"Welcome to our company blog. Within these blog posts, we hope to share our insights on clinical quality management, the patient-centered medical home, chronic disease management in primary care, evidence-based medicine, and the use of technology in ambulatory care settings."

- David Morin, CEO and Donald Nease Jr., MD, Chief Medical Officer

We've now talked to many of the providers for whom, on their behalf, we submitted quality data to PQRI (via Cielo Clinic). All of the providers we have spoken with have received their reimbursement! Reimbursements have ranged from hundreds of dollars to thousands of dollars, but since it is a formula on allowed charges, of course the amounts will vary. We've also received comments from people that have previously done the very-manual claims submission process for PQRI that registry submission is the "only way to go". Remember, just by using our product in the normal course of care delivery, we are taking care of capturing the data needed for reporting and, at the appropriate time, doing the data uploads. That's pretty simple and that's how it should be. Dave Morin CEO and Co-Founder Cielo MedSolutions

I'm going to go out on a limb here and comment on a request we hear often: "can we just use your registry to upload to CMS to get our PQRI money?" Answer: yes, you can. But, think about this. If you do the minimum 30 chart pulls, abstract the data, key it in and upload it, you're probably looking at about a $1,000 expense. And, I haven't budgeted for the software yet. The average reimbursement from PQRI is $600. Your and your staff's time is VERY expensive, and valuable. Is this really the way you want to invest your time and money? Now, if you use a clinical quality management system to manage all your patients for all their needs, you not only get PQRI $$s, you get the value of any other pay-for-performance program, you build the base for your patient-centered medical home, and you prepare yourself for any other quality program that comes in the future. Your patients are better cared for, your practice is operating more efficiently and you may just be generating more revenue in your practice as you keep your patients up to date on their screening, prevention and chronic disease management needs. Shortcuts sound great, but they unfortunately don't work. And, in this case, I think they actually cost you more than doing things the right way. Dave Morin CEO and Co-Founder Cielo MedSolutions LLC

In case you missed it, please take a look at our letter to our colleagues: Dear Colleagues, The last few months have been quite busy here at Cielo MedSolutions. We continue to build a dynamic company that provides the very best technology solutions that are cost-effective, easy to implement, drive improvement and fit the needs of ambulatory care providers nationwide. In parallel with growing our customer base by 450 percent this year, we've also achieved the following notable milestones: Cielo Clinic Endorsed by TransforMED - Cielo MedSolutions and TransforMED are now Preferred Business Affiliates. TransforMED -a subsidiary of the American Academy of Family Physicians (AAFP)- provides support to primary care physicians and health systems that want to transform their practices into Patient-Centered Medical Homes. Cielo MedSolutions' customers will have access to TransforMED's practice transformation services, and TransforMED will encourage the use of Cielo Clinic's integrated patient registry, clinical decision support and population management tools by practices implementing a Patient-Centered Medical Home. Cielo Selected for PQRI Reporting to CMS - Cielo Clinic has been designated by the Centers for Medicare and Medicaid Services (CMS) as qualified to submit quality data on behalf of eligible professionals for 2008 PQRI reporting. Providers can now directly upload their quality data to CMS for PQRI reporting using Cielo Clinic. Cielo Awarded a National Cancer Institute Grant - We have been awarded a grant by the National Cancer Institute to study and design a next-generation chronic disease management system. This solidifies our research and development into the future needs of ambulatory care providers. Cielo Studying LEAN Principles - Through our partner, Altarum Institute, we are studying and documenting the benefits of LEAN principles in relation to the use of Cielo Clinic. This work is being done at a customer site and the knowledge gleaned from it will translate into additional benefits for all Cielo Clinic users. Cielo Participating in Innovation Study with Community Health Centers - Our hosting partner, the Michigan Primary Care Association, has been awarded a grant by HRSA to study innovation in the Community Health Center market. Four CHCs will be provided Cielo Clinic with tablet PCs and wireless networks to study disease management through the use of technology. Cielo Success Story Published Online - One of the latest success stories on Cielo Clinic is featured in the Agency for Healthcare Research and Quality's Health Care Innovations Exchange (see http://cts.vresp.com/c/?CieloMedSolutions/6d4251a388/deec28db9b/0e2d81dc0c, keyword "cielo"), an online database of innovations that improve the delivery of care to patients. In this story, you will see how the University of Michigan Health System, Department of Family Medicine, managed thirteen quality measures to high levels of compliance using the product. Cielo Drives Dramatically Higher Disease Screening Rates - The September 2008 issue of Medical Care, the journal of the American Public Health Association, includes a paper detailing a grant-funded study of using Cielo Clinic to improve colorectal cancer screening rates in twelve practices throughout the state of Michigan. Average screening rates at the beginning of the study were at 41.7 percent. By the end of the study, that rate had jumped to 66.5 percent. Cielo Supporting Free Clinics - In support of our community, we are engaging with free clinics in the metro-Detroit area to improve care delivery to disparate populations and build a registry of clinical information on the uninsured. In addition to the above achievements, we've also added a host of new functionality and a wealth of additional third-party interfaces to our software-as-a-service product offering. Much of this new functionality is a direct result of our customers' requests. And, we have an aggressive product roadmap and a new group pricing model, both of which we'd be happy to share with you. Organizations work with us at Cielo MedSolutions not only for of our great technology, but also because of our dedication and our support for the overall success of their quality improvement initiatives. We continue to enhance our solutions by bringing together other technology partners, consultants and best practices to create turnkey solutions for successful pay-for-performance programs, patient-centered medical homes, quality improvement initiatives and clinical integration efforts. Thank you for being a colleague of Cielo MedSolutions. Please stay tuned as we continue to build a dynamic company focused on the needs of ambulatory care providers. If you haven't had a chance to see Cielo Clinic in the last few months, I urge you to take a fresh look. Simply contact Mike Kleczka at 734-827-1000 x1 or mkleczka@cielomedsolutions.com. Sincerely, David J. Morin CEO Cielo MedSolutions LLC

I'm asked quite a lot about uploading clinical data directly to CMS to support the PQRI program. Along with the questions we often hear conjecture about the status of the project and what a provider can do. Today I will outline Cielo’s involvement in the programs. CMS has put forward two programs related to Registries submitting data on behalf of practices for PQRI measurement. 1) 2008 PQRI Registry Test & 2) 2008 Registry-Based Data Submission. Cielo is involved in both the Test program as well as the Data Submission program. Goals of the Registry Test program are to validate a registries' ability to gather, calculate and report on PQRI quality measures. Goals for the Registry-Based Data Submission program are to enable physicians to participate in the 1.5% incentive payment portion of PQRI through an alternative reporting system (their Registry). Cielo’s involvement in the two PQRI related projects: PQRI Registry Test Program The 2008 PQRI Registry Test program was initiated by CMS in early 2008. This program was a “test submission only” program in which no incentive payments were available. Cielo has been involved from the inception of this program including a meeting at CMS offices in Baltimore. As part of our test submission we captured, calculated and reported PQRI measure #1 (Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus). We were notified earlier this week that our first submission was validated without error and that we have met the requirements of the program. Registry-Based Data Submission In May of this year Cielo self-nominated to be accepted into the Registry-Based Data Submission program. There are NO approved vendors yet. Registries had until May 31 to submit their self-nomination and must go through an interview, documentation and testing process prior to the end of August. Around August 31, 2008 there will be an announcement from CMS listing the registries that qualify. Once selected a registry will be allowed to submit PQRI data to CMS in January and February 2009. Cielo has met all steps involved with this process and awaits an announcement of the selected vendors. I think it should be noted, though, that there is quite a bit of "devil in the details" and would highly recommend reading about the projects at the CMS website. As usual, it’s never as easy as “just dropping in a registry”. Chris King Senior Vice President Cielo MedSolutions