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Chair:  

Scribe: Dana Marcelonis
 

Attendees

Present

Name

Affiliation

  •  
Robert DieterleEnablecare
  •  
Stratametrics
  •  
Nita ThingalayaIBC
  •  
Cambia Health Solutions
  •  
Gregory MagazuCaseNet
  •  
Jeanie SmithBCBSFL
  •  
Corey SpearsInfor
  •  
Optum
  •  
Ashley SteddingCMS
  •  
Barbara AntunaAIM Specialty Health/ Anthem
  •  
Mary Kay McDanielCognosante
  •  
Michael GouldIBC
  •  
Laurie BurckhardtWPS Health Systems
  •  
Serafina Versaggi
  •  
Sreenivas MallipeddiMCG Health
  •  
Susan BellileAvaility
  •  
Susan LangfordBCBST
  •  
BCBSAL
  •  
Tracey McCutcheonKPMG
  •  
Dawn PerreaultBCBSM
  •  
CMS
  •  
Anupam ThakurBCBS FL
  •  
Anthem
  •  
Allscripts
  •  
BCBSM
  •  
Chris JohnsonBCBSAL
  •  
MITRE
  •  
ZeOmega
  •  

  •  

  •  
Cigna
  •  
eClinicalWorks
  •  
Tibco
  •  
Eddy NievesEpic
  •  
Christopher Gracon


  •  
Centene
  •  
Andrea KentCoverMyMeds
  •  
BC Idaho
  •  
Keya ShahCasenet

Present

Name

Affiliation

  •  
John BialowiczBCBSM
  •  
Nandini GangulyScope Info Tech/ EMDI
  •  
Peter Muir
  •  
CAQH
  •  
Pallavi TalekarScope Info Tech
  •  
Kelly TaylorCMS
  •  
Karen L. ZapataAnthem
  •  
Brandon RaabAnthem
  •  
Cindy MonarchBCBSM
  •  
Michael CabralCMS
  •  
Nick RadovUHC
  •  
Epic
  •  
James Derrickson
  •  
Laurie WoodromeLabcorp
  •  
Ric LightHumana
  •  
Harvey KuangExpress Scripts
  •  
BCBS AL
  •  
Gevity
  •  
Julia ChanCW Global Consult
  •  
Ken Lord
  •  
Edifecs
  •  

  •  
Roland Gamache
  •  
Alberto S. LlanesAnthem
  •  
Mark ScrimshireNew Wave
  •  
EMR Direct
  •  
Patrick MurtaHumana
  •  
Ranjith KandurAnthem
  •  
MITRE
  •  
Joe MinieriMITRE
  •  
Dave Foster
  •  
Providence
  •  
Betty SullivanAllscripts
  •  

  •  
June Bronnert
  •  
Cynthia GinsburgCMS
  •  
Eshaa DhalleClinicalWorks
  •  
Ronald MacDurmon
  •  
Cigna
  •  
Edifecs
  •  
Cigna
  •  
Mona ChandrapaleClinicalWorks
  •  
Sonja ZieglerOptum


Minutes Approved as Presented 


This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."


Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

Decision Link(if not child)
ManagementReview ANSI Anti-Trust Policy



Connectathon

Connectathon Debrief 
  • No code brought to Connectathon for this track aside from MITRE Reference Implementation
  • Good discussions re: 
    • Difference between PDex and PCDE
    • HIMSS participation for PCDE
      • GuideWell
      • Edifecs
      • Medicare FFS
      • Implementations will be ready for HIMSS
      • ZeOmega is tentative
  • Google Doc with Q&A from Connectathon (Mark Scrimshire / Nick Radov) : 1yhvT3lAwWTMTKcioTcyizyrqCuZa0BN8mJR7VbJMSE4/edit#heading=h.uh3ke1w3wit3
  • Breakout session re: how we authorize exchange of information between 2 health plans


PCDE Ongoing Work
  • 2 PCDE work streams:
    • Need to align with HIMSS clinical scenarios - appropriate set of current treatments and clinical history to support end to end demonstration
    • Supplemental Guide - provide additional examples of the type of information that would be exchanged (e.g., clinical examples tied to specific problems and treatments) to ensure we have a standard way to represent it
      • Starting to create a list of good examples that are appropriate to guide payers that have to create and consume these documents
  • Revisit 3 primary use cases: 

    https://confluence.hl7.org/display/DVP/Payer+Coverage+Decision+Exchange+Use+Cases

    • Comorbid condition of chronic obstructive sleep apnea and COPD - in the Reference Implementation
    • Diabetes
    • May Terry will review the above and adjust based on HIMSS clinical scenario to review on this call next week
  • Open Issues
    • How do we identify and exchange guidelines?
      • If commercially or publicly available (e.g., Milliman, Medicare), fairly straightforward
      • If proprietary, not normally published - what do we do?
        • Could be attached as a PDF if available, to provide context to receiving health plan
      • If folks have feedback/ideas, please send to May Terryor Robert Dieterle
    • Duplication of data
    • Provenance
    • Ability of plan to move data without member's permission
      • Covered under HIPAA, but Minimum Necessary does apply
      • PDex - what is allowed plan to plan without member intervention?
      • Sensitive data requires member permission to exchange
    • Ability to send old plan member demographics to identify the patient
      • Deterministic FHIR search operation - chance of false match is high
      • May need probabilistic match supported by $match operation
    • Impact of CMS final rule

ManagementNext agenda

Review proposed clinical scenarios/examples (May Terry)


 Adjournment

Adjourned at 2:40pm ET


Supporting Documents


Action items


Create Decision from template