Payers on FHIR
Lenel James, Business Lead – Health Information Exchange & Innovation, Blue Cross Blue Shield Association
A value-based care perspective
Why is FHIR different
Document-based exchange doesn’t let you delve into the context of the data received.
FHIR fits in to real-time operations
FHIR fits Payer workflows.
Value-based care
Local patient-center programs that meet national quality and affordability criteria to drive unparalleled value
– Measured Value
– Integrated Care
– Customer Flexibility
Provider Empowerment
eg. ACTIONABLE Analytics
Industry Vantage Point
Use technology to improve collaboration. Death to the Fax!
FHIR Use cases
FHIR for information Exchange
– Basic Patient management
– Structured Data Capture
– Patient Scheduling
– Financial Resources
Mapping Claim 837 to FHIR is underway.
FHIR Use Cases – Patient:
– Care Gaps
– Risk Adjustment
– EOB delivery
– Patient Demograph
Lenel Makes a shout-out to #BlueButton on #FHIR work at CMS
FHIR Uses Cases: Practice:
- Value-based contract performance
- HEDIS/ Care gap measures
- Provider Attestations.
Looking at HEDIS on FHIR
– Matching with FHIR DAF profiles.
Value-based Care Use Case:
- Colorectal Cancer Screening Member Requests.
NantHealth built demo in 4 weeks using FHIR.
IBX saved $0.5M by shifting their New Health Portal to use FHIR.
The Big Picture
FHIR coexists.
Trust: Must be a collaborative process.
Patient interaction supports better care.
What you can do
Learn FHIR now so you can support Pilots.
- Look at where you do Clinical Data Exchange
- Look at FHIR use cases
- Review FhIR Education and Background links
- Plan to attend the September Connectathon
- Get on the list of news from ONC.
-Check out ONC Proving Ground
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