|Innovation Messaging Group|
|6.5.2017||12:30pm – 2:30pm||Navarro Room, Hyatt Regency/GTM|
|Meeting called by||Dan Kazzaz|
|Type of meeting||Taskforce Meeting|
|Attendees||Dan Kazzaz||Dave Chelli|
|Isabella Beaton||Sherry Wilson|
|Troy Aswege||Mary Kay McDaniel|
|Ellen Sluder||Durwin Day|
|Kim Peters||Daniel Wei|
|Rachel Forrester||Tony Benson|
|Tammy Banks||Elizabeth Templeton|
|Betty Lengvel-Gomez||Deborah Strickland|
|Phone Attendees||Abbey Fetzer||Dave Kraft|
|Leslie Elsarboukh||Jim Seidler|
|Pallavi Talekar||Murali Athuluri|
|Nathan Apter||Darlene Sutara|
|Overview||The Innovation Messaging Group mission is to drive down healthcare costs by reducing
the effort needed to implement complex message flows not yet addressed by any
standards organization (for example, complex prior authorizations, claim attachments,
DME orders, etc.) This group will oversee the development and adaptation of
standardized, structured formats, data transport, and digital signature that support high
value health care, improved quality, and enhanced efficiency.
|End Goal of Taskforce Mission||· Interoperable and non-proprietary
· Embedded in end-user workflows (provider, payer, supplier)
· Capable of real time, bi-directional exchange
· Include standardized federally acceptable digital signatures
|Ellen Suder, Medforce||Ellen discussed DME and DMEPOS Incentives. Overall, DME providers want to be paid
faster and have fewer denials. Slides provided show DME has the highest percentage of
improper payments due to insufficient documentation but the lowest improper payment
amount compared to other service types. This indicates that these are a lot of smaller
transactions, leading to “death by papercuts.”
|Discussion||What are the incentives for the referral partners?
· This is a “fight against habit” as everyone already knows how to use their fax machine.
Submission of pre-claim approvals, claims, clinical documents, and signed orders all
have similar information (essentially asking “give me information on this patient.”)
· How can we leverage this similar information into a straightforward workflow?
· Orders are similar to prior authorizations
o Headers (ICD codes)
· Taskforce to come up with universally supported schema based on common denominators
Right now, it is a relatively heavy lift for the EMRs.
· Troy Aswege of Noridian Health Services brings up the importance of automation. Automating this process as much as possible is important for provider satisfaction.
· The providers must be able to control what should be released
o When messages are sent
o Tracking of what is sent and the status of the information
Validation and tracking are big concerns for everyone
· There is a need to properly capture and convey when a prior auth. is needed, as expressed by Tammy Banks (Optum), Mary Kay McDaniel, and Sherry Wilson.
What about government mandate?
· A development plan and pilot will be needed to prove this will work without government mandate
· CMS will want a proof of concept through pilot
o If successful and the industry is on board, there may not be a need for regulations or regulatory process involvement
|Conclusions and Going Forward||How do we codify the information so that it gets to everyone, is easily known, and can be digested if they need to get a prior authorization?
The “What” of the Taskforce:
· Develop message structure
· Define eSignature needs (message level, documentation level, sub-documentation level)
· Communication infrastructure (SMTP, FTP)
· Create, modify, and document the message schema
· Pilot participants
· Meeting coordination
· How do we leverage those existing resources and collective groups?
o HIMSS and WEDI are collaborating to define and discuss prior authorizations
· Business Requirements
· Business Case
To Be Determined:
· What are the drivers for…
o Providers – ROI
· Where does the workflow start?
o Patient to provider
o Provider to someone else
· What is the minimal set of information needed to track to get started?
Things to Keep in Mind:
· No one provider wants to sign off on the whole CCDA (only the part he/she is responsible for.)
· Validation and tracking are big concerns for everyone
· Payers’ requirements need to be kept in mind