HIMSS12 Review/Discussion -- Key Payer Takeaways, Emerging Topics and Next Steps

Naveen Rao, MHS

Here are some of the key discussion areas explored by the HIMSS Patient-Centered Payer Roundtable at the 2012 Annual HIMSS Conference & Exhibition. This is a useful summary for anyone seeking to become more involved with HIMSS13 in New Orleans or a HIMSS work group.

The HIMSS Patient-Centered Payer Roundtable is a monthly meeting of HIMSS members from within and beyond the payer community who discuss emergent issues in health IT. This session, led by David Fitzgerald of Aetna, focused on the takeaways from the 2012 Annual HIMSS Conference & Exhibition last February in Las Vegas, as it involved payers and the intersection of technology, delivery system redesign and meaningful reform. Below is a summary of key discussion areas and more information for anyone interested in submitting ideas for next year’s annual meeting or getting involved in a HIMSS workgroup.

Expanding Payer Footprint

Since 2011, payer attendance increased from 266 to 380, an increase of 42%. This figure does not include payer subsidiaries, such as representatives from Aetna’s Medicity, or UHG’s Optum group.  The payer audience and attendance increase from HIMSS11 would be significantly greater by including those groups. Payers are not only increasingly attending to learn from other attendees, but also to share their expertise in data-driven population health management. One area to build further payer engagement around might be Health Insurance Exchanges, required at the state level by 2014 under the Affordable Care Act.

Big Thinking
While the keynote speakers were certainly high profile, including Donna Brazile, Biz Stone, Dr. Corine Mariano, Dr. Farzad Mostashari and Dave Garets, some talks, particularly Mr. Stone’s, were not topical to Health IT. A highly regarded session was a talk given by Mark Bertolini, about health reform from both a 10,000 foot level as the CEO of Aetna, as well as from an “on the ground” patient and caregiver perspective.

Big Deals
The topics causing the most buzz during the weeklong meeting were diverse, spanning the realms of technology, business and government.
•    Information exchanges are not yet ready for the limelight.
•    The reaction to the delay in transition to ICD-10 was mixed, with most agreeing with the need, but not all agreeing with the timeline.
•    Meaningful Use Stage 2 NPRM was released, and while it was certainly not a surprise, the announcement is a big step forward for analysts, delivery systems, health plans, vendors and virtually all other stakeholders in health care today.

Several folks on the call expressed skepticism towards the ubiquitous trend of “open-source” offerings, writing them off as marketing ploys rather than meaningful strategy. Other business announcements made during or before the meeting included the GE/Microsoft joint venture, “Caradigm.” This prompted a swirl of speculation about possible technology platforms and market strategy. Optum’s announcement of a cloud solution and Aetna’s promotion of the iTriage platform also contributed to some of the buzz at this year’s event.

Accountable Care and Big Data
Despite an inescapable presence in health reform discussions, Accountable Care fell somewhat flat this year. Showroom presentations were buzzword-heavy, and the “knowledge center” presentations were lacking in innovation and practicality. While the industry is ready technology wise and commitment wise, many communities are still trying to define a clear vision of what Accountable Care will look like.  While leaders such as UPMC and some of the Beacon communities are sharing their work effectively, this year felt low on new players and new models.
The analytics backbone running through ACOs were heavily pitched by vendors, but overall it remains a nascent area. Despite this, there is growing hype and demand surrounding issues such as secondary use of data for research, clinical and business intelligence applications, and how to get data to the front lines more quickly. One call participant noted how provider panels are now talking about the same issues – referrals, network alignment, care management – as payers. “It’s like looking in the mirror,” he noted. Increased collaboration between this roundtable and other such committees within HIMSS may offer further opportunities to explore these convergences.

Interoperability Showcase
This year’s interoperability showcase focused on demonstrating use cases as they related to establishing data flow across patient-centered medical homes, as well as standalone sessions about the use of IHE and HL7 for payer/provider e-care management. While the showcase was well received, some roundtable members expressed skepticism about how to scale these demonstrations of interoperability across the system on a national scale. Participants noted there are a lot of barriers at the organizational level.

Concluding Thoughts and HIMSS13
With an eye towards the 2013 annual meeting, the roundtable closed with a review of HIMSS12’s in-person event and opportunities to build out next year’s agenda. This year’s Patient-Centered Payer Roundtable event included Horizon Blue Cross Blue Shield of New Jersey, who shared a case study about coordinating care across the health plan, provider, case manager and patient’s lives. Participants applauded the spectrum of participants (payer, provider, nurse, patient were all represented on the panel), but encouraged both a stronger focus on IT and increased promotion to patients and patient advocates. 

Roundtable staff announced information regarding the call for proposals for HIMSS13, which will be uploaded to the website soon. All HIMSS roundtable members and others from the payer and health plan sector are encouraged to submit proposals and ideas. Finally, HIMSS is also looking for more volunteers to get involved in the Roundtable and its teams.

Here are some of the key discussion areas explored by the HIMSS Patient-Centered Payer Roundtable at the 2012 Annual HIMSS Conference & Exhibition. This is a useful summary for anyone seeking to become more involved with HIMSS13 in New Orleans or a HIMSS work group.

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