Bölümler
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WEDI Chair Elect Merri-Lee Stine of Aetna CVS Health speaks with Jonathan Blum, Principal Deputy Administrator and Chief Operating Officer with CMS. The two discuss CMS' plans for the rest of the year, success stories during this administration and success stories surrounding the No Surprises Act and the Interoperability and Prior Authorization Rule.
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Michael welcomes Michelle Barry (Availity) and Martin Cody (Madaket Health), WEDI's Provider Information Subworkgorup Co-Chairs. The three discuss the mission of the subworkgroup, which includes identifying business issues impacting the transmission and receipt of provider directory data. An extensive and complicated issue, Martin and Michelle reflect on an outstanding provider directory data panel at last week's WEDI national conference and offer a preview of the topics that will addressed at their special virtual spotlight on November 7 as they and WEDI's No Surprises Act Taskgroup discuss the critical issues with provider directory data and the impact of the act on healthcare stakeholders including patients.
The November 7 event is free and open to all healthcare professionals. Register at wedi.org and select Events.
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Michael discusses the Sequoia Project's Payer to Payer FHIR API Implementation Workgroup with its co-chairs, Nancy Beavin from Medica, Bob Oakley from Evernorth and the Project Lead, David Pyke with Sequoia.
The workgroup was created to identify practical, implementation-level implications from a business and governance perspective. The guests discussed the workgroup makeup, their mission, what they've heard so far and why a payer, small, medium or large, should join their community of practice.
To learn more about the workgroup, visit https://sequoiaproject.org/interoperability-matters/payer-to-payer-api-workgroup/
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Michael welcomes Huthaifa Khan, Director, Solutions Architecture with Virtual Health. Huthaifa, a veteran health care professional, discusses the emergence and rapid adoption of the FHIR standard in healthcare data exchange, along with implementation stories, and its potential future in the industry.
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Join Dr. John Harris as he takes you on a deeply personal journey through the highs and lows of transitioning from traditional paper billing to modern electronic systems. With several decades of experience in healthcare, Dr. Harris shares invaluable insights into the benefits of digital billing—streamlined processes, faster payments, and improved patient care. But this story isn't just about the smooth road; it's also about the bumps along the way and an ending you might not have seen coming.
In this episode, Dr. Harris delves into the challenges faced during the transition, culminating in the unfortunate and harrowing experience of being part of the Change Healthcare ransomware attack, revealing the toll it has taken on his practice, and the lessons learned in cybersecurity and data protection.
Hosted by WEDI Privacy and Security Co-Chair Lesley Berkeyheiser, this episode offers a compelling look at the intersection of medicine, evolution, technology, and resilience.
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Michael welcomes Teri Thomas, CEO of Volpara and CBO of Lunit to discuss the evolution of AI in healthcare. Teri explains how Volpara and Lunit are using AI to help better understand cancer risk, empower patients in personal care decisions, and guide recommendations about additional imaging, genetic testing, and other interventions. Teri offers her thoughts on the current AI landscape, benefits and challenges in implementation, the federal government's role and any privacy & security considerations.
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Michael chats with Outcomes Rocket CEO Saul Marquez on the proper steps healthcare solutions companies should take to properly market their services to an industry eager to drive change. What are Saul's 3 pillars of marketing, what strategies provide the highest ROI and what should companies avoid in order to create significant connections with their potential clients?
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This is a companion episode to Episode 156, a conversation with CMS' National Standards Group Director Michael Cimmino on Administrative Simplification.
Michael welcomes Paul Anderson (Health Insurance Specialist) and Jamie Lookabill (Technical Advisor, Enforcement Division) with the Centers for Medicare & Medicaid Services to offer an introductory look at the administrative simplification enforcement process. Paul and Jamie offer information on the different types of HIPAA enforcement, how CMS communicates with the industry about enforcement, and the overall enforcement process, from filing a complaint, the use of ASETT (Administrative Simplification Enforcement and Testing Tool), corrective action plans and civil monetary penalties.
To learn more about administrative simplification, please visit go.cms.gov/adminsimp
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This episode is sponsored by InterSystems, the leading provider of AI-enabled data management solutions for industries with complex challenges, including healthcare, financial services, and supply chain and logistics.
Michael welcomes Steven Berkow, Senior Advisor, Value-Based Care with InterSystems. The two discuss Steve's involvement at WEDI's Summer Forum in Chicago, where he served as a moderator for the payer panel on the CMS Interoperability and Prior Authorization Rule. The two discussed the challenges and potential solutions for improving interoperability within healthcare data, and the importance of standardizing APIs for healthcare providers.
Be sure to read InterSystems' latest white paper The APIs Are the Easy Part: Maximizing Your ROI While Meeting CMS Interoperability and Prior Authorization Requirements
Health plans should be able to harness the investment in IT infrastructure mandated by the latest CMS rule on interoperability and prior authorization to create the data liquidity needed drive top strategic goals, such as reducing provider abrasion, improving member experience, increasing productivity, and supporting value-based care. The scope of CMS-0057-F, however, is wide ranging. This white paper:
Summarizes new requirements for the four types of information sharing addressed, namely payer-to-payer, payer-to-provider, payer-to-member, and prior authorization submission and determination.Analyzes processes and workflows impacted by the regulation and resulting opportunities for performance improvement.Provides key “Questions to Consider” that should inform plan investment decisions.Designed to be shared with IT, clinical, and operational leaders, the paper will help your leadership team achieve larger strategic returns on mandated plan investment while meeting regulatory requirements.
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Michael chats with Nametag CEO Aaron Painter on how emerging technology, patient-centric data policies and even remote working is affecting the cybersecurity infrastructure in healthcare. The two discuss the "old school" nature of social engineering attacks and steps that the industry can take to combat threat actors.
Aaron's article in Forbes magazine can be found here- https://www.forbes.com/councils/forbesbusinesscouncil/2024/05/17/combating-threat-actors-in-the-us-healthcare-sector/
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From our recently concluded Summer Forum, Part 2 of a discussion with 2 providers working on implementing the CMS Interoperability and PA Rule.
Semira Singh, Director Population Health Informatics, ProvidenceAnna Taylor, AVP, Population Health & Value Based Care, MultiCare Connected CareThe moderator, from the AMA, former WEDI Board Chair Nancy Spector
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From our recently concluded Summer Forum, Part 1 of a discussion with 2 providers working on implementing the CMS Interoperability and PA Rule.
Semira Singh, Director Population Health Informatics, ProvidenceAnna Taylor, AVP, Population Health & Value Based Care, MultiCare Connected CareThe moderator, from the AMA, former WEDI Board Chair Nancy Spector
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Michael welcomes back Shweta Maniar, Global Director, Life Sciences Solutions and Strategy for Google Cloud. The two discuss the continued emergence of artificial intelligence in health care, the need for standards or a framework in health care regarding AI, and how people new to AI can brush off misconceptions and dive in feet first and learn how they can access and leverage this growing technology.
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Michael welcomes 3 of the 4 co-chairs of WEDI's Prior Authorization Subworkgroup:
Heather McComas, Director, Administrative Simplification Initiatives, American Medical AssociationDavid Delano, Senior Director of Services, Massachusetts Health Data ConsortiumRaj Godavarthi, Associate VP of Technology and Interoperability, MCG HealthThe 3 discuss the changes in the workgroup and the industry since the January 2024 release of the CMS Interoperability and Prior Authorization rule, the exciting role of artificial intelligence in PA, and how their unique stakeholder roles offer a full, detailed dialogue during their monthly meetings.
Tons of Prior Authorization-related education coming to you courtesy of WEDI. Visit wedi.org and click CALENDAR for more information
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Michael welcomes Donna Campbell (HCSC) and Amanda Abbott (BCBS of Kansas), WEDI's Eligibility and Benefits Workgroup Co-Chairs. The co-chairs discuss the workgroup's missions and the latest discussion topics that workgroup is undertaking, including improving efficiencies in the E&B process through standards and emerging technology.
If you are interested in joining the workgroup, contact Ariana Poole at [email protected].
You must be a WEDI member to join. To become a WEDI member, contact Bill Allder at [email protected]
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The threat from cyberattacks is growing exponentially and health care organizations are particularly vulnerable. Michael chats with WEDI's Privacy and Security Workgroup Co-Chairs, Lesley Berkeyheiser of DirectTrust and Thanh-Thien Nguyen of Kaiser Permanente on suggested actions that health care organizations big and small can adopt, customize, and implement as they seek to establish good cyber hygiene.
The top 10 list will be available soon on wedi.org
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From WEDI's Spring 2024 conference, Sequoia's David Pyke moderates a conversation with its Payer to Payer FHIR API Implementation Workgroup Co-Chairs, Robert Oakley with Evernorth and Nancy Beavin with Medica. Learn more about the workgroup here- https://sequoiaproject.org/interoperability-matters/payer-to-payer-api-workgroup/
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Guest host Michael Pattwell, WEDI Board Members, Co-Chair of its Payment Models Workgroup, and Principal Business Advisor with Edifecs, chats all things value based care with Lynn Carroll, Chief Operating Officer of HSBlox.
The two offer a fascinating look at the progression from fee for service to value based care, recent models launched by CMS, and the importance of data interoperability and standards in improving value based care delivery and contract administration.
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