The Dish on Health IT

Gary Austin kicks off the discussion by asking the panel about the massive increased use of telehealth. Guest Brian Bamberger defines what he means by telehealth and the distinction between telehealth and telemedicine. The panel moved on to address rule changes that make the use of telehealth more accessible to everyone. Bamberger acknowledged that telehealth for a long time was adopted to service patients in more rural areas but that moving forward, telehealth can improve accessibility for at risk, mobility challenged individuals in urban areas as well as capacity is built. There is no reason physicians or patients shouldn't continue conducting more routine visits as virtual visits. Jocelyn shared that her municipality, where she is a government official, has leveraged their first responders to do virtual visits for triage and help disseminate information. In the future, remote monitoring, delivering test results and other routine visits can be done virtually. This practice may increase usage overall and potentially increase the number of preventative visits which can help improve outcomes and for certain, generate more data that would be available for analysis. The panel then discussed how to "productize" telehealth in a fiscally viable way. What's pricing? What technology is needed? Will it help reduce medical loss ratios for payers? How does telehealth fit into value-based care? Bamberger makes that point that telehealth will also be critical for the next epidemic or for the second wave of this one. The panel then discussed the risk of fraud and ways to monitor and avoid it. Each panel then shared their closing thoughts on impact, action items and strategies payers and providers should take around telehealth.

Jonathon Feit, co-founder and CEO of Beyond Lucid Technologies & Consulting joins The Dish on Health IT hosts, Ken Kleinberg, Pooja Babbrah and special guest host Ed Daniels to talk about the role of emergency services (EMS) in the healthcare ecosystem now and in the future and how EMS fits into healthcare’s interoperability journey.

The hosts, Ken Kleinberg and Pooja Babbrah briefly introduced themselves. Guest host, Ed Daniels introduced himself by saying that the majority of his career has been spent on interoperability, data exchange and HIEs. Ed was a volunteer firefighter for 14 years and is currently working on the development of a multi-stakeholder collaborative on eConsent which is why this discussion was of particular interest to him.

Jonathon then introduced himself explaining that he is not a field practitioner or first responder. He shared that he joined the military after September 11, 2001 but discovered that his Tourette’s syndrome disqualified him from service, which led him to find another way to serve. He decided to leverage his skills as a technologist to solve problems related to data exchange to support EMS and first responders.

Beyond Lucid, the company Jonathon co-founded is focused on solving these issues. Right now, Beyond Lucid spends half of their day in the world of Fast Healthcare Interoperability Resources (FHIR), EMS, critical care both ground and air, the other half of the day is in the world of electronic health records (EHRs) focusing on things like patient matching. Beyond Lucid is currently running the Oregon Portable Orders for Life Sustaining Treatment (POLST) registry from a technology standpoint and are branching into pediatrics and medical complexities. What Jonathon finds interesting about this work is identifying what field providers do and what they need. Using end of life medical orders as an example, Jonathon pointed out that there is really a 0% margin of error. If someone has indicated in their records that they don’t want to be resuscitated but first responders are unaware of these records, the patient’s wishes may not be followed.

Another aspect of data exchange from the field to health systems so that data captured in the field can be incorporated into the patient’s record fast enough for it to be useful in how the patient is cared for in the emergency room (ER). The future of Beyond Lucid is focused on car crashes, winning a patent on a system to gather crash intelligence about the passengers such as number of passengers, whether children are in the car, or special medical needs of passengers such as hemophilia. There are mission critical pieces of data that need to be exchanged in real-time.

What prompted Jonathon to reach out to Point-of-Care Partners initially was the episode of the Dish on Health IT about social determinants of health (SDOH) because it highlighted patient data that helped look at patients as people. SDOH is important to providing holistic care.

Host, Ken Kleinberg asked for a little more context of how EMS fits in the overall healthcare ecosystem, asking specifically about how EMS has historically been billed separately from other healthcare services as transport.

Mr Feit explained that yes, it’s true that EMS is billed as transport is many places but it’s a yes with an asterisk because things are changing due to COVID. He explained that you really have to look more broadly to federal laws and how EMS is regarded. For example, up until the last 18 months, CMS regarded EMS as a supplier to healthcare, not a provider. This impacts not only how services are billed but related to interoperability rules as well. Meaningful use doesn’t apply to EMS which is a big problem because EMS uses a different data set that falls under the department of transportation and not Health and Human Services (HHS). He added that EMS is the most expensive taxi ride you’ll ever take. With the exception of one value-based care experiment happening now, EMS services are generally billed on a per mile basis and the rate is cost adjusted based on the experience level of the driver and the severity of the patient. EMS is emerging as a central part of safety net care in rural spaces where there aren’t enough doctors to serve the population and the fact that it’s a service available 24/7. Viewing EMS as a provider is a critical distinction that’s starting to change.

Ed agreed with how Jonathon characterized the current view of EMS in healthcare generally and in regulation. Ed explained that historically, ambulances were intended to just g...

This episode features guest, Daniel Stein, President of Stewards of Change Institute (SOCI). The discussion explores why connecting the healthcare ecosystem with human services is critical and goes on to highlight the role of consent specifically highlighting the new “Modernizing Consent to Advance Health and Equity” report published by SOCI with industry input.

Co-host, Ed Daniels, Senior Consultant with POCP, then introduced himself explaining that he’s worked in Health IT for over 30 years and has been working in the world of electronic informed consent over the last several months.

Guest, Daniel Stein, President of SOCI then introduced himself and gave an overview of the work of Stewards of Change. He first focused on SOCI, which is a non-profit that cuts across and connects all the public welfare and safety net programs from healthcare to social services. SOCI has worked to bring together all the different players in these realms. Daniel explained that he got started in this work 20 years ago after a career at Kraft Foods working in project management. He started working with a non-profit in California and became intrigued by how certain business practices could be applied in the non-profit world and that’s how he started on this path.

Daniel explained that he gained insight from work he did related to child welfare in California and New York, he observed there were huge disconnects between the services families really needed and the ability of families to access these services. It was clear these families were already stressed and then were asked to jump through hoops and hurdles to understand eligibility, fill out documentation and such to get the services they needed. On top of that there was a lot of duplication between service providers. He made the point that If you wanted to design a worse program, you really couldn’t. Daniel explained that he started to ask how this bumpy process of accessing services could be smoothed out.

Ken then pivoted to ask Ed about his background in emergency services and other work he’s done to give his perspective of the problem outlined by Daniel. Ed agreed that he recognizes that disconnection Daniel outlined and its impact on people and their families. Ed then pointed out the role of consent in contributing to that problem of disconnection. Ed then asked Daniel how he feels the industry is doing at tackling these issues.

Daniel responded by saying that he’s encouraged that there has been movement over the last couple of years specifically the acknowledgement of the importance of social determinants of health and the need to explore how to capture that information. While healthcare is taking steps in the right direction, there still seems to be some hesitancy. Healthcare is so large and so complex, it’s still somewhat insular with just a few systems and solutions starting to look at connecting outside of healthcare.

Ken followed up by asking for Daniel to dig into the work to connect healthcare and human services, and specifically about Project Unify. Daniel responded that in the beginning of the Obama administration, SOCI had the opportunity to work on the Affordable Care Act (ACA) through a contract with the Administration for Children and Families (ACF). In the ACA, there was a provision that explicitly looked to integrate health exchanges, the infrastructure of the ACA and all the services under HHS. This provision is still in the rules and regulations. Recent guidance coming out of CMS has reiterated this provision. SOCI helped translate this provision and communicate it out to the states at the time. Unfortunately, things didn’t go as smoothly as one would hope primarily due to the complexities of the ACA. It also became clear that there was a lack of connection between the Centers for Medicaid and Medicare Innovation, CMS, Office of the National Coordinator (ONC) and ACF. SOCI was instrumental in helping bring these federal agencies together to better understand the whole person approach to care.

Daniel explained that Project Unify grew out of a 4-year initiative funded by the Kresge Foundation. SOCI’s proposal to Kresge outlined the need to bring together subject matter experts (SMEs) from across healthcare and social care to avoid recreating the wheel. SOCI used the funding they received to establish the National Interoperability Collaborative (NIC). The NIC’s purpose is to bring all these various stakeholders together to share information about the challenges and initiatives to solve problems being done across the various fields and cross-pollinate. The NIC has been holding conferences and has hosted over 75 webinars over the las...

Ken Kleinberg, Practice Lead of Innovative Technologies at Point-of-Care Partners (POCP), and host of The Dish on Health IT kicked off the episode by welcoming co-host Jocelyn Keegan and our special guest, Gabriela Pelin, Chief Innovation Officer with Avaneer Health. This episode will feature a discussion on how Avaneer Health is establishing a trusted network to streamline health care processes, the technology they're using that significantly includes blockchain and the vision they have for the industry. Ken explains that he first met the folks at Avaneer, a couple of HIMSS conferences ago and he’s been excited about the work they're pioneering ever since.

Jocelyn Keegan, Payer Practice Lead at POCP introduced herself explaining that she is a devoted change agent focused on getting stuff built and done for real. She went on to say that her focus, at POCP is on interoperability, prior authorizations, and the convergence of where tech standards and product strategy happens. Jocelyn also conveyed that she is the program manager for Da Vinci Project, which is probably one of the most expansive FHIR accelerators to date. Jocelyn explained that she is excited to hear from Gabriela and the work that Avaneer is doing, especially with the introduction of technologies like blockchain into the space.

Guest, Gabriela Pelin thanked Ken and Jocelyn for having her on and expressed excitement to be part of the podcast. She began introducing herself explaining that her career seemed to constantly land her in the middle of transformation or innovation. Gabriela went on to say that luckily, over the past three and a half years, she stumbled over blockchain technology. She discovered that blockchain is a fascinating technology that enables people to work together. Her drive for innovation was immediately stoked and she was propelled to understand it. She went on to explain that Avaneer has many people at the table from very influential payers and providers who are all very interested in how to make progress in applying blockchain in healthcare.

Ken then asked Gabriela to give a high-level overview of Avaneer health, their founders, participants, targeted use cases, and the network being established. He explained that he thinks most listeners will likely be wondering if Avaneer is like a clearing house or other entity already out there.

Gabriela explained that the founders of Avaneer talked for a long time with founding network members about the purpose of the work, why the network needed blockchain and what about the industry needed to change. Each discussion brought them back to wanting to improve the patient experience and outcomes because each person either has been, will be or have a loved one that is a patient and that it was imperative to improve the overall experience and outcomes because all people deserve better.

Gabriela went on to explain that the health care market is notorious for discrepancy in interests between the different players in the market, and they don't necessarily naturally work together to solve broader, industry problems. Avaneer wanted to create a network that would allow these stakeholders to come together to fix these issues for all patients and their families.

Avaneer wants to reimagine the industry, and all of the steps in the back-office administration and care delivery so that we can accelerate healthcare, Gabriela explained that this is how they came up with the idea of connect once and consume many solutions, many use cases and connect direct. Moving forward, Avaneer wants payers, providers, pharmacies, clearing houses, really anyone needing to exchange clinical and administrative data to be part of this all-inclusive network so that everybody can connect directly, and we can make a difference for people.

Ken then asked for Gabriela to list founders and members, and to describe some of the use cases Avaneer is tackling first.

Gabriela explained that Avaneer has payers like, Anthem, Aetna, CVS, and HCSC. Those organizations are considered visionaries in terms of the different projects they take on to move the market and make a difference for their members. Cleveland clinic, known for its innovation in the industry, is also a member. She explained that Avaneer members so far are early adopters and that there are also members from the financial and broader technology industries participating like PNC Bank and IBM. The participation of these non-healthcare companies brings a different point of view an...

Welcome to "The Dish on Health IT," a podcast brought to you by Point-of-Care Partners, a leading health IT consultancy. Each episode features a rotating panel of senior consultants and guests who discuss trends and innovations in health IT, providing insights and recommendations to help organizations leverage advances to solve their business problems.

In this episode, POCP hosts Tony Schueth, CEO of Point-of-Care Partners, and Pooja Babbrah, PBM and Pharmacy Lead, are joined by Shivani Patel, Executive Vice President of Patient Access Operations and Technology Solutions at Asembia. Together, they delve into key topics including specialty prescribing, pharmacy interoperability, TEFCA, and consent management, highlighting how technology, policy, and process improvements can drive positive changes in healthcare.

The conversation kicks off with an introduction to specialty prescribing. Shivani explains that specialty prescribing involves treatments that are typically more complex than standard prescriptions due to factors like high cost, special storage requirements, and adherence challenges. She points out the logistical gaps and barriers in the specialty space, such as prior authorizations and communication challenges between stakeholders. Pooja adds that the lack of a standardized definition for specialty medications further complicates the process, leading to delays and confusion.

Moving on to pharmacy interoperability, Pooja describes it as the ability to share clinical data between pharmacists, providers, and other stakeholders. She emphasizes the importance of providing pharmacists with the right information they need, instead of overwhelming them with excessive data. For instance, pharmacists should not have to sift through 500 pages of patient records to find relevant information. Instead, they need targeted, pertinent data to improve patient care and streamline processes.

The discussion then shifts to TEFCA (Trusted Exchange Framework and Common Agreement), which aims to fill information gaps in the healthcare system by setting standards for data exchange. Shivani and Pooja discuss how TEFCA can enhance transparency and interoperability, helping pharmacists and other stakeholders' access and share necessary patient information more efficiently. Shivani notes the potential of TEFCA to establish a universal patient identifier, which could significantly improve data sharing and patient care coordination.

Consent management is another crucial topic covered in this episode. Effective consent management is essential for pharmacy interoperability and ensuring patients' privacy and data security. Shivani and Pooja explore how consent management can be improved to make the sharing of patient information more seamless and secure. They emphasize the need for standardized consent processes that allow patients to control their data while ensuring that relevant information is accessible to healthcare providers.

Throughout the episode, the panel highlights the role of technology in improving the prescription journey. Shivani discusses how Asembia uses technology to support the industry by connecting stakeholders and providing tools to manage patient care better. This includes everything from prior authorizations to benefit checks and copay cards. Pooja underscores the importance of industry collaboration and transparency to create standardized solutions that benefit all stakeholders.

Towards the end of the episode, Shivani shares insights about the Asembia Summit, an annual event that gathers industry stakeholders to discuss trends and innovations in specialty pharmacy. She invites listeners to attend AXS25, the next Asembia Summit, which will take place from April 27th to May 1st, 2025, at the Wynn Las Vegas. The event offers a premier forum for learning, networking, and exploring the latest advancements in the industry.

Tune in to this episode to gain a deeper understanding of the complexities of specialty prescribing, the importance of pharmacy interoperability, and how collaborative efforts in technology, policy, and process can enhance healthcare delivery. Don’t miss the insights shared by industry stakeholders on why they attend the Asembia Summit each year. For more information and to suggest future topics, email us at [email protected] or tweet us at @POCPHIT.