Tuesday, November 09, 2010

#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
Catherine Peper, CISSP, CISM
Vice President of Health Information Technology
Blue Cross Blue Shield of Florida 

 View Biography

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

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. 

Posted via email from More pre-blogspot than pre-posterous