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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
  •  
Cara BerryAvaility
  •  
NCPDP

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
  •  
Josh Lamb
  •  
Jamie StampsEdifecs


Minutes Approved as Presented 


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Agenda Topics

Agenda Outline

Agenda Item

Meeting Minutes from Discussion

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



CMS Connectathon Debrief
  • More participation than the last Connectathon
  • 9 participants across 4 different organizations
  • Focus areas:
    1. Helping organizations prepare for HIMSS scenario
      • Mettle and Edifecs have finished up messaging for the HIMSS scenario
    2. PCDE discussions
      1. Member discovery - how do we identify members across health plans
        • For v1, require that a member of a new plan must have either a member ID or subscriber ID from the old plan - if they don't have it, they'll have to call the old plan to get it
        • If we tried to do probablistic matching, could potentially lead to inappropriate disclosure of information
      2. What is considered 'active treatment'
        • What is the exact information that needs to be sent
        • What information re: why/how decision was made need to be sent
        • Need to send enough information for new plan to continue the coverage
        • Supplemental guide to provide more examples per condition would help bridge this gap/need for more guidance
      3. Old plan could have many MACs - how much of what they get from potentially multiple MACs need to be aggregated in order to bundle and send to the new plan
        • How does CMS act as old plan/source of data?
          • Would it look like Blue Button? That's mostly claims so limited data set
          • If CMS takes infrastructure they have for Blue Button/EOB resource - instead of populating EOB resource, populate US Core resources - wouldn't it still be the right source data since it comes from all 7 different claim types?
            • Is the database that's the input into the Blue Button query be the basis for all the claims data for CMS? 
            • Not necessarily - different MAC types/systems (e.g., A/B MACs vs. DME MACs, etc.)
          • MACs have some clinical data when they audit, quality data could be relevant
          • Plan on having a follow up discussion to determine if CMS could use PCDE IG as is vs. changes we might need to make to support
            • Does CMS have a source of aggregated data that would populate PCDE?
            • Does CMS have substantial non-claims data that could be made available when a Medicare FFS member goes to a Medicare Advantage plan? If so, where is it and how would we get access to it? 
            • Michael Cabral will follow up with Mel Combs-Dyer and FFS folks
        • If part of goal of NPRM is to move patient data with the patient from plan A to plan B, is CMS expecting they would behave as other payers are required to behave - this would typically be in preamble of NPRM
      4. Should we consider functional cognitive status to be included inside PCDE bundle - these are usually clinical surveys - would commercial payers have a copy of these or is just provider to provider?
        • Mental status questionnaire, activities of daily living (ADLs) as other examples

ManagementNext agenda

Share HIMSS scenario and other examples


 Adjournment

Adjourned at 2:35pm ET


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