Friday, June 10, 2016

#CM4H16 Lenel James – BCBSA – Payers on #FHIR

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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