More from WHIT:
Availity (who recently purchased RealMed) talking about connectivity between HealthPlan, Provider and Patient.
| 4:45 pm - 5:30 pm |
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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.
