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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
  •  
Neena Dakua

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

Establish list of examples to be fleshed out in supplemental guide
  • Existing examples:
    • Chronic Obstructive Pulmonary Disease (COPD) / O2 Therapy
    • Diabetes/ Insulin/ Step Therapy
  • Additional examples
    • Condition/Problem – Treatment
      • Cancer/Oncology – Cancer management/ immunosuppression
      • Transplant – immunosuppression
      • Congestive Heart Failure (CHF) – Diuretics/ pacemaker
      • Sleep Apnea/Obesity – PAP/CPAP/Weight management
      • Sleep Apnea –  PAP/CPAP
      • Arthritis – autoimmune/pain/surgery
      • Pregnancy (high risk)
      • Pregnancy
      • Pregnancy Delivery
      • Behavioral health (e.g., ADHD, chronic depression, autism, etc.)
      • Substance abuse
      • Renal Failure – Dialysis
    • Treatment
      • Home health
      • OT
      • PT
      • Hospice
      • Diabetes management/Dietician
      • Fall management (including PT/Pain/Surgery)
      • Orthopedics
      • Prosthetics
    • Other Considerations
      • Step Therapy
    • PA
      • Yes for all of above examples
    • Reference to Guidelines
      • Yes for all of above examples
    • Procedures
      • COPD, Home Health, PT, OT, Hospice, Renal Failure,  - possibly
      • Cancer/Oncology - yes
    • Lab
      • Behavioral health, hospice, home health, arthritis - depends on condition
      • Diabetes, COPD, Cancer/Oncology, Renal failure, Transplant, CHF, Sleep Apnea/Obesity, Sleep Apnea, Pregnancy, Substance Abuse - yes
    • Notes
    • Care Plans
      • Do payers have active care plans for any of the above conditions (i.e., payer is doing something for the specific condition)?
        • Home Health
        • Oncology
        • CMS actively monitor their care plans (MA), but need to follow up on the conditions
          • Home health
    • Images
      • Home health, PT, OT, Hospice, Transplant, Pain Management, Behavioral Health, Sleep Apnea -  depends on condition
      • Cancer/Oncology, CHF, Arthritis, Pain Management, Fall Management, Pregnancy - yes
    • Monitoring
  • Need to define "procedures", "treatment", "monitoring"
  • Spreadsheet will be posted on Confluence

ManagementNext agenda



 Adjournment

Adjourned at 2:53pm ET


Supporting Documents


Action items


Create Decision from template