Payers on FHIR ® : A Value-Based Care Perspective Presented by: Lenel James, Business Lead – Health Information Exchange & Innovation Blue Cross and Blue Shield Association Member HL7 Attachments Work Group & HL7 Payer User Group Past Co-Chair HL7 EHR Work Group

OBJECTIVES  Define FHIR and Value-Based Care – A Payer Perspective  Share Industry Vantage point – HIMSS15 and HL7 Payer Summit  Review FHIR Uses Cases – The Payer Perspective o Vendor o Deep Dive with a Blue Plan  Summarize the Big Picture  Identify Your Role

Source: Haft(2014). Blue Value-based Care: Locally Delivered, Nationally Leveraged. HL7 International; 2016 Payer Summit, Chicago, IL

Source: Cowell(2015). Population Health Success at the North Carolina State Health Plan. HIMSS15 Annual Conference & Exhibition, Chicago, IL.

aaaaaaaaaaaaaaaaaaaa Source: Cowell(2015). Population Health Success at the North Carolina State Health Plan. HIMSS15 Annual Conference & Exhibition, Chicago, IL.

OBJECTIVES  Define FHIR and Value-Based Care – A Payer Perspective  Share Industry Vantage point – HIMSS15 and HL7 Payer Summit  Review FHIR Uses Cases – The Payer Perspective o Vendor o Deep Dive with a Blue Plan  Summarize the Big Picture  Identify Your Role

Source: Prothero(2016). Interoperability is Essential. HL7 International; 2016 Payer Summit, Orlando, FL.

Source: Keegan(2016). Use FHIR to Extend and Sew Together Standards. HL7 International; 2016 Payer Summit, Orlando, FL.

Source: Barnowsky(2016). FHIR From Proof of Concept to Production. HL7 International; 2016 Payer Summit, Orlando, FL.

OBJECTIVES  Define FHIR and Value-Based Care – A Payer Perspective  Share Industry Vantage point – HIMSS15 and HL7 Payer Summit  Review FHIR Uses Cases – The Payer Perspective o Vendor o Deep Dive with a Blue Plan  Summarize the Big Picture  Identify Your Role

What Might I Do?  Is your organization currently actively participating in clinical data exchange?  Does your EDI administrative financial team have experience with clinical exchange standards (e.g. V2, C-CDA or FHIR)? Where Can I Start?  Assess applicability of FHIR Use Cases to your organization  Review FHIR education and background links below: o o o  Determine if you or someone from your organization should attend the upcoming September HL7 FHIR Connectathon or the HL7 training sessions   Stay informed on actions, activities and news from the Office of the National Coordinator (ONC) o o Your Role YOUR ROLE

Payers on FHIR ® : A Value-Based Care Perspective Presented by: Lenel James, Business Lead – Health Information Exchange & Innovation Blue Cross and Blue Shield Association Member HL7 Attachments Work Group & HL7 Payer User Group Past Co-Chair HL7 EHR Work Group

ATTACHMENTS

Payer Use Cases are highlighted for several of the track: Financial Value Based Attributions and Payments Prior Authorization SDC (Structured Data Capture) Questionnaire could allow for automation of manual processes related to closing gaps on care Clinical Quality Format on FHIR eClinical Quality Measure reporting and related data element C-CDA on FHIR CCD and Discharge Summary for transitions of care CDS Hooks (similar to ADT alerts) A triggering clinical observation or action, like a high- cost medication, recorded for a patient Assess Payer Connectathon Interests

 C-CDA on FHIR C-CDA on FHIR  CDS Enablement Services CDS Enablement Services  CDS Hooks CDS Hooks  CQF on FHIR CQF on FHIR  Data Access Framework Data Access Framework  FHIR Genomics FHIR Genomics  Structured Data Capture Structured Data Capture Financial Lab Orders Patient track Provider Directories & Scheduling Provider Directories & Scheduling SMART-ca on FHIR Terminology Services Workflow FHIR Themes/Tracks

FHIR Connectathon tables set up for each track. Here’s what it looks like

34 ONC Tech Lab: Introduction Represents the way in which ONC organizes and approaches its standards and technology work Focuses on what ONC can uniquely contribute to improve existing standards and build consensus around those that best serve specific interoperability needs Designed to provide stakeholders with common connection points to ONC's standards and technology efforts

35 ONC Tech Lab: Four Areas The ONC Tech Lab is organized around and focused on the following four areas: 1. Standards Coordination: – ONC works with SDOs and industry stakeholders to identify standards gaps and areas where more clarity or reduced optionality is needed – Connecting new program, policy, and business requirements to technical standards and infrastructure needs 2. Testing and Utilities: – Collaborative work on testing tools (including those in support of the ONC Health IT Certification Program and the Standards Implementation & Testing Environment, utilities for health IT developers and providers to test their health IT functionality in the field, and coordination with industry sector stakeholders on the development of additional testing resources and testing events ONC Health IT Certification ProgramStandards Implementation & Testing Environment

36 ONC Tech Lab: Four Areas (continued) 3. Pilots: – Supports implementation pilots for standards (especially those identified in the Interoperability Standards Advisory)Interoperability Standards Advisory – Stimulate cooperation and creativity among the active nationwide pilot community in a way that brings greater visibility to all of the inspiring interoperability pilot work that is taking place – To learn more about the interoperability pilot work, please visit the Interoperability Proving Ground at 4. Innovation: – Activities in this area center on continuing our work with start-up communities – Administering challenge contests and focusing on forward-looking standards and technology activities that can bring a glimpse of the future to the present

37 ONC Tech Lab: Pilots – Interoperability Proving Ground – The Interoperability Proving Ground (IPG) is an open, community platform where you can share, learn, and be inspired by interoperability projects taking place across the nation – To learn more about the interoperability pilot work, please visit the IPG at – Please visit the IPG and register your interoperability projects today!

38 High Impact Pilots and Standards Exploration Awards May 9 th : ONC released two FOAs – High Impact Pilots (HIP) and Standards Exploration Awards (SEA) HIP: $1.25 million (3-7 expected awards) SEA: $250,000 (3-5 expected awards) Cooperative Agreements Period of Performance: 12-months total Letters of Intent due by June 10, 2016 FOA Applications due by July 8, 2016 Informational webinars will be held on May 23 and May 26 and will be recorded and made publically available at:

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