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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
  •  
Celine LefebvreAMA 
  •  
 Ben Largley
  •  
Dawn PerraeultBMBSMI 
  •  
Emily TenEyck CAQH
  •  
Joe QuinnOptum 
  •  
Lindee Chin Edifects 
  •  
Lorraine Doo CMS 
  •  
Padame Metal Solutions 
  •  
Rajesh g
  •  



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

Review proposed clinical scenarios/examples (May Terry)

Notes by Bob:

May presenting and leading conversation

Dive into payload – coordination with the HIMSS scenarios based on conversation with Viet earlier this week

  • Julia create three scenarios – two were prototyped at a high level as part of connectathons
  • Talked about supplemental guide and differentiated from PDex
  • Actors (member, old plan, new plan)
  • Workflow – patient mediated, asynch vs synch
  • Think in terms of clinical and administrative data
  • Discussed the administrative data and example of commercial to MA Plan
  • Discussed the implications of multiple practitioners, specialties and locations
  • Include DME, HH and supportive services
  • How to handle sensitive information (e.g. HIV)
  • Reviewed and discussed scope of PCDe – active treatments, monitored conditons ....
  • in scope:
    • examples:
      • Chronic condition being treated;
      • Preparation for surgery
      • Cancer in remission – e.g.: in this case, the type of monitoring could be expensive, but necessary in monitoring for recurrence.
    • Continuity of treatment
    • **services for conditions (chronic or acute) that are being treated, tracked, or monitored, and may involve a care plan**
  • The intent of use for PCDECarePlan is as convenience as a construct to hold the pieces together.
  • Q: how much history does the new plan need to authorize the continuity of care for the member?
    • As far back for the Utilization Mgr (UM) to understand the problem.
    • Potentially to start…5 years.
    • If the payer has the information, they should include it.
    • Go as far back as the (interop) rule covers, but at least information that would impact the new UM's decision(s).
  • Q: do we include services for conditions not covered by the old plan? (e.g.: covered by another plan)
    • Yes, if it's allowed. Privacy rules might be affected.
  • Q: do we include services for conditions which have been denied by the old plan? (e.g.: asserting it's not covered by the old plan).
    • **Needs further exploration on HIPAA concerns**
  • Q: how to handle sensitive health information?
    • Start with federal and state law.
    • DISCUSS FURTHER NEXT WEEK.





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 Adjournment

Adjourned at 


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