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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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Michael chats with RJ Kedziora, Co-Founder of software company Estenda about the evolution of digital health and digital therapeutics. The two discuss the advances in emerging tech, privacy and security challenges, the role of regulations and the hopes that digital health can break down those data silos that still plague us.
Estenda is holding a webinar; Driving Quality in Digital Health: The Role of Generative AI in Testing, on June 14th from 12pm- 1pm eastern. Find out more below.
https://www.eventbrite.com/e/driving-quality-in-digital-health-the-role-of-generative-ai-in-testing-tickets-902441475747
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The Centers for Medicare & Medicaid Services National Standards Group, within the Office of Burden Reduction and Health Informatics, focuses on reducing administrative burden and advancing interoperability and national standards. CMS engages beneficiaries and the health care community to understand their experiences, inform solutions, and infuse a customer-focused mindset throughout the agency.
Michael welcomes CMS NSG Director Michael Cimmino to the podcast to discuss the who, what, where, when and why of administrative simplification and burden and how a standard becomes a standard.
This is part 2 of a 2 part podcast conversation with CMS NSG on Administrative Simplification. Coming soon, an episode on enforcement. Learn more about CMS' work on admin simp at go.cms.gov/adminsimp
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In April 2024, WEDI held a member position advisory (MPA) event on the critical topic of maintaining business continuity within healthcare organizations in the wake of cyber-attacks. The event, entitled, From Crisis to Continuity: Maintaining Health Care Data Exchange Following a Cyber Attack, offered best practices, suggestions, and key steps that stakeholders from HHS and the private sector can consider when exchanging data, processing information, and maintaining lines of communication. From WEDI’s recently concluded Spring conference, a debrief of the MPA event presented by WEDI’s privacy & security workgroup co-chairs, Lesley Berkeyheiser with DirectTrust and Thanh Thien Nguyen from Kaiser Permanente.
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Michael chats with returning guest Denis O'Shea, Founder and Chairman of Mobile Mentor, about their 2024 Endpoint Ecosystem Study, which explored the intricate dynamics of hybrid work in high-risk and highly regulated industries. Conducted across the United States, Great Britain, and Australia, the study involved 2,400 knowledge workers in healthcare, finance, government, and education to understand employee attitudes and their actions related to company security and their experience, and their productivity as remote workers.
Review the study at https://endpointecosystem.com/
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A continuation from last week's episode on health equity data efforts from the federal perspective.
Our moderator is Nancy Spector, Coding and HIT Advocacy Director at the AMA and former WEDI Board Chair.
Our panel:
Kristie Clarke, CDR, US Public Health Service, Senior Advisor on Data for Health Equity, Office of Public Health Data, Surveillance, and Technology, US Center for Disease Control and PreventionKelly Cronin, Director, Center for Innovation & Partnership, Deputy Administrator, Administration for Community Living, HHSJawanna Henry, Interoperability Systems Branch Chief, Office of Policy, Office of the National Coordinator for Health ITMeagan Khau, Director of Data Analytics& Research Group, CMS Office of Minority Health -
From WEDI's February 2024 Health Equity Forum, we welcome federal representatives to discuss how they are using data, tech and standards to address health disparities and the importance of community relationships.
Our moderator is Nancy Spector, Coding and HIT Advocacy Director at the AMA and former WEDI Board Chair.
Our panel:
Kristie Clarke, CDR, US Public Health Service, Senior Advisor on Data for Health Equity, Office of Public Health Data, Surveillance, and Technology, US Center for Disease Control and PreventionKelly Cronin, Director, Center for Innovation & Partnership, Deputy Administrator, Administration for Community Living, HHSJawanna Henry, Interoperability Systems Branch Chief, Office of Policy, Office of the National Coordinator for Health ITMeagan Khau, Director of Data Analytics& Research Group, CMS Office of Minority Health - Daha fazla göster