This year’s Workgroup for Electronic Data Interchange (WEDI) National Conference kicked off day 2 with interactive sessions led by Keynote Speaker Seema Verma, Centers for Medicare and Medicaid Services‘ (CMS) Administrator, and Dr. Jack Lewin, National Coalition on Health Care‘s Chairman.
In Seema Verma’s keynote session, the focus was modernizing healthcare. She explained how we do not have a one stop shop for healthcare, “…data and digital health reform will drive change through interoperability.”
— Administrator Seema Verma (@SeemaCMS) October 17, 2018
Verma explained that 26% of the total national budget of $1 trillion is allotted to healthcare. She emphasized the need to drive a new era of digital health, citing “we are committed to removing technical and political barriers and challenges … to hold healthcare vendors accountable and center on open APIs for better data access and sharing … align the healthcare industry on a common path to interoperability, and are looking for innovators to solve our most complex challenges. Patient security often masquerades as patient profiteering.” She suggested that once information is freely flowing from patient to provider, and provider to patient, we will be able to improve drastically.
CMS will be releasing a data quake; a new wave of data available to the providers and issuers. She explained “We have the ability to take that data and unleash it. We’re unleashing the most powerful force in our economy: the consumer.” The innovations coming out of CMS are helping to set a standard in a new healthcare ecosystem. An app economy is where the industry is most likely headed. Verma speaks to unleashing the power of consumerism and embarking on a digital revolution with taking on the API-first open data strategy.
Another presentation worth noting was Dr. Jack Lewin’s ‘Turning the corner on value-based care’, with insight on value-based care and the reimbursement tied to payments for care delivery and the quality of care provided. According to Deloitte, this shift to value-based reimbursement models creates a new paradigm in which care is delivered by an entire coordinated care community sharing in the responsibility—and risk—of outcomes and costs, touching almost every part of the health care delivery operation.
In healthcare, interoperability focuses on the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. Opening with “issues on interoperability is a politics problem not an IT problem,” Lewin dove right into his views on interoperability creating value, suggesting that if CMS were to require this with payments, the transition would happen quite quickly.
In addition to this, Lewin shared how data exchange models that exist already range from ACO, Medicare Advantage, Managed Medicaid, Physicians Networks, and IPAs. Lewin highlights it’s all about the new payment models “If it takes having an Uber bring your patient or wearable biometrics to get a patient care, new payment models will take us there,” Lewin added.
Softheon also held a session, ‘834 Enrollment: Pit Falls, Enhancements, and Best Practices.’ Softheon EVP and GM Bill Gaynor opened with a discussion on 834 enrollment transactions, explaining how they are the lifeblood of on-exchange and off-exchange commercial benefit enrollment, finance, and customer services operations at health plans. Varying 834 file formats and evolving local requirements can have a negative impact on health plan operations, finance, and consumer experience. Softheon is able to configure 834s to be agile and easily imported into core systems and platforms. We feature standard EDI file (834, 820) validation. Upon import, files are parsed into line-level transactions and normalized. In addition to 834s, we can send and receive files in multiple industry-standard formats including: XML, X12, 820, TA1, 999, and more.
Thank you to all attendees that joined our session and visited our booth! To continue the conversation, contact Hamoon Hadavand, Senior Account Executive, here: firstname.lastname@example.org.
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