The Collective Voice of Health IT, A WEDI Podcast

This is a companion episode to Episode 156, a conversation with CMS' National Standards Group Director Michael Cimmino on Administrative Simplification.  Michael welcomes Paul Anderson (Health Insurance Specialist) and Jamie Lookabill (Technical Advisor, Enforcement Division) with the Centers for Medicare & Medicaid Services to offer an introductory look at the administrative simplification enforcement process. Paul and Jamie offer information on the different types of HIPAA enforcement, how CMS communicates with the industry about enforcement, and the overall enforcement process, from filing a complaint, the use of ASETT (Administrative Simplification Enforcement and Testing Tool), corrective action plans and civil monetary penalties.  To learn more about administrative simplification, please visit go.cms.gov/adminsimp

This episode is sponsored by InterSystems, the leading provider of AI-enabled data management solutions for industries with complex challenges, including healthcare, financial services, and supply chain and logistics. Michael welcomes Steven Berkow, Senior Advisor, Value-Based Care with InterSystems. The two discuss Steve's involvement at WEDI's Summer Forum in Chicago, where he served as a moderator for the payer panel on the CMS Interoperability and Prior Authorization Rule. The two discussed the challenges and potential solutions for improving interoperability within healthcare data, and the importance of standardizing APIs for healthcare providers.  Be sure to read InterSystems' latest white paper The APIs Are the Easy Part: Maximizing Your ROI While Meeting CMS Interoperability and Prior Authorization Requirements  Health plans should be able to harness the investment in IT infrastructure mandated by the latest CMS rule on interoperability and prior authorization to create the data liquidity needed drive top strategic goals, such as reducing provider abrasion, improving member experience, increasing productivity, and supporting value-based care. The scope of CMS-0057-F, however, is wide ranging. This white paper: Summarizes new requirements for the four types of information sharing addressed, namely payer-to-payer, payer-to-provider, payer-to-member, and prior authorization submission and determination. Analyzes processes and workflows impacted by the regulation and resulting opportunities for performance improvement. Provides key “Questions to Consider” that should inform plan investment decisions. Designed to be shared with IT, clinical, and operational leaders, the paper will help your leadership team achieve larger strategic returns on mandated plan investment while meeting regulatory requirements.   

Michael chats with Nametag CEO Aaron Painter on how emerging technology, patient-centric data policies and even remote working is affecting the cybersecurity infrastructure in healthcare. The two discuss the "old school" nature of social engineering attacks and steps that the industry can take to combat threat actors. Aaron's article in Forbes magazine can be found here- https://www.forbes.com/councils/forbesbusinesscouncil/2024/05/17/combating-threat-actors-in-the-us-healthcare-sector/  

From our recently concluded Summer Forum, Part 2 of a discussion with 2 providers working on implementing the CMS Interoperability and PA Rule. Semira Singh, Director Population Health Informatics, Providence Anna Taylor, AVP, Population Health & Value Based Care, MultiCare Connected Care The moderator, from the AMA, former WEDI Board Chair Nancy Spector

From our recently concluded Summer Forum, Part 1 of a discussion with 2 providers working on implementing the CMS Interoperability and PA Rule. Semira Singh, Director Population Health Informatics, Providence Anna Taylor, AVP, Population Health & Value Based Care, MultiCare Connected Care The moderator, from the AMA, former WEDI Board Chair Nancy Spector

Michael welcomes back Shweta Maniar, Global Director, Life Sciences Solutions and Strategy for Google Cloud. The two discuss the continued emergence of artificial intelligence in health care, the need for standards or a framework in health care regarding AI, and how people new to AI can brush off misconceptions and dive in feet first and learn how they can access and leverage this growing technology. 

Michael welcomes 3 of the 4 co-chairs of WEDI's Prior Authorization Subworkgroup: Heather McComas, Director, Administrative Simplification Initiatives, American Medical Association David Delano, Senior Director of Services, Massachusetts Health Data Consortium Raj Godavarthi, Associate VP of Technology and Interoperability, MCG Health The 3 discuss the changes in the workgroup and the industry since the January 2024 release of the CMS Interoperability and Prior Authorization rule, the exciting role of artificial intelligence in PA, and how their unique stakeholder roles offer a full, detailed dialogue during their monthly meetings.  Tons of Prior Authorization-related education coming to you courtesy of WEDI. Visit wedi.org and click CALENDAR for more information

Michael welcomes Donna Campbell (HCSC) and Amanda Abbott (BCBS of Kansas), WEDI's Eligibility and Benefits Workgroup Co-Chairs. The co-chairs discuss the workgroup's missions and the latest discussion topics that workgroup is undertaking, including improving efficiencies in the E&B process through standards and emerging technology. If you are interested in joining the workgroup, contact Ariana Poole at apoole@wedi.org. You must be a WEDI member to join. To become a WEDI member, contact Bill Allder at ballder@wedi.org

The threat from cyberattacks is growing exponentially and health care organizations are particularly vulnerable. Michael chats with WEDI's Privacy and Security Workgroup Co-Chairs, Lesley Berkeyheiser of DirectTrust and Thanh-Thien Nguyen of Kaiser Permanente on suggested actions that health care organizations big and small can adopt, customize, and implement as they seek to establish good cyber hygiene.   The top 10 list will be available soon on wedi.org

From WEDI's Spring 2024 conference, Sequoia's David Pyke moderates a conversation with its Payer to Payer FHIR API Implementation Workgroup Co-Chairs, Robert Oakley with Evernorth and Nancy Beavin with Medica. Learn more about the workgroup here- https://sequoiaproject.org/interoperability-matters/payer-to-payer-api-workgroup/