Transcription
Connecting Dots:How Open Data, APIs and Payment Reform will FuelCare Delivery ReformAneesh Chopra@aneeshchopra
American Competitiveness @ Stake1 The Goal: Constraining HC inflation toGDP 0% unlocks 1T in value by2025, enabling investments tomaintain competitiveness2 The Context: A growing coalition ofpublic and private stakeholdersbelieve that better care will costless3 The Call to Action: By opening updata and adjusting paymentmodels, we can tap into theexpertise of the American people tosurface, then scale, what works
Open Government Data as InfrastructureSource: https://graphics.wsj.com/medicare-billing/; CareJourney
MyHealtheData Empowers Reformers
Interop via Consumer Directed ExchangeSource: https://support.apple.com/en-us/HT208647 ONC
CURES Act, CMS Closing API Gaps1. ADT for Patient and Physician Notification2. Claims Data from Payers– Payer to Provider Use Cases3. Real-time Benefit Check (RTBC)– Point of prescribing or enrollment– Prior Authorization using CDS Hooks4. Provider Directories5. Bulk Data Access6. Price Data from Payers and Providers7. Quality Data – FHIR-enabling eCQMs8. Access to Expanded Clinical DataSource: blog.hl7.org
Progress @ the Pace of StandardsPublished Implementation GuidesData Query Implementation GuideProvider Directory ImplementationGuideScheduling Implementation GuideCDS HooksClinical Notes Implementation GuideAfter dramatic reduction in aircraftmanufacturing following WWI, then-SecretaryHoover encourages industry collaboration onengine, wing standards, commercialized onpopular DC-3, Boeing 247Source: http://argonautwiki.hl7.org/index.php?title Main PageBulk Data Access ImplementationGuideQuestionnaire ImplementationGuideOnly “Data Query”implemented at scale(due to regulation)
The Era of “Substitutable” Apps“Bulk” FHIR StandardsHealth SystemsIntermountainHealthcareJefferson HealthMarshfield ClinicMUSCMount Sinai (NY)MultiCareOCHINOrthoVirginiaRush University MCTrinity HealthU.S. Department of VAPayer “Data @ Point of Care”SDOH Screening AssessmentHealth PlansAnthemBCBS of North CarolinaBCBS of South CarolinaBCBS of TennesseeCambiaFlorida BlueHumanaManifest MedExMedigoldOscar HealthSecurity Health PlanSource: logy/; https://dpc.cms.gov; ta-implementation-guide
CMS Adopts API-based Interop PortfolioSource: https://support.apple.com/en-us/HT208647 ONC
Health Org Conundrum: Data Control?Interop via FHIRApplicationsHealth System-Managed API Gateway (“BlueBar”)FHIRServerFHIRServerEMR 1EMR 2FHIRServer Claims Data XVA EHR Recommendations: “.support for VA-approved third-party apps including viathe Digital Veterans Platform Permit and approve connecting all VA approved secureapps without additional fees or licensing.” Agreed in final contract.Source: Department of Veterans Affairs Electronic Health Modernization, Request for Proposal Interoperability Review Report
A Fiduciary’s Toolkit: 5 Digital Enablers1Consumer Data Access viaTrusted Apps2Apps for Provider Directories(No ‘Surprise Billing’)3Open Standards for PhysicianScheduling4Open Standards for PatientAssessments5Open Data for PerformanceTransparency (TBD)“The old login system cost 250M tobuild 70M annually to stay online. Thenew system cost about 4M to build,and less than 1M to maintain.”Source: orst-website-in-america/397784/
Defining “Shoppable Services” in the OpenColumn AColectomy ServicesPreoperativePre-Surgical E/MPre-Surgical Imaging/LabPre-Surgical OtherSubtotalOperative StayFacilityOperating ClinicianAnesthesiaImaging/Lab Professional FeeOther SNF/IRF/LTACSequelaePAC OtherSubtotalTOTALCMS awarded Brandeis “EGM” 40M contract todevelop an open-source grouper; potentialfoundation for “shoppable” servicesColumn BColumn CMedicare PricesColumn DMedian Provider Prices25th percentile75th percentile 175218309702 316202209727 233201312746 3505437801,672 17,3841,9005491255820,016 22,8181,7253391395825,069 17,5161,8214781674520,027 40,2865,4631,9126687948,408 6495561,4022,3614,96825,686 8886691,5112,5785,64631,442 7156021,4542,4945,26526,038 1,5731,1443,4904,98811,19461,274Service ProfilesMedicareCommercialPrice Differentials
Putting it Altogether: Trusted NavigatorsCJ Index Provider ScorecardLink: ADT Feed SchedulingSource:eMedicare;CareJourney
Guardrails on the Health Data Economy“Beyond HIPAA:” Contractually bind third-party vendors and contractors to our privacy policiesand prohibit use or disclosure of user information (including de-identified, anonymized orpseudonymized data) for any undisclosed purposes without express consent from the user.Source: 019/05/2019 CARIN Code of Conduct 05082019.pdf; Sample list of CARIN members
Interop via Consumer Directed Exchange. Source: blog.hl7.org CURES Act, CMS Closing API Gaps 1. ADT for Patient and Physician Notification . MUSC Mount Sinai (NY) MultiCare OCHIN OrthoVirginia Rush University MC Trinity Health U.S. Department of VA H
