Question 4: How Does Your EDI Partner Reduce the Burden of Claims Submission for Providers?
Plan members want access to a range of high- quality providers. Without a robust provider network, health plans are challenged to grow membership and differentiate themselves from competitors.
The Council for Affordable Quality Healthcare (CAQH) 2022 Index reported that providers spend ten minutes submitting a single electronic claim on average. For paper, it’s 22 minutes. A large part of this is repetitive data entry. These time blocks add up to significant resource drains in a typical day. Alleviating stressors will reduce payer-provider friction and promote cooperation in your common goal to improve health outcomes for members.
With the right EDI partner, you can streamline operations, reduce administrative burden, and improve your organization’s bottom line. Embracing new technologies and cooperative partnerships can help you gain a competitive advantage and, ultimately, provide better care to members.
Our fourth and final question leads you to ask yourself: “Is my EDI partner providing holistic support to my partner’s and my own organization’s operations?”
Ready to jump to all four questions? Want to see how your EDI partner stacks up? Download our white paper here.
How Does Your EDI Partner Reduce the Burden of Claims Submission for Providers?
Plan members want access to a range of high- quality providers. Without a robust provider network, health plans are challenged to grow membership and differentiate themselves from competitors.
The healthcare industry is becoming more consumer-driven and labor shortages continue to mount. Health plans need to be mindful of provider relationships and the administrative burdens your claims processing may be placing on them.
The Council for Affordable Quality Healthcare (CAQH) 2022 Index reported that providers spend ten minutes submitting a single electronic claim on average. For paper, it’s 22 minutes. A large part of this is repetitive data entry. These time blocks add up to significant resource drains in a typical day. Alleviating stressors will reduce payer-provider friction and promote cooperation in your common goal to improve health outcomes for members.
Your healthcare EDI partner should help you to help providers with an affordable billing tool. Our solution, MYUHIN, reduces repetitive data-entry, and solidifies coding and submissions data to satisfy your processing requirements. Providers can use MYUHIN to submit claims, check patient eligibility, and search, view, and download payment information from any computer, any where.
UHIN is a national EDI network built in 1993 by health plans. We partner with payers and providers across the US. Our approach to EDI and customer service is different. If you’re interest in learning more, please contact us today.
Question 3: Are Providers Frequently Contacting You With Questions About Their Claims?
Health plans constantly seek to optimize their high-performing provider networks which provide value to members and patients. To grow these important networks, payers should nurture their provider relationships through personal attention and cutting edge technology.
This is particularly important at a time of mounting staffing shortages and rhetoric of economic downturns. Additionally, medical claim volume increased by 28% in 2022 as vaccines became available, medical offices reopened and pandemic regulations softened. When you add this up, the need for administrative simplification becomes more obvious for health plans and providers.
Tracking down claims, managing denials and submitting myriad claims can burden staff, compound labor costs and decrease profitability. When your provider network is stressed then your ability to grow as a carrier is impacted. Your EDI partner should automate workflows and manage your trading partner network so your support staff can focus on more strategic priorities, rather than answering phone calls and emails all day long.
Our third question addresses this concern as you ask yourself, “how does my EDI partner stack up?”
Ready to jump to all four questions? Want to see how your EDI partner stacks up? Download our white paper here.
Are Providers Frequently Contacting You With Questions About Their Claims?
When resources are tied up managing claim inquiries, you’re likely underperforming your peers and weakening your organization.
An inability to provide visibility to track and troubleshoot claims in a timely fashion can create financial implications. The increased demand on staff can decrease productivity, which could further delay payments and lead to staff burnout and turnover. Payers must respond to providers within a regulated timeframe, and providers rely on prompt payment for cashflows and their own business growth. Further dissatisfaction amongst providers and members can upend the collaborative nature of interoperability and could drive providers and members away to different plans.
The volume of inquiries to track down claims can burden staff and compound labor costs through the need to hire additional people. The situation can foster negativity between providers and operators, reducing satisfaction for both groups. Your EDI partner should work with you to increase your ability to automate claims processing. Part of this is facilitating a simple, electronic process for providers to submit their transactions and understand the status along the way.
UHIN is a national EDI network built in 1993 by health plans. We partner with payers and providers across the US. Our approach to EDI and customer service is different. If you’re interest in learning more, please contact us today.
Question 2: Can your Clearinghouse validate claims? Can you customize validation to your needs?
Claim validation should be par for the course. Still, many clearinghouses cannot properly validate claims. Much less, health plans are left unable to customize settings that allow for certain transactions while rejecting others. This leads to decreased adoption of auto-adjudication and on-going manual intervention that increases costs and decreases productivity.
SNIP Validation is a common solution for EDI data validation and compliance. There are seven (7) SNIP types and each health plan can tailor type settings to their needs. The right EDI partner works with their health plans to ensure the types are appropriately calibrated and implemented.
This leads to the second question to ask when wondering, “how does my EDI partner stack up?”
Ready to jump to all four questions? Want to see how your EDI partner stacks up? Download our white paper here.
Can your Clearinghouse validate claims? Can you customize validation to your needs?
Ensuring claims are HIPAA compliant and in a valid EDI format before they enter your system is key to streamlining the claims process.
Effective validation reduces administrative workload, mitigates risk of non-compliance, and helps avoid wasted time and provider appeals. SNIP Validation is an important step for pre-adjudication, scalability and profitable growth. Every plan operates at a different level of preparedness. One health plan may be working toward full automation, while another might seek to relieve staff burden to focus on other initiatives. Depending on your systems and goals, an EDI partner can support and modify the validation set-up to support your strategic needs.
SNIP Types
EDI Standard Integrity Testing: Validates the basic syntactical integrity of the EDI submission.
HIPAA Balance Testing: Involves ensuring that amounts reported in different places add up correctly.
HIPAA Inter-Segment Situation Testing: Testing of specific intersegment situations described in the HIPAA implementation guides.
HIPAA External Code Set Testing: Testing for valid implementation guide-specific code set values, as well as other code sets adopted as HIPAA standards.
Product Type/Type of Service Testing: Ensures that the segments (records) of data that differ based on certain healthcare services are properly created and processed into claims data formats.
Trading Partner-Specific Testing: The Implementation Guides contain some HIPAA requirements that are specific to Medicare, Medicaid, and Indian Health.
UHIN is a national EDI network built in 1993 by health plans. We partner with payers and providers across the US. Our approach to EDI and customer service is different. If you’re interest in learning more, please contact us today.
Question 1: Why are you with your current EDI vendor?
Health plans are often led to believe that healthcare electronic data interchange (EDI) vendors and Clearinghouses are utilities. Just a means to an end. It’s true that utilities – such as water – and EDI vendors both follow regulated protocols and move standardized, secure things.
When you turn on the faucet in your kitchen or bathroom, you expect clean, clear water delivered immediately and at your desired temperature. Often it works perfectly. However, you don’t typically choose where the water comes from or the company who provides water to you. You don’t adjust your settings at an infrastructure level and underlying delivery issues may be well beyond your control.
As a health plan, you can select your EDI vendor, enhance your provider network, adjust settings at an infrastructure level, and get ahead of underlying issues. Beneath the surface, health plans can work with expert EDI partners (not just vendors) to navigate turbulent waters together and deliver seemingly fluid experience and impactful outcomes. This process is understandably daunting despite the increased adoption of automated processes.
For this reason, health plans should ask four key questions to understand the value that their EDI vendor is bringing to the table. Our next four blog posts will cover these four simple, yet critical questions for health plans:
With many options out there, why are you with your current EDI vendor? Are they just a vendor in your tech stack or do they serve you as a partner should?
Can your Clearinghouse validate claims? Can you customize validation to your needs?
Is your provider network frequently contacting you with questions? How does this impact your staff, strategy and budget?
How does your EDI partner alleviate the burden of claims submission and simplify your administrative workflow?
Ready to read all four questions now? Want to know how your EDI partner stacks up? Download our white paper here.
Why Are You With Your Current EDI Vendor or Clearinghouse?
Our first post is introspective. We’ll look at the reasons you may be with your current Clearinghouse or EDI vendor, and how they should serve you to meet the strategic objectives of your department and company as a whole. Keep reading about the way it’s always been, and the futurist approach that health plans should take with a key strategic EDI partner.
The Way Clearinghouses Have Worked
Healthcare EDI networks have been built on vendor relationships that can be daunting and confusing, despite best intentions and the increased adoption of automated processes. Vendors offer “sticky” solutions that can entangle health plans with complicated agreements, abrasive onboarding processes, and technology that may not provide meaningful value.
Today, the essence of a partnership can get lost in the complications of healthcare EDI management. We can shift this paradigm by remembering we’re all in this together – from payers to trading partners, and providers to patients.
So, What Keeps You With Your Current Clearinghouse?
Does your partner simplify administrative burden? Do you have visibility into transactions? Do you receive timely, expert guidance on future X12 standards and HIPAA compliant transactions? An EDI partner should be focused on your holistic operations, and not merely transactions (though they should do those well, too). Perhaps it’s time to rethink the status quo.
If your EDI vendor is not serving you as a partner, you may want to consider what this relationship is costing you.
UHIN is a national EDI network built in 1993 by health plans. We partner with payers and providers across the US. Our approach to EDI and customer service is different. If you’re interest in learning more, please contact us today.
Health plans could save billions each year by accelerating administrative efficiencies for themselves and providers. A new CAQH report breaks down the opportunities and showcases the value of a clearinghouse partner as electronic data interchange (EDI) becomes the norm. Working with a trusted clearinghouse partner – one who knows the complexities of today and tomorrow – will help you navigate the future.
A Decade of Success Reporting on a Digitally Enabled Administrative Environment
Administrative transactions, including benefit and eligibility checks, prior authorizations, and claim processing, form the backbone of the entire healthcare system. Health plans and providers must be able to conduct these EDI transactions in a swift, secure, and standardized manner to enable delivery of timely and informed care.
CAQH, a non-profit alliance of health plans and their partners, has tracked adoption of electronic transactions every year since 2013. The most recent edition chronicles a decade of commitment to digitizing administrative processes and strengthening EDI connections between disparate systems in the payer and provider environments. The adoption of many electronic transactions has increased, such as claims submissions, eligibility and benefit verification, and acknowledgements.
Automation is the key to getting it right. Throughout the past decade, the use of EDI has skyrocketed by 25 percent, according to the latest edition of the CAQH Index Report. Now, nine out of every ten transactions take place digitally, reducing industry-wide operating costs by approximately $187 billion every year.
Despite this progress, there are still opportunities for health plans to control costs, maximize resources, and trim the time it takes to conduct the business of healthcare. Certain critical processes have a long way to go, like prior authorization and attachments.
Currently, only 28 percent of PAs are being exchanged digitally while the electronic submission of attachments that support medical claims is similarly low, starting at 6 percent in 2016 and only rising to 24 percent by 2022.
During the coming years, health plans will need to reexamine their current workflows to boost the use of digital strategies for sharing documents and data with their provider partners, particularly as transaction volumes have risen 28 percent since the COVID-19 pandemic, paired with a 47 percent increase in overall medical spending.
Experienced and trusted clearinghouses will be central to success. Clearinghouses make it simple for plans and providers to share information and collaborate around patient care, creating the right environment for the smooth and seamless exchange of vital administrative data.
Uncovering Opportunities to Reduce Burdens in Key Administrative Areas
The positive results so far have saved hundreds of billions for health plans, as well as an average of 14 minutes per transaction for medical care providers. But addressing these notable areas of opportunity and transitioning fully to EDI could produce a further $25 billion in cost reductions, representing 41 percent of the current spend.
Specifically, health plans can focus on the following areas to trim their budgets and provide relief to payer and provider staff members:
Eligibility and benefit verification: Representing the highest proportion of annual spend, health plans could save up to $12.8 billion if they work with providers to digitize the 10 percent of transactions that remain manual. Closing the gap will be crucial for sustainability as the volume of transactions continues to increase.
Prior authorizations (PAs): A well-known pain point across the industry, PAs are time consuming and complicated to submit manually. The medical industry could save close to $450 million per year by creating more automated and streamlined PA processes, not to mention trimming 11 minutes per transaction off of a provider’s daily calendar.
Claims submissions: As the volume of medical services increases, so too will the claims for reimbursement, adding to the $11.1 billion industry spend. CAQH points out that training staff to conduct electronic claims submissions can take time and money, so beginning the adoption and education process now, before volumes exceed current norms, will be important for achieving savings and maximizing staff productivity.
Attachments: Supporting information for reimbursements is rarely sent electronically, creating a $213 million annual savings opportunity. CMS recently proposed standardsfor these transactions to help guide adoption and simplify data exchange.
Claims status inquiry: Payers and providers are spending 50 percent more on claims check ups as margins remain slim following the pandemic. Broadening the automation of claims status updates could help the industry save $3.6 billion a year, plus 15 minutes per transaction for providers. A clearinghouse solution with automated features can help to achieve this goal for plans and their partners.
Remittance advice: Similar to claims status inquiry, automating the delivery of remittance advice could save medical care stakeholders up to $2 billion a year by increasing efficiency and reducing time spent on phone calls and follow-ups.
Capitalizing on these transactions to reduce spending and staff burdens will be important for health plans as the volume of medical transactions is expected to continue to increase.
While there are small spending increases associated with adopting digital transaction tools, the savings far outweigh the required investment, CAQH states. Automating these processes can produce further cost reductions by avoiding the need to attract and retain larger workforces, especially as qualified staff are now in short supply.
Leveraging Clearinghouses to Achieve Administrative Efficiency
Clearinghouses make all of these transactions possible, so health plans will need to evaluate their existing capabilities, and find the right partner, if necessary, that offers a tested and sophisticated approach to automation if they wish to take advantage of these savings opportunities.
Plans should look for clearinghouse solutions that have deep experience and an exceptional reputation for reliability, agility, and standards-based collaboration between disparate trading partners.
Health plan leaders should also conduct thorough internal reviews of their established workflows – and work closely with their contracted providers to understand their processes and frequent problems, too – in order to identify potential areas of improvement. Next, they should seek out a clearinghouse partner with capabilities to fill in those gaps and accelerate savings in time, staffing, and operational spending.
By adopting more modernized digital clearinghouse solutions with the capacity to streamline communications and complete tasks in a quick and trustworthy manner, health plans can begin to take advantage of everything that EDI has to offer.
Preparing for the Future of EDI
In just a few years, plans that proactively embrace electronic transactions at scale can position themselves for significant cost reductions, fewer burdens for staff, and better administrative experiences across the entirety of the care continuum.
The right clearinghouse partner will proactively work with plans to develop a tailored roadmap to greater EDI adoption, help staff to maximize their productivity in this new ecosystem, and stay on top of evolving federal regulations guiding the evolution of electronic transactions.
With a 30-year history of helping health plans accelerate the adoption of electronic transactions, UHIN has been instrumental in creating a more cost effective, less burdensome future for critical information exchange. Our experts meticulously evaluate the needs of each of our partners and work with leaders to create a customized plan for expanding EDI activities with an eye toward improving efficiency across the enterprise.
As more and more administrative transactions go digital, health plans can’t afford to be left behind. Get started today with a consultation with our experienced team.
Clearinghouses are more than just utilities for moving claims from provider to payer. They are integral to improved healthcare interoperability and the quest to extract valuable insights from clinical and administrative data.
How Clearinghouses Help to Enable Interoperability
When talking about interoperability in healthcare, clearinghouses aren’t always the first thing that comes to mind. For many years, the conversation has been much more focused on the exchange of purely clinical data from one provider to another – a challenge that is still only partially solved even after decades of hard work.
While clinical data exchange is certainly vital to success for patients, health plans, and providers, it’s just the tip of the interoperability iceberg. Accurate claims data is equally important for making informed, proactive decisions about patient care.
Claims data doesn’t just offer deep insights into everything from overall provider performance patterns and to an individual’s ability to engage with their care plan. It’s also essential for the day-to-day business of being a payer: reimbursing providers for the wide variety of services aimed at improving member health.
Clearinghouses are the technology that makes this all possible. By coordinating the secure flow of claims information between providers and health plans, clearinghouses quietly and steadily keep the $4.3 trillion healthcare industry humming along.
It’s easy to look past this type of “middleware” solution, especially when it works well enough to avoid causing any major issues. But skipping over clearinghouses during the interoperability discussion would be a mistake, especially as payers and providers start to engage with increasingly complex, unstandardized data sets and new types of clinical and financial partners in a more patient-centered, value-based environment.
It’s time to take a closer look at the clearinghouse as a fundamental enabler of trusted interoperability between trading partners and ensure that both payers and providers are maximizing the value of what these important platforms can do.
The Crucial Role of Clearinghouses in Healthcare Operations
Every year, healthcare providers submit hundreds of millions of claims for patient services to thousands of health plans across the nation.
Just building the electronic pipelines to shuffle all this data back and forth each day is a monumental task. Making sure that the information is accepted and processed in a standardized manner, correctly integrated into a health plan’s internal reimbursement systems, and returned to the provider in a timely manner with the right payment – or a clear explanation for denial – is even more challenging.
Clearinghouses work in conjunction with electronic billing software to handle these processes digitally, proactively identifying common data integrity issues that may result in a denial or delay. Once a provider generates a claim using the standard 837 claim format, the clearinghouse accepts the file, scours it for any obvious errors, and sends it on to the correct health plan if it passes all the checks.
The plan then conducts further analysis for clinical and administrative suitability of the claim and makes a decision on whether to reimburse as requested, deny outright, or ask for clarification.
The more sophisticated and trustworthy the clearinghouse, the less work has to be done on each side of the partnership. Robust clearinghouses with more automation, advanced analytics capabilities, and a trusted position within the health IT community are associated with lower overall denial rates and higher first-pass success rates, which is good for providers, as well as reduced administrative burdens on the payer side.
The American Medical Association estimates that electronic clearinghouses can reduce the cost of claims processing by approximately 60 percent compared to similar paper-based workflows, freeing up time and capital to devote to other clinical or operational priorities.
According to CAQH, transitioning to fully electronic transactions could save the industry up to $25 billion per year, or 41 percent of annual spend in 2022.
Using Clearinghouses to Create a Network of Networks for Better Claims Data Exchange
A single clearinghouse cannot work in isolation, because health plans don’t just receive claims from their established, contracted in-network providers. They also get claims from an untold number of out of network clinicians from anywhere in the country.
This can be challenging on several levels. First, reimbursement rates and requirements are different for these partners. Second, out-of-network providers may not be familiar with the correct formatting and data requirements necessary to get their claims adjudicated quickly. And third, without being directly connected to the prospective payer’s proprietary clearinghouse, these providers must simply trust that hitting “send” on their claim form will result in getting that information where it needs to go.
This is where the right clearinghouse solution can take interoperability to the next level. Clearinghouse vendors must work with their peers, trading partners, and competitors to ensure that all claims, no matter their origin, are routed to the appropriate recipient with as few gaps and errors as possible.
Data standards like ASC X12 Version 5010 make it possible for clearinghouses to assemble into “networks of networks” and make certain that any provider can reach any payer whenever necessary.
Fortunately, the ASC X12 standard is well established in the electronic data exchange community, and claims are typically highly structured documents with relatively few unknowns, making it easier for clearinghouses to engage in the type of interoperability that is often so elusive in the clinical data ecosystem.
Trust as the Bedrock of Interoperability Between Payers and Providers
With trillions of dollars and huge volumes of sensitive clinical data shooting across the claims superhighways at any given moment, it’s essential that all parties involved have full and complete trust in their clearinghouses.
Choosing a clearinghouse with a strong reputation for security, service, experience, and responsiveness can turn an oft-overlooked piece of the interoperability puzzle into a valuable and proactive partner for improving clinical care and administrative efficiency.
A prospective clearinghouse solution provider should be able to demonstrate its mature and wide-reaching connections with peers across the industry to foster seamless interoperability for both in- and out-of-network claims. Platforms should also include process enhancements such as tools to generate cleaner claims, timely provider notifications at key steps in the process, and helpful resources to address any provider questions or problems that arise before or during claims submission.
With a trusted and collaborative clearinghouse, health plans and providers can work together more efficiently and effectively to accomplish their daily tasks while moving into the optimal position to take advantage of everything that rich, robust claims data has to offer.
Clearinghouses shouldn’t just feel like part of the furniture. Instead, they should become an active and integrated part of a health plan’s larger interoperability goals. By simplifying and streamlining the claims submission process, clearinghouses don’t just save time and money for payers. They can also unlock the full potential of claims data for broader financial and clinical analytics purposes, such as provider performance monitoring, population health management, and other high-priority value-based care activities.
Every patient deserves a full, dynamic portrait of their care story. We believe in our power to create a more vibrant and complete picture together.
The HIT Conference will feature four tracks with sessions covering topics like population health, interoperability, care delivery, and health equity, as well as popular sessions from previous PES conferences, like “Medicare Hot Topics” with Lori Weber and the Payer Panel. Join other healthcare professionals and attend sessions by esteemed speakers from the State of Utah, Office of the National Coordinator (ONC), University of Utah Health, Amazon Web Services (AWS), Noridian Healthcare Solutions, BYU, AUCH, Comagine, SLCo Health Department, UHIN, and more to be announced!
This event is tailored for professionals across the healthcare ecosystem, such as CEOs, CTOs, CIOs, Chief Medical Officers, VPs, directors, doctors, nurses, administrators, office managers, billers, educators and many more roles at health plans, hospital systems, providers, clinics, higher education institutes, and nonprofit organizations.
PES at HIT
For the first time ever, we’ve combined the annual Provider Education Summit (PES) and the HIT conference into a one-day, hybrid event. PES is an educational event for health plans and providers, billers, office managers, coders, administrators and more. PES will have a dedicated track, Provider Education, at the HIT conference this year.
Welcome Keynote
Rich Saunders
Chief Innovation Officer, Utah
Rich Saunders is Utah’s first chief innovation officer and is charged to help lead the Cox-Henderson administration’s commitment to aggressively upgrade state government efficiencies, innovations, and responsiveness to Utah residents, including a world-class customer experience initiative, and organizing the One Utah Health Collaborative nonprofit. Rich previously served as the executive director of the Utah Department of Health during the COVID-19 pandemic, and before state government, was an entrepreneur for 25 years with extensive experience in multiple verticals and significant sales networks nationwide. Rich has an ongoing passion for leadership, knowledge, organizational health, and service to his community.
Closing Session
Brittany Bowe
Olympic Speed Skater and Medalist
Three-time Olympian, Two-time Olympic medalist, 1,000-meter world record holder
Brittany Bowe led the way for Team USA as the flag bearer for the 2022 Winter Olympic Games in Beijing. She is a Three-time Olympian and Two-time Olympic medalist who gave up her spot in the 500m at the 2022 Winter Olympic Games for Teammate Erin Jackson – recognized as one of the most selfless acts in Olympic history.
1,000-meter world record holder… Reigning 1,000-meter season-long world cup champion… Won seven consecutive 1,000-meter world cup races from December 2018 to December 2019, the longest win streak by a U.S. woman. She helped end a 12-year U.S. women’s drought with an Olympic bronze medal in the team pursuit, and finished top-five in all four of her races at the 2018 Olympics. She is also a Six-time world champion, 20-time world championship medalist and 73-time world cup medalist.
As a gay athlete and LGBTQ+ advocate, uses her platform to promote inclusion and support others. She volunteers as an ambassador for nonprofits Right to Play and Athlete Ally.
Brittany suffered a concussion while training for the 2018 Olympics and was diagnosed with POTS, which means the body does not control blood pressure or heart rate after you stand up. She overcame her fear from that setback and, through an aggressive rehab program, returned to the podium.
Brittany previously played college basketball at Florida Atlantic University and won 32 world championship medals in inline skating before switching to ice. She is dedicated to maintaining a healthy balance between the physical, mental and spiritual aspects of life, and is working toward her yoga teacher certification. Also, Brittany is a cat owner.
Motto: “Practice doesn’t make perfect, perfect practice makes perfect!”
Tracks and Speakers
10:00 a.m. “A Novel Outpatient Complex Care Model – Using Claims Data for Risk Stratification and Evaluation” Dr. Peter Weir | Executive Medical Director of Population Health, University of Utah Health
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A review of the Intensive Outpatient Clinic – highly coordinated and integrated care for Medicaid members with complex mental and medical health problems that result in high utilization.
11:00 a.m. “Partnerships to Increase HPV Vaccine Rates for Utah’s Community Health Centers” Shlisa Hughes | Quality Improvement Director, AUCH
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AUCH is committed to preventing HPV related cancers through improving HPV vaccination rates. AUCH has partnered with Huntsman Center for HOPE, the U of U, Huntsman Cancer Center, the American Cancer Society and the UDHHS, and Utah’s Federally Qualified Health Centers to use automation and interoperability with clinical workflows to improve immunization rates for Utah’s youth. We will share results and innovations from across the state.
Kassy Keen, MPH | Health Equity Bureau Manager, Salt Lake County Health Department
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Health equity has gained increased attention, resources, and support as COVID-19 and social justice movements transform our communities. Often we discuss health equity frameworks, which can be abstract and confusing, offering little guidance around implementation. So, what does it look like to incorporate health equity into systems, programs, and policies in the medical and health field? In this presentation, we will discuss operationalizing health equity, and explore a broad scope of tangible ideas to build capacity, and instill new processes, procedures, and data to create better outcomes for our communities.
2:00 p.m.Orion Health Presentation Chad Peterson | Chief Revenue Officer, Orion Health
3:00 p.m. “Using Analytics to Improve Personal and Population Health“ Sara Hallvik | Vice President of Data Solutions, Comagine Health
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Health data can be a powerful tool in improving both personal and population health, but one must consider several factors first. Data governance determines who and how data is used. Data quality determines whether results can be trusted. Combining data sources increases the complexity but can also increase the power of the data. This opens the way to descriptive, predictive, and prescriptive analytics, where one can harness their data’s true potential.
10:00 a.m. “Why Are We Still Challenged by Identity Matching and Data Quality?Follow Oscar’s Patient Journey” Gregg Church | President, 4medica, Inc.
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Access to accurate, complete, and timely data is one of the most valuable assets in any healthcare organization. The push toward value-based care and population health initiatives including the response to COVID-19 have amplified the need for efficient exchange of quality patient data, filling gaps in information and offering providers and payers a more complete picture of the patient. Quality data improves care coordination, clinical outcomes, and saves lives but can only be achieved with accurate patient identification or matching across multiple sources.
Learning Objectives:
The need for exchanging reliable clinical and administrative data in “real time” for better care coordination and population health management
How patient data is being exchanged securely and reliably for care coordination decisions
How HIE’s and health networks use quality health data to exchange and provide ‘actionable’ data insights in and out of their community
11:00 a.m.“Setting Utah’s Standards: You Hold the Power” Boyd Kreeck | Business Analyst, UHIN
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The UHIN Standards Organization is a nonprofit, broad-based coalition of Utah healthcare insurers, providers, and others, including local government entities. The purpose of the Standards Committee is to develop administrative, technical, and billing standards and specifications based on existing federal and state regulation.
Standards created by the committee and approved by the UHIN Board are provided to the Utah State Department of Insurance, Utah Health and Human Services and published in State Rules and made available to the public at UHIN.org. In addition to developing Utah Standards, the UHIN Standards Committee participates in the development of National standards and guidance.
1:00 p.m. “The Present and Future of HIEs“ Michelle Suitor | Director of the Clinical Health Information Exchange, UHIN
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A discussion on the history of interoperability and an overview of the various standards covered from both the claims and clinical standpoint. This session will explore what that means for Utah, and provide examples of specific use cases.
2 p.m. “Coordinating and Aligning Health IT: An update on nationwide health IT and interoperability goals” Micky Tripathi, Ph.D., M.P.P. | National Coordinator for Health Information Technology, the U.S. Department of Health and Human Services
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Join ONC’s National Coordinator Micky Tripathi for updates on:
ONC’s work to align health IT activities across HHS agencies
How the Trusted Exchange Framework, Common Agreement (TEFCA) will ease information sharing across networks of EHRs and other health IT systems
The continued implementation and enforcement of the information blocking regulations
Data standardization efforts to promote equity, reduce disparities, and support public health data interoperability
And more!
3:00 p.m. “HIE Transformation: It’s About More Than Data“ Mary-Sara Jones | Sr. Business Development Executive, Health & Human Services, Amazon Web Services (AWS)
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The Public Health landscape is changing. It is getting broader and deeper. The global pandemic highlighted fragmentation across and within organizations and the incompleteness of the data available to decision makers. There is a hunger for better, richer, cleaner data to support more holistic decisions and move efforts toward prevention. For many states data modernization and digital transformation will occur in parallel. Immediate updates to shared data infrastructure can provide meaningful insights while updated paradigms of service delivery are reimagined with modern technology to better meet provider and constituent expectations. Health Information Exchanges play a central role in creating and maintaining a connected data ecosystem driving improved patient outcomes and community vitality. This presentation with Natasha Nicolai explores future models for HIEs, how data transformation can provide immediate community impact, and what is required to create the parallel path to digital transformation.
3:00 p.m. “HIE Transformation: It’s About More Than Data“ Natasha Nicolai | AWS WWPS SLG Leader, Health and Human Services Analytics, Amazon Web Services (AWS)
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The Public Health landscape is changing. It is getting broader and deeper. The global pandemic highlighted fragmentation across and within organizations and the incompleteness of the data available to decision makers. There is a hunger for better, richer, cleaner data to support more holistic decisions and move efforts toward prevention. For many states data modernization and digital transformation will occur in parallel. Immediate updates to shared data infrastructure can provide meaningful insights while updated paradigms of service delivery are reimagined with modern technology to better meet provider and constituent expectations. Health Information Exchanges play a central role in creating and maintaining a connected data ecosystem driving improved patient outcomes and community vitality. This presentation with Mary-Sara Jones explores future models for HIEs, how data transformation can provide immediate community impact, and what is required to create the parallel path to digital transformation.
10:00 a.m. “Beating Hypertension, the Silent Killer“ Nickee Andjelic, MS, CHES | Maternal and Infant Health Program Manager, Utah Department of Health and Human Services
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The Utah 6|18 Workgroup is a cross-collaborative workgroup focusing on addressing 6 high-cost and preventable health conditions with 18 evidence-based and cost-effective interventions. For 2022, the workgroup selected to focus on self-monitoring blood pressure (SMBP) by hypertensive patients with clinical support to improve health outcomes and reduce healthcare costs. Hypertension is the silent killer and is a comorbidity and risk factor for a number of other chronic conditions. One in 4 Utah adults have diagnosed hypertension and 15-30% of Utah adults have undiagnosed hypertension. Strong evidence supports that SMBP interventions, when combined with additional support like patient counseling, education, or web-based support, are effective in improving blood pressure outcomes in patients with high blood pressure. Home blood pressure monitors are a covered benefit under Utah Medicaid and many resources are available to support clinic training and member education to encourage accurate SMBP and clinical support.
10:00 a.m. “Beating Hypertension, the Silent Killer“ Dr. Richard Ferguson | Chief Medical Officer, Health Choice Utah
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The Utah 6|18 Workgroup is a cross-collaborative workgroup focusing on addressing 6 high-cost and preventable health conditions with 18 evidence-based and cost-effective interventions. For 2022, the workgroup selected to focus on self-monitoring blood pressure (SMBP) by hypertensive patients with clinical support to improve health outcomes and reduce healthcare costs. Hypertension is the silent killer and is a comorbidity and risk factor for a number of other chronic conditions. One in 4 Utah adults have diagnosed hypertension and 15-30% of Utah adults have undiagnosed hypertension. Strong evidence supports that SMBP interventions, when combined with additional support like patient counseling, education, or web-based support, are effective in improving blood pressure outcomes in patients with high blood pressure. Home blood pressure monitors are a covered benefit under Utah Medicaid and many resources are available to support clinic training and member education to encourage accurate SMBP and clinical support.
10:00 a.m. “Beating Hypertension, the Silent Killer“ Rachel Vasquez | Quality Program Manager, Health Choice Utah
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The Utah 6|18 Workgroup is a cross-collaborative workgroup focusing on addressing 6 high-cost and preventable health conditions with 18 evidence-based and cost-effective interventions. For 2022, the workgroup selected to focus on self-monitoring blood pressure (SMBP) by hypertensive patients with clinical support to improve health outcomes and reduce healthcare costs. Hypertension is the silent killer and is a comorbidity and risk factor for a number of other chronic conditions. One in 4 Utah adults have diagnosed hypertension and 15-30% of Utah adults have undiagnosed hypertension. Strong evidence supports that SMBP interventions, when combined with additional support like patient counseling, education, or web-based support, are effective in improving blood pressure outcomes in patients with high blood pressure. Home blood pressure monitors are a covered benefit under Utah Medicaid and many resources are available to support clinic training and member education to encourage accurate SMBP and clinical support.
11:00 a.m. “The Challenge is HOW not Why: Integrating the Social Determinants of Health in Healthcare“ Dr. Len Novilla | Associate Professor, BYU
1:00 p.m. “Countering Cybersecurity Risks Across Your Organization” Keith Roberts | Information Security Analyst, UHIN
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Presentation on the importance of cybersecurity in healthcare. We’ll look at a recent data breach investigations report, how to stop cybersecurity, and the importance of staff training.
2:00 p.m. “Decentralized Identity and Verifiable Credentials in Health Care“ George McEwan | Chief Strategy Officer (CSO), Department of Government Operations at the State of Utah
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On May 26th, 2011 Google introduced Google Wallet on android phones. Not to be left out of a really good marking term, Apple followed suit on September 19th 2012, launching Apple Wallet. Ten years later and it is still “novel” to pay with a phone. What happened and why does it matter now?
The future of legally binding, decentralized digital identity and verifiable credentials has expanded beyond simple digital wallets and is debuting in government in the near future. This session provides the background you’ll need to participate in the next identity revolution.
3:00 p.m. “Intro and Overview of the One Utah Health Collaborative“ James Wissler | Executive Director, One Utah Health Collaborative
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This intro/overview of the One Utah Health Collaborative will have an emphasis on the barriers and the importance of community alignment regarding interoperability. A panel of innovators, clinicians, and interoperability experts will join Jaime Wissler to discuss the questions of how and why we’re working toward a longitudinal health record.
10:00 a.m. “Motivating for Performance: How Leaders Can Help Teams Find Their Drive” Blake Bishop | Vice President of Data Services, Neovest, a JPMorgan Chase subsidiary
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Intrinsic motivation plays a pivotal role in organizational performance management. Not surprisingly, there is a strong correlation between employee motivation and business success. The factors that drive the desire to perform, however, may come as a surprise to many. In this presentation, we will explore what intrinsic motivation is, why intrinsic motivation matters, and how you as a leader can motivate your team members to perform at their peak.
11:00 a.m. “Medicare Hot Topics” Lori Weber | Provider Relations Specialist, Noridian Healthcare Solutions
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This presentation encompasses updates, important topics and valuable resources to assist your practice with successful Medicare billing.
1:00 p.m.“Life of a Claim: Creation, Rejection, Elation” Joy Cone | Application Support Analyst, UHIN
2:00 p.m.MYUHINClaims Greg Lobato | Group Product Manager, UHIN
3:00 p.m. Payer Panel Representatives from DMBA, EMI, HCU, Noridian Medicare B, PEHP, Regence, SelectHealth, and University of Utah Health Plans
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Q&A session with a panel of provider relations specialists and representatives from national and local, Utah health plans. This popular session answers some of providers most pressing questions. In previous years, questions have included:
Which are the most common errors that keep claims from processing?
What are the procedure codes with modifiers that should be used for phone visits for each insurance company?
Are all the payers reimbursing for Telehealth visits at the same rates as in person visits during the pandemic?
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Venue
Salt Lake Marriott Downtown at City Creek
75 S W Temple Street Salt Lake City, UT 84101
Free parking for 2022 HIT Conference attendees
REFUND POLICY
We will accept refund requests up to 10 days following the date of the conference. To be eligible for a refund, you must submit via email to events@uhin.org. In your email, include your name, order number, and number of tickets to be refunded, as well as a reason for the refund request.
Once we receive your request, we will review and notify you on the status of your refund. If your request is approved, we will initiate a refund to your credit card or original method of payment.
Please contact events@uhin.org with any additional questions.
