On October 7 and 8, stakeholders including banks, employers, health plans, government, consumers, technology companies and providers convened at the Vanderbilt Center for Better Health (VCBH) in Nashville, Tenn., for the G7@HIMSS MBProject Leadership Forum, a two-day intensive roundtable discussion aimed at advancing tomorrow’s healthcare financial network.
In this first of three meetings scheduled over the course of the next year, G7 members spent the first day examining how medical banking could serve accountable care organizations (ACOs) as they are expected to play a large role in the future as a result of healthcare reform.
“We decided it would be a good idea for us to get out ahead of the curve to discuss information technology requirements of ACOs,” said John Casillas, senior vice president, HIMSS Business-Centered Systems. “Specifically, what are the banking and financial system components that can facilitate the more efficient operation of an accountable care organization?”
A particular challenge to facilitating this discussion was “because ACOs exist today only through analogy,” said Tom Lloyd, director Innovation Center, VCBH. “You can’t actually touch a new ACO; there are only examples of organizations that embody aspects of ACOs.”
Instead, the participants developed a model of an ACO and determined how technology could aid in the both managing and tracking patients through an ACO, as well as potentially how to manage bundled payments.
On day two, using a paper HIMSS published in 2008 on real-time adjudication (RTA) as the basis for discussion, the participants sought to find if the industry had progressed in implementing RTA, as well as what other elements would help the industry move ahead with RTA in the future.
The holy grail of RTA is to move the process to completely electronic, while also ensuring that both the electronic funds transfer and remittance advice data are transmitted via a single transaction, as opposed to separately, as they are today.
“It is important that we have tools and business processes and best practices that help health plans implement electronic remittance advice and funds transfer and that providers have the tools needed to integrate that data and money in a clean way into their practice management systems,” said Casillas.
Based on the work done at the forum, HIMSS has reaffirmed its commitment to moving RTA forward as a priority.
“The results of this work are a set of recommendations that will inform how to aid these different stakeholders to further develop their RTA capability,” noted Lloyd.