comparative Effectiveness Research

 

 

Alfred O. Berg, M.D., M.P.H. (chair)

Professor

Department of Family Medicine

University of Washington School of Medicine

Seattle

 

Sally C. Mortom, Ph.D. (vice chair)

Professor and Chair

Department of Biostatistics

Graduate School of Public Health

University of Pittsburgh

Pittsburgh

 

Jesse Berlin, Ph.D.

Vice President of Epidemiology

Johnson & Johnson Pharmaceutical Research and

Development

Titusville, N.J.

 

Giselle Corbie-Smith, M.D., M.Sc.

Professor

Departments of Social Medicine and Medicine

School of Medicine

University of North Carolina

Chapel Hill

 

Kay Dickersin, M.A., Ph.D.

Professor of Epidemiology, and

Director

Center for Clinical Trials and U.S. Cochrane Center

Johns Hopkins Bloomberg School of Public Health

Baltimore

 

Jeremy Grimshaw, M.B.Ch.B., Ph.D.

Senior Scientist

Clinical Epidemiology Program

Ottawa Hospital Research Center, and

Director

Center for Best Practice

Institute of Population Health

University of Ottawa

Ottawa, Ontario

 

Mark Helfand, M.D., M.S., M.P.H.

Professor of Medicine and Medical Informatics and Clinical Epidemiology, and

Director

Oregon Evidence-Based Practice Center

Oregon Health and Science University

Portland

 

Vincent E. Kerr, M.D.

President

Care Solutions

United HealthCare

Fairfield, Conn.

 

Marguerite Koster, M.A., M.F.T

Practice Leader

Technology Assessment and Guidelines Unit

Southern California Permanente Medical Group

Pasadena, Calif.

 

Katie Maslow, M.S.W.

Scholar in Residence

Institute of Medicine

Washington, D.C.

 

David A. Mrazek, M.D., F.R.C.Psych

Chair

Department of Psychiatry and Psychology

Mayo Clinic

Rochester, Minn.

 

Christopher Schmid, Ph.D.

Director

Biostatistics Research Center

Institute for Clinical Research and Health Policy Studies, and

Professor of Medicine

Tufts Medical Center

Tufts University

Boston

 

Anna Maria Siega-Riz, Ph.D.

Professor of Epidemiology and Nutrition, and

Associate Chair of Epidemiology

Gillings School of Global Public Health

University of North Carolina

Chapel Hill

 

Harold C. Sox, M.D.

Editor Emeritus

Annals of Internal Medicine

American College of Physicians of Internal Medicine

Hanover, N.H.

 

Paul J. Wallace, M.D.

Medical Director

Health and Productivity Management Programs 

The Permanente Federation

Oakland, Calif.

 

STAFF

Jill Eden

Study Director

 

The Alembic Foundation today announced its incorporation as a nonprofit 501(c)(3) to design and build Open Source technologies that empower citizens so they can understand, participate in and help guide the services-driven, networked information economy of the 21^st century. The Alembic Foundation will define and build technology projects aimed at the difficult challenges inherent in managing personal and private data by organizations of all sizes on behalf of individuals, in a way that empowers those individuals.

The Foundation aims to accomplish this in two ways:

• By serving as a neutral forum to foster collaboration with organizations and individuals from industry, the public and government to confront and solve real-world challenges
• By providing a basic toolset for communities of interest to organize themselves, define their project(s) and determine the relevant governance structure that assures success

"The Alembic Foundation exists for the public good, and to contribute to the public commons through open processes that create open technologies for transformation," said David Riley, Alembic's president. "The Foundation will be tackling projects that will benefit from using open technologies to solve real-life challenges. As our first project, the Alembic Foundation is going to expand on the Federal Health Architecture's (FHA) CONNECT project to create a truly open community that uses Open Source technology for health information exchange." 

A Webinar announcing further details about the Alembic Foundation and the Aurion Project will be held on Tuesday, March 22 at 1:00 pm EDT. To register for the Webinar, click https://www2.gotomeeting.com/register/722650370. 

The Aurion Project: An Evolution of FHA's CONNECT Open Source Project

Alembic's first project, Aurion, is an Open Source software project that will promote health IT interoperability nationwide in accordance with nationally-recognized standards. The direct ancestor to the Aurion Project is the multi-award winning CONNECT program built by FHA under the leadership of the Alembic Foundation's CEO, David Riley, and its chief operating officer, Vanessa Manchester, who previously worked within the FHA program management office.

Riley and Manchester chose Aurion as the initial project of the Alembic Foundation because they believe the Foundation can provide an effective vehicle for the public and private sectors to work together to build upon CONNECT. Supporting this important work through a nonprofit organization expands the ability for organizations of all sizes to contribute to Aurion through development and resources. It also opens more opportunities for organizations to participate in setting the requirements for and influencing the direction of Aurion.

According to Brian Behlendorf, the chief technology officer for the World Economic Forum, "Creating a nonprofit foundation to continue the work started by the federal government is the right thing to do. It allows the project to grow and involve a far larger constituency in its development, with clearer rules of engagement for everyone. Our hope is that this unleashes greater degrees of collaboration and innovation."

Aurion 3.1, released today, is the CONNECT 3.1 codebase rebranded. With the release of Aurion 4.0 on May 3, 2011, the Alembic Foundation will assume a custodial agent role for the development efforts of a robust open community and ecosystem being built around the Aurion platform. After the release of Aurion 4.0, the Aurion community will continue to evolve the software to ensure that it remains a powerful, open source option for a Nationwide Health Information Network compliant gateway.

Alembic Foundation Board of Directors

The Alembic Foundation has named its first three members of the Board of Directors. Over the course of the next year, the board will expand to a total of 15 board members. Current members of the board include:

• David Riley, Chairman of the Board and president of the Alembic Foundation, and former lead to the CONNECT Project under the Federal Health Architecture
• Brian Behlendorf, chief technology officer for the World Economic Forum and long-time open source expert advising the White House, the Department of Health and Human Services, and others
• Jon Teichrow, president of the Mirth Corporation with 25 years' experience at the intersection of technology and healthcare

More information about the Directors' backgrounds can be found at www.alembicfoundation.org.

About the Alembic Foundation

The Alembic Foundation is a nonprofit organization (501(c)(3)) dedicated to promoting transformation through disruptive innovation using open processes in open communities to create open technologies that are contributed to the public commons. We aim to make those technologies readily available for use by any and all who want to improve their lives, creating a better future for themselves and others by becoming first class citizens in a services-driven, networked information economy.

For more information about the Alembic Foundation, please visit www.alembicfoundation.org.

About the Aurion Project

Aurion is an open source health information exchange platform that implements the Nationwide Health Information Network standard services and specifications. Aurion is the first project chartered through the Alembic Foundation. It builds upon Aurion's direct ancestor, the multi-award winning CONNECT program built by FHA, to enable the secure exchange of interoperable health information among diverse organizations using a wide variety of technologies. Organizations implementing Aurion as a part of their health information exchange strategy gain the benefits of implementing nationally-recognized standards that enable data exchange with federal agencies as well as with numerous other health IT stakeholders.

(via http://www.alembicfoundation.org/)

(“Hail To The Chief” plays as the President enters.)

THE PRESIDENT: Thank you! (Applause.)

Can we go with the song that we talked about? (Laughter.) (“Born In The USA” plays.) (Laughter and applause.)

THE PRESIDENT: Some things just bear repeating. (Laughter.) Good evening. As we gather here tonight, all across the world a powerful spirit of change is tearing down old regimes, decaying institutions, remnants of the past. So, look out, Gridiron Club! (Laughter.)

I mean, look at this getup. (Laughter.) Forget about winning the future. How about entering the present? (Laughter and applause.)

Anyway, it’s great to be here. And I'm glad we're ending on time because I really couldn't stay here much longer. (Laughter.) I have to get back to not being involved in the budget negotiations. (Laughter.) My schedule is just packed with meetings that I'm not attending. (Laughter.)

You know, the last time I attended this dinner was in 2006. A lot has changed in those past five years. Back then I was a newcomer who couldn't get anything done in the Senate. Now I'm a President who can't get anything done in the Senate. (Laughter.)

But it’s good to be back and have a chance to spend time with so many members of the press. And, Susan, thank you for the extraordinary job that you’ve done tonight. (Applause.) I know people say that I have a testy relationship with the media -- but how can that be? I hardly ever see you. (Laughter.)

Come on, I love the press. I even sat for an interview with Bill O’Reilly right before the Super Bowl. That was a change of pace. (Laughter.) I don't often get a chance to be in a room with an ego that's bigger than mine. (Laughter.)

And while I know I have my share of critics out there, I don't focus on the negative stuff. I just don't pay much attention to it. Most days I barely skim through the comment section of Huffington Post -- Daily Kos -- Fire Dog Lake -- The Daily Dish -- boingboing.net. (Laughter.)

All right, I hear the criticisms. I do. For example, I know that people think I'm not passionate enough. That I'm too cool. That I'm too detached. But as I was going through my daily routine -- sitting alone in my study -- (laughter) -- meditating, thinking about how to win the future -- (laughter) -- I pondered this critique, and calmly rejected it -- (laughter and applause) -- as thoroughly illogical. (Laughter.) And for all those who think I golf too much, let me be clear. I'm not spending time on the golf course -- I'm investing time on the golf course. (Laughter.)

Here’s another criticism I haven’t paid much attention to -- we heard a little bit of it tonight -- my reliance on the teleprompter. Republicans even tried to take it away from me. And I'm fine with that. As if I can't speak without a -- without a -- (laughter) -- a teleprompter. (Laughter.) I want to acknowledge a few people in the house tonight. Kathleen Sebelius did a great job, didn’t she? (Applause.)

She does a great job each and every day. In these tough times I've asked all my Cabinet members to cut even those things that they care deeply about. In Kathleen’s case, it was her once-promising political career. (Laughter.)

My understanding is the Speaker of the House, John Boehner -- is he here? He couldn't show up, huh? Okay. I mean, we've heard a few jokes about John, and I've made a few jokes over the years about John’s unusual coloring. (Laughter.) I used to think that it was a tan, but after seeing how often he tears up I've come to realize that's not a tan -- that's rust. (Laughter.) Think about it. (Laughter.) I want to congratulate my dear friend Chris Dodd on his new role as head of the MPAA. Though I'm wondering what life experience could possibly prepare Chris to deal with a town full of blowhards and inflated egos. (Laughter.)

America’s favorite voyeur, TSA Administrator John Pistole is in the house. No hard feelings, John. I mean that literally. Please. (Laughter and applause.) Last but not least, Rahm Emanuel is here -- already hard at work on Chicago’s problems. (Laughter.) Let me just be the first to say: Welcome home. (Laughter and applause.) Unless anybody from the Illinois Supreme Court is here -- then welcome to Washington. (Laughter.) You know, the day I hired Rahm as my chief of staff, unemployment was under 8 percent and my approval ratings were in the 60s. So, good luck, Chicago. (Laughter.)

Thankfully, Bill Daley came over from Wall Street to take his place. And the senior staff actually seems pretty happy with the change -- particularly the new executive bonus plan. (Laughter.) I do have a couple of regrets to pass along. My Secretary of State could not be with us.

I've dispatched Hillary to the Middle East to talk about how these countries can transition to new leaders -- though, I've got to be honest, she’s gotten a little passionate about the subject. (Laughter.) These past few weeks it’s been tough falling asleep with Hillary out there on Pennsylvania Avenue shouting, throwing rocks at the window. (Laughter.) Settle down. (Laughter.)

Former Congressman Chris Lee wanted to be here tonight. But apparently he didn’t know the rules -- no shoes, no shirt, no service. (Laughter.) Speaking of Republican exploratory activities -- (laughter) -- we have quite a few considering presidential candidacies. Of course, there’s our outstanding speaker for the evening, Mitch Daniels. (Applause.) Did a great job.

Mitch, I heard your friends over at FOX News told you that you don't look like a President. But I wouldn't worry about it -- they say the same thing about me every single day. (Laughter.) I know some people discount Mitch because he’s not -- as they say in the NBA -- long enough. (Laughter.) But the don't realize how scrappy he is. I watched him during dinner. He tore into that fillet like it was a public employee. (Laughter and applause.) And Mitch is experienced. Before he was governor Mitch was a pharmaceutical executive and he was George W. Bush’s budget director. I don't have a joke here. I just want to point it out. (Laughter and applause.)

To all the journalists in case you didn’t know. (Laughter.) Haley Barbour is here. And I want to thank him for working with Michelle on the “Let’s Move” campaign. I do have one thing to clear up, though, Haley. You know, when Michelle said, you need to run, she didn’t mean for President. (Laughter and applause.) I wanted to be clear about that.

Tim Pawlenty is not here. But he’s hard on the campaign trail. To be honest, I think the American people are going to have some tough questions for Tim -- specifically, who are you? (Laughter.) And where did you come from? (Laughter.) Which is okay -- two years into my presidency and I'm still getting those questions. (Laughter.) But I have to say, as much as I admire Haley, Mitch, Tim, all the others, I'm a little biased towards my dear, dear friend, Jon Huntsman. (Laughter.)

In fact, I was just telling the Des Moines Register, nobody has done more for my administration than Jon Huntsman. (Laughter.) As his good friends in China might say, he is truly the yin to my yang. (Laughter.) And I'm going to make sure that every primary voter knows it. (Laughter.) If there’s a fish fry for Jon Huntsman in Cedar Rapids, guess who’s going to be at the grill. (Laughter.)

Barack Obama. (Laughter and applause.) If you see me on the streets of Nashua, wearing my parka and waving a sign, give me a honk for Huntsman. (Laughter.) The next GOP nominee for President. Love that guy. (Laughter.) All these jokes are in good fun. (Laughter.) They’re all in the spirit of bipartisanship, a spirit that's sweeping the nation. (Laughter.)

We're seeing people with strong disagreements get along as never before. You have the former Massachusetts governor Mitt Romney, current Republican presidential candidate Mitt Romney -- working together every day, sharing a host body. (Laughter.) It’s inspiring. (Laughter.) Or creepy. (Laughter.) Depending on how you look at it. (Laughter.)

Allow me to close on a serious note.

As has already been mentioned, we meet tonight in celebration, but also great sorrow over the loss of one of the Gridiron’s most beloved members and one of America’s most respected journalists. For nearly half a century, David Broder set the standard for political coverage. He was fair. He was honest. He was insightful. Nobody worked harder than David or with greater dignity -- even as he covered a process that's sometimes lacking in those qualities. He appreciated the great pageant of democracy like nobody else. But he also understood its deeper meaning. And his passing only reminds us of the importance of the work that all of you do. These are momentous times. We face extraordinary economic challenges here at home.

We have young men and women who are making extraordinary sacrifices, sometimes the ultimate sacrifice, for us overseas. We're seeing transformative change all around the world. And yesterday we were reminded how tragedy can strike at any moment. Tonight, of course, our thoughts and prayers are with the people of Japan. And I want to reiterate that the American people will stand with Japan as they recover and they rebuild.

But whatever challenges we face and however history unfolds, we rely on all of you -- the press -- to tell the story. Those of us who are fortunate enough to be in positions of power may have our gripes about how the media covers us, but that's only because your job is to hold us accountable. And none of us would want to live in a country without that failsafe -- without a free press and freedom of expression. That's what people all around the world are fighting for as we speak. In some cases, they’re dying for those rights. And that's what many reporters risk their lives to uphold -- from Kandahar to Tripoli.

So let us protect and cherish those freedoms here at home, and never take them for granted. And enjoy yourselves for the rest of the evening. My understanding is -- although, Susan, you did an outstanding job keeping things on time, that the bar is still open and will be open until midnight. Last I checked, so is the government. (Laughter.) Thank you very much, everybody. Thank you. (Applause.)