Are You Ready for CMS Interoperability?

Editor's Notes

• #3: There are 2 important pressures that are reshaping healthcare today. The first are the mandates for data interoperability being imposed by the Government and CMS as part of the Cures Act that state that there must be public APIs for provider and patient information. The APIs themselves are not really the issue though, it’s the need for well managed, complete and trusted data that is good enough to be shared, and that incoming information that may be in a variety of forms, can be understood and combined with existing information. Second is the ongoing for insight into the business through various forms of reporting and then the agility to be able to respond to those insights to drive more operational efficiency – whether that in clinical outcomes, managing utilization, procurement or some other aspect of the business – we all know that all organizationa are increasingly run through data. So it follows that bother these critical activities must be backed by ‘trusted master data’ – that is, the relatively slow moving data that forms the pillars of the business. Some of those what we call ‘domains’ are listed at the bottom of the slide. These and more can be ‘master data’ and aligning and synchronizing this data across and between systems is key to integratin gnad interoperating between those systems
• #4: There are 2 important pressures that are reshaping healthcare today. The first are the mandates for data interoperability being imposed by the Government and CMS as part of the Cures Act that state that there must be public APIs for provider and patient information. The APIs themselves are not really the issue though, it’s the need for well managed, complete and trusted data that is good enough to be shared, and that incoming information that may be in a variety of forms, can be understood and combined with existing information. Second is the ongoing for insight into the business through various forms of reporting and then the agility to be able to respond to those insights to drive more operational efficiency – whether that in clinical outcomes, managing utilization, procurement or some other aspect of the business – we all know that all organizationa are increasingly run through data. So it follows that bother these critical activities must be backed by ‘trusted master data’ – that is, the relatively slow moving data that forms the pillars of the business. Some of those what we call ‘domains’ are listed at the bottom of the slide. These and more can be ‘master data’ and aligning and synchronizing this data across and between systems is key to integratin gnad interoperating between those systems
• #6: A talk though on this slide In reality, the way master data is captured and updated across most organizations is fragmented and discontinuous. It’s MDM’s job to listen for new and updated information, link the correct information together, and assemble the puzzle pieces incrementally. Complicating this process is the fact that information is often incomplete and inconsistent. It would be like trying to assemble a jig saw puzzle where the picture side of the pieces had been damaged, and only part of the picture were visible. First build: In this scenario, the first piece of information available might be from an external source, such as a marketing lead file or in this case, Dun & Bradstreet. Here we capture information about Debora Varchy with Crete Carrier Corporation Second build: The next interaction might be with the parts department, when Debora orders a replacement part. In this case, the parts representative captures her name as “Deb Varchie” and abbreviates the company name to “Crete Carrier Corp.” MDM figures out that this is the same person, with the same company, and aggregates the information together. Third build: The next interaction might be with the service department, when the new part doesn’t work properly. In this case, the service representative captures her name as “Debby Varchy” and abbreviates the company name to “CCC”. Again, MDM recognizes that this is the same person and the same company, and continues to aggregate the information we know about Debora and Create Carrier Corporation. Fourth build: The next interaction might be with the warranty division, as the replacement part is clearly defective.….same story. Fifth build: MDM has taken these fragments of master data, correctly reconciled them, and used them to assemble an aggregate composite record that is the most complete, most up to date information available on Debora Varchy and Crete Carrier Corporation. As part of this process, MDM captures each contributing system and the primary keys for the data from each contributing record. This cross reference information is a gold-mine for analytics, allowing transactions from multiple systems to be correctly aggregated, even when the information in those systems is inconsistent or incomplete. Furthermore, the best, most complete composite data set can be shared back to operating systems, ensuring that invoices are sent to the most current and accurate billing address, or orders shipped to the best, most current delivery address, etc. What MDM is doing, really, is collecting updates and changes to key master data as they are captured across multiple systems. The real magic is two-fold. MDM will link up information fragments to build out the complete, composite picture, even when the information is not 100% accurate and consistent, and MDM will apply rules to assemble the best, most complete composite record – e.i. identify the best address, the best email, the best company name, etc.
• #8: Chargeback – industry average is 4-5% comes from chargeable supplies; their average was 1% as some items were misclassified for chargeback – so 3-4% underbilling Undercharging by 3-4% = $20mm/year
• #11: About 6.4M patient lives annually Business units – Providers, Practice Management, and RCM/Billing