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Emdeon: A Leader inToday’s National Health Information Network
Providers
HealthcareInformation
PBM Services ePrescribing
RCM & PaymentDistribution
Payers
Patients
Pharmacies
350,000
55,000
1,200
155 million
5 billion
Emdeon – We make healthcare efficient.
Emdeon – We make healthcare efficient.
What is Transparency Hard?
Price
1. Healthcare is not retail – there is no price at the point of service
2. What a hospital charges is not the “price”
3. What an insurance company pays is the “price”
4. But the consumer can’t buy at that “price”
Quality
1. Data is not digital
2. Lack of standards means even digital data is meaningless
3. There is no good clinical information exchange
4. Consumer-friendly communication of medical terms is difficult
Everybody is asking the same question…
HIMSS Financial Systems Steering Committee
6 Public-Private Collaborations
7 State & Local Initiatives
5 Value Driven Healthcare Initiatives
3 Business Coalitions
Total = 21 separate initiatives
Biopsy 11000 Average Rates by State
Analysis data metricsERAs from 31 payers, Dec2007-Feb 2008 36 million claims $23 billion in charges 146,841providers 13.5 million insured 101,450 procedure / modifier combinations 725 average good estimates per state
Key rounded to nearest $10
HIT Over the Next 5 Years
Oct. 2010
Hospitals will receive payments from Medicare and Medicaid for the successful implementation and effective use of EHRs.
J an. 2011
Adoption incentives will be activated for eligible healthcare providers
J an. 2011
Covered entities should begin
internal activities.
The Secretary shall promulgate a final rule to establish a unique health plan identifier.
Oct. 2012
Oct. 2013
The compliance deadline for all
covered entities
Eligibility for a Health Plan and Health Care Claim Status Operating Rules effective.
J an. 2013
J an. 2014
Electronic funds Transfers and Health Care Payment and Remittance Advice Operating Rules effective.
J an. 2016
All remaining HI PAA Transaction Operating Rules effective.
The Secretary shall promulgate a final rule to establish a standard for electronic funds transfers.
J an. 2014
J an. 2016
The Secretary shall promulgate a final rule to establish a standard and single set of operating rules for health care claims attachments.
Covered entities should begin internal testing.
J an. 2010
Covered entities should achieve Level 1 compliance and begin Level 2 activities and deployment.
Dec. 2010
The compliance deadline for all covered entities.
J an. 2012
2010 2011 2012 2013 2014 2015 2016-2022
Begin High Level Activities
(awareness, communication,
education, impact assessment,
strategy)
Internal Activities -Development, internal testing, production, readiness
Begin I nternal Testing Begin External Testing and move to
production Initiate payment reduction to Medicare hospitals and eligible professionals that fail to adopt
EHRs
Adopt new versions of standards and operating rules in more timely manner. Current thought is ~ 3years as needed.6020 could be adopted in ~ Nov. 2010.
EHR Timeline PPACA TimelinesICD-10 Timeline5010/ D.0 Timeline
I’ll take an e-copy of my records please…
http://www.youtube.com/watch?v=UlGXTyIipZA&feature=player_embedded