|Innovation Messaging Group|
|7.10.2017||2:00pm – 3:00pm||Go To Meeting|
|Meeting called by||Dan Kazzaz|
|Type of meeting||Taskforce Meeting|
|Dan Kazzaz (SES)||Mary Kay McDaniel (Cognosante)|
|Nikhil Shrirao (Informatics in Context)||Robert Dieterle (Enable Care)|
|Tori Buck (Summit Healthcare)||Jeff Salmon (SES)|
|Elizabeth Templeton (Florida Blue)||Vikram Simha (Informatics in Context)|
|Nathan Apter (Medforce)||Michelle Barry (Availity)|
|Murali Athurluri (MAeHC)||Dan McDonald (Optimity)|
|Pallavi Talekar (Scope Infotech)||Dave Kraft (Country Meadows)|
|Isabella Beaton (SES)||Catherine Graeff (Sonora)|
|Abbey Fetzer (SimplyHIE)||Therasa Bell (Kno2)|
|Leslie Elsarboukh (Surescripts)||Rebecca Elhassid (SES)|
|Tony Laurie (Noridian)||Mehul Shah (Scope Infotech)|
|Taskforce Mission||The Innovation Message 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.|
|Current Events||· Optimity has stepped up to the plate to put together white paper once requirements have been put together.
· Tammy Banks (Optum) will be leading the focus group initiative, with Ellen Sluder (Medforce) and Rachel Forrester assisting.
· Technical groups have already started forming.
· MAeHC has been working with Harvard Pilgrim to look at some of the current rules.
· There is an interest in the initial pilots for the initiative, focusing on what would happen if all information needed for a prior auth is submitted with the request using a CCDA.
o Most EMRs send CCDAs over Direct so Direct could be used to send a prior auth as well as the additional information.
o This is not limited to prior auths.
|EDMI Program Presentation (Pallavi Talekar)||· EDMI Program focuses on provider to provider communication.
· The presentation given by Pallavi Talekar follows a patient who requires Home Health Agency services (HHA).
· EDMI has the following:
o 12 Active Pilots (50% HHA pilots, 42% DMEPOS Pilots, 8% Lab Pilots)
o 6 pilots are trending
o 53+ Pilot Participants
o 3 Workgroups
· There are 3 Use Cases:
o 1st Use Case – Order
– Hospital sends referral with order and other medical documents to HHA
– HHA decides to accept or reject
o 2nd Use Case – Request for Medical Documentation
– HHA requests additional medical documentation from hospital
– Hospital sends documentation to HHA
o 3rd Use Case – Request Signature
– HHA sends document
· These use cases assume:
1) Physician/practitioner at hospital has already written order for HHA services in EHR
2) Discharge planner at hospital has spoken with patient/family and chosen to use HHA
3) Certain business rules and validation steps may be pertinent to organization’s policies.
· Because all communication currently happens by mail/fax, this means slower processing rates, higher costs, higher admin burden, and delayed services and audit processes.
· EDMI is suggesting an agnostic standardized approach by creating an EMDI Implementation Guide with the goal of improving data quality.
· EMDI Transport Protocols to be used could be Direct, restful API, or Connect with a transport gateway enterprise service platform.
· EMDI supports Message Data Standards such as x12, HL7, FHIR.
· With this new workflow, the use cases remain the same but all communication happens electronically and the information can now be ingested directly into the EHR system, allowing the EHR system to send an order acceptance notification to the hospital.
· Those that are successfully working with the EDMI program appear on the CMS Interop Proving Group (link provided in the slide deck)
|MAeHC – NEHEN Presentation and Demo (Murali Athurluri)
|· MAeHC is currently working with New England Healthcare Exchange Network (NEHEN) on a real-time prior authorization pilot program (partnering with Informatics in Context.)
· Surveys were sent out to 200+ organizations to gather information to address the challenges across prior authorizations.
· The process for prior auths is currently manual, costly, and inefficient for both providers and payers.
· Prior auths with attachments have shown a high savings opportunity per transaction, with estimates upward of $45 per transaction.
· Pilot Payer: Harvard Pilgrim Health Care
· Pilot Providers: Baystate Health System; VNA Care Network; BIDMC – ObGyn Service; Department of Surgery & Ambulatory Operations; Partners Healthcare; UMASS Health Alliance Referral Teams
o Medical policies selected for the pilot program:
o Home Health Care
· For the pilot, each provider was given access to a portal to submit the referral. The referral is run through the eligibility engine, and, based on the user input, clinical guidelines are provided.
· Validation Steps:
o Companion Guide
o Business Rules
o Clinical Logic
· Projected Savings:
o If NEHEN were to proves 10k of transactions with 80% touchless (all electronic and no additional phone calls or follow ups), it would yield a cost savings of $160k per month (annual savings of over $2M.)
· Benefits include:
o Easy to add new medical policies to the engine
o Automation of HIPAA standard transactions with business AND clinical rules
o User System Agnostic (open to all platforms/EHRs/clearinghouses)
· EDI 278-275 Standards-Based Solution
· Nikhil of Informatics in Context the presented a demo of how the system actually works, showing how rules change based on procedure code chosen by the user as well as the types of questions the system asks if additional information is needed. Once the user answers all given questions, the system checks and then certifies.
Conclusions and Going Forward
|· Enormous cost savings opportunities exist in merging and expanding projects like those discussed in the meeting.
· Subgroups will be meeting between now and the next Taskforce Meeting (September)
· Please let us know what subgroup you would like to be involved in.
· Slides for the presentations will be distributed to all attendees