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.
LEADERSHIP:
- Lammot du Pont, Senior Advisor, Manatt Law
- J. Leonard Lichtenfeld, MD, MACP | Deputy Chief Medical Officer, American Cancer Society, Inc.
- Morgan Honea, CEO, CORHIO
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 |
November 2018 | Interoperability Standards Advisory (ISA) Overview by Brett Andriesen, ONC; Maintaining a Value-Based Care Model with Innovative IT Infrastructure by Dr. Raul Vasquez and Dr. Chet Fox of Greater Buffalo United ACO. |