Innovation Messaging Group – June 5, 2017 Meeting Minutes

 

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
   
Taskforce
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)

o   PDFs

·      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)

 

The Needs:

·      Create, modify, and document the message schema

·      Pilot participants

·      Meeting coordination

·      VOLUNTEERS

·      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

o   DME

·      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

 

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