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Value & Reimbursement Workgroup

This workgroup looks at value-based care through the lens of accelerators and barriers. It identifies slowdowns in the clinical workflow and the technologies that can reduce the burden on the clinical workflow; ways to improve the relationship between payers and providers and patients; and the systems that can be put in place to enhance communication between physicians and patients.

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LEADERSHIP:

  • Lammot du Pont, Senior Advisor, Manatt Law
  • J. Leonard Lichtenfeld, MD, MACP | Deputy Chief Medical Officer, American Cancer Society, Inc.

GOAL:

Using the framework of fictional patient ‘Oscar’, who lives with multiple chronic conditions, the workgroup analyzes the impact of value-based payments on technology decisions, examines changing relationships that shape technology needs, and identifies technologies that reduce clinical, administrative, and financial workflow burdens (e.g., automation of pre-authorizations).

PRIORITIES:

  • Identify Gaps in Care: Two options are possible:
    • (1) payer transmits gaps in care reports to the ACO based on Oscar’s adjudicated (or unadjudicated) claims
    • (2) ACO transmits gaps in care to providers/care managers based on Oscar’s expected tests/procedures and clinical information provided through an HIE
  • Prior Authorization: Trace the prior authorization path for the specialists
  • Quality Reporting: Define how reporting is done for Oscar’s conditions (ideally directly from EHR) and the provision of feedback to the providers including data elements, format, and frequency
  • Referral Management: Close-loop referrals between providers
  • Financial Management: Discuss how the ACO tracks the costs for its attributed population and uses the data to inform its care processes

 

MEETING HIGHLIGHTS:

February 2018 Highlights from eHI's Executive Summit, the Value & Reimbursement Roundtable
April 2018 Begin to develop the 'Oscar' persona, the patient with a chronic condition on which to model best practices and address priorities
May 2018 Harmonize workgroup measures
June 2018 Discuss medical cost trends impacting health IT purchasing in 2019 with Ingrid Stiver, Senior Manager, Health Research Institute, PwC and Dee Dee Xia, Manager, Health Industries Advisory, PwC
July 2018 Discuss pre-authorization challenges and solutions with Delaware Health Information Network
August 2018 United Healthcare Presentation: Use of Quality Measurements in Chronic Care Management
September 2018 United Healthcare Presentation: Social Determinants of Health; Validic presentation: Remote Monitoring Integration with Clinical Workflows + Advancements in Supporting Payment Models 
October 2018 Coordinated Behavioral Care presentation: Behavioral Health Support and Reimbursement of Care