#WHIT closing session from Day 2

More from WHIT:

Availity (who recently purchased RealMed) talking about connectivity between HealthPlan, Provider and Patient.

4:45 pm –
5:30 pm
CLOSING KEYNOTE PANEL DISCUSSION: Payer and Provider Collaboration ??? Pioneering Partnerships Advancing Cost Savings and Achieving Better Outcomes
  • Payment models to promote cost savings and better quality of care
  • Leveraging the power of providers and plans coming together to contain the rising cost of health care
  • Payer initiatives to incentivize improved quality and cost savings
  • Identifying and overcoming challenges
Peper_catherine2_60x70
Catherine Peper, CISSP, CISM
Vice President of Health Information Technology
Blue Cross Blue Shield of Florida 

 View Biography

Taylor_joseph
Joseph Taylor, CEBS, RHU, HIA
Vice President, Enterprise Business Process, Enterprise Health Care Management
Health Care Service Corporation 

 View Biography

Craig Schneider – Moderator

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:

Electronic Transactions:
97% E&B
90% Claims Submissions
72% claims status
70% E remittance Advice (big focus area)
36% EFT
25% Auth/Certs
26% e-RX
10% CareCalc
<1% ACP

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
– e-Appeals

Challenges:
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. 

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