Redesigning Systems to Support Payment Transactions
transcription of a video recorded January 19th, 2012
Catherine Pepper begins her talk by pointing to her 25 years of experience with Blue Cross Blue Shield in Florida, working in Provider Connectivity. Pepper shares that “the Blues” (Blue Cross Blue Shield) serve 100 million members. Strict state regulations in places like Florida present a situation in which 3% is a good annual profit margin, as current profits impact next year’s coverage rates.
Pepper reports on the efforts of rapid adoption of HIT in Florida and how companies are working together. In her experience, Pepper reports that “Collaboration ain’t for sissies,” and that BC/BS coordinated 140 million transactions last year.
A chart is presented showing that for BC/BS 97% of benefit status is now electronic, 90% of claims are electronic and 78% of payment is electronic.
Pepper emphasizes the need to design ACOs paper-free, handling both administrative transaction and clinical capabilities.. She refers to the current moment of institutional changes as a “period of extreme standardization.”
The frustration of continual compliance and the need for stability to innovate IT systems, is next up on Pepper’s talk. She makes the points that capturing data electronically to facilitate exchange and analytics of data remains a priority.
The use of single purpose networks are lightly criticized by Pepper and share stresses the need to connect all networks to coordinate patient care. Also highlighted is the need for data driven insights at the point of care, rather than many days later.
Pepper continues by stressing the fundamental differences of Patient Centered Medical Home and that providers are contributing new services (i.e. more holistic approaches). She draws attention to the importance of population management in all care providers.
Pepper then details the way information will be shared in the future, including remote monitoring, EMR systems, and HIEs. Pepper maintains that the 1st reason to support health information exchange is to improve patient safety, quality, and affordability of care. She elaborates on the payer to provider HIE collaborative approach.
The broad view in determining the priorities for health plans, i.e. claims, performance health statistics, care gaps, etc should be placed on payers, according to Pepper. She also underlines the need for better sophistication of data sharing. Pepper then notes the competitive nature of care and uses the example of generic prescription writing as a percentage of all prescriptions as an example.
Reported next is the frequently requested information from providers, including lab results, authorizations, prescription history, and telemedicine. Pepper then relays the details of HIT Payer Collaborative in Florida, including data workflow integration, the importance of baseline metrics, and confidentiality of patient records.
The critical success factors of next generation HIT systems are next examined. Of concern are industry collaboration, integrated data exchange, and aligned incentives for payers, physicians, hospitals, and patients.
Catherin Pepper then concludes her prepared remarks and opens the floor to audience questions.