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