More from WHIT:
Availity (who recently purchased RealMed) talking about connectivity between HealthPlan, Provider and Patient.
|4:45 pm –
Catherine Peper taling about next generation of HIT systems
– Industry Standards codes and formats
– PCMH and other emerging models
Competitors have to cooperate
Multi-Payer solutions are essential.
“Payers spend a lot to look different. Providers and integrators spend a lot to make payers look the same.”
Availity & Humana drive market leading adoption:
90% Claims Submissions
72% claims status
70% E remittance Advice (big focus area)
Driving to 95% of all transactions being Electronic.
New in 2011:
– Enhanced Clinical Reviews
– Coordination of Benefits (e-COB)
– Care Opportunities / gaps in real time
– e-Campaign/contact management
ANSI 5010 – 1/1/2012
ICD-10 – 10/1/2013
Extreme Standardization coming immediately afterwards.
AHIP: ICD-10 will cost average Health Plan $12/Member
Alternative Care Delivery, Financing and Funding:
– Patient centered Medical Home
– e-visits / online care / telemedicine
– Accountable Care Organizations
– Gain Sharing
– Bundled Payments
– Collaborative Care
We need to address standardization of clinical quality measures otherwise we will drown clinicians.
Joe Taylor: VP and Enterprise Process Leader – CEBS
In clinical – If you build it they don’t come. You have to integrate and meet the clinician where they want to be.
We need a coordinated Partnership, Technology and Reimbursement Strategy
Practice Criteria and capabilities:
How ready is the practice? Access, EMR, NCQA criteria etc.
Shared Data on Gaps in Care via Clinical Connectivity – can you leverage MedDecision, Availity etc.
Use of High Value Efficient services – Specialist, Hospitalists, Ancillaries
Joe Taylor: Not sure how HIEs will work in practice.