A Look Back at the Chicago Summer Forum and a Look Forward at Upcoming WEDI Education
Nancy Spector, MSC, WEDI Senior Director, Federal Affairs
It’s been a month since the WEDI Summer Forum where attendees gathered onsite in Chicago at the Loyola University campus and hundreds more joined us virtually. The buzz in the room and later feedback was that the event was a resounding success, due in large part to the wonderful speakers, moderators, sponsors, and setting. Chicago does not disappoint in the summer! Being near Lake Michigan, indulging in deep dish pizza, and having a beautiful city view rounded out the intense focus on prior authorization, health IT, and regulatory requirements.
The Forum featured some of the nation’s leading experts on the CMS-0057-F Interoperability and Prior Authorization Final Rule. Sessions included a panel with Denny Brennan (WEDI Board Chair-Elect), Dr. Donald Rucker (1upHealth, gold sponsor), Heather McComas (American Medical Association), Lauren Bedel (Massachusetts Health Data Consortium), and Karuna Relwani (Blue Cross Blue Shield Association) provided insights on how building trust between payers and providers can be a solution for improved collaboration that will shape future work beyond prior authorization. The session “Leaning Forward: Harnessing FHIR to Lead Beyond Mandates” was led by Jason Van Der Jagt (Edifecs, a Cotiviti Business, Platinum Sponsor). Cara Wahmann (HCSC), John Roszkowiak (CenCal Health), and Michael Lunzer (Itiliti Health, platinum sponsor) discussed the complexity of payers digitizing their clinical policies and guidelines for prior authorization and the delicate balance of automation and human oversight. Timothy Bennett (Drummond Group, Gold Sponsor) led a panel discussion focused on real-world CMS 0057F testing experiences. Tim was joined on the panel by Denny Brennan, Ron Wampler (Aetna, a CVS Health Company), Mark Scrimshire (Onyx Health, Gold Sponsor), and Michael Marchant (Sutter Health).
The forum also showcased the WEDI Prior Authorization Subworkgroup co-chairs, Heather McComas, Janice Bakos (Aetna, a CVS Health Company), Raj Godavarthi (MCG Health), and Michael Lunzer summarizing potential actions and next steps for the successful implementation of CMS-0057-F. Important to mention the networking break that included Stan’s Donuts, a Chicago must! Thank you, Tennr (Silver Sponsor)! Keep your eyes open for a reprise this fall of WEDI’s CMS-0057-F survey on the industry’s implementation of and readiness to meet the compliance deadlines.
The Summer Forum also provided attendees with an update on X12’s work from their CEO Cathy Shepard. Cathy discussed the forthcoming Version 008060 transactions, updated administrative processes, and proof of concept project. Donna Campbell (HCSC) offered a deep dive into the changes to the eligibility and benefits transaction, AKA the 270/271, in Version 8060. If you are interested in this next version of the X12 transactions, plan to attend the WEDI National Conference November 3-6 either in person in Washington, DC or virtually. There will be more in-depth reviews of the other transactions and the next steps for having them adopted under HIPAA.
Summer is now giving way to fall with the return of pumpkin everything, college football, and long sleeves. As the kids head to school, WEDI has its own back to school line up of education for the health care industry.
On September 4, Itiliti Health is sponsoring a session with Michael Lunzer and Keith Brick focusing on the need to seamlessly integrate across core systems to drive end-to-end prior authorization automation. They will discuss solutions that connect external care guideline vendors and internal systems like utilization management, case management, and claims platforms to enable compliance, streamline workflows, and prepare for a future state of touchless PA.
InterSystems is sponsoring a 2-hour and 15-minute virtual event on September 10 on the mandated APIs for electronic PA, which are just the starting point for transforming PA. Steven Berkow (InterSystems) will talk about the need to leverage the CMS-0057-F requirements to scale electronic prior authorization and advance value-based care. Stephan Rubin (Optum) will outline how the Da Vinci DTR Implementation Guide (IGs) provides an industry-wide roadmap for automating the needed documentation for prior authorization and overcoming gaps in existing health plan and provider workflows. Wrapping up the event will be a panel of experts discussing innovation in prior authorization with moderator Anna Taylor (MultiCare Connected Care), Danny Cawood (MCG Health), Joe Ellis (UnitedHealth Group), and Julie Smith (InterSystems). They will focus on scalable and accurate automation, AI-powered adjudication, AI in rules processing, and deploying other technology and policy changes for more efficient processes.
Next up is the September 25 virtual event spotlighting state Medicaid strategies for implementing CMS-0057-F. This webinar will feature CMS officials walking through the key provisions of the Final Rule, a high-level overview of the technical components of the regulation by Michael Lunzer and Keith Brick (Itiliti Health). Malathi Subbiah (State of Utah) and Stephanie Brown (CRISP DC) will provide, as state Medicaid leaders, real-world updates on progress made, planning strategies, and operational challenges. The event will close out with a discussion of next steps and needed resources for the Medicaid industry.
Our October 9 event is sponsored by MCG Health and features speaker Raj Godavarthi outlining how leveraging standards can lead to smarter decisions and how implementation of the HL7 Da Vinci Project CRD, DTR, and PAS IGs allow payers and providers to make faster and more informed authorization determinations. The session will highlight how practical approaches to combining automation efficiency with transparent metrics can result in stakeholders experiencing both speed and soundness of prior authorization decisions.
Planning for WEDI’s Fall National Conference (November 3-6) is well underway. Keynote speakers include Sarah Iselin, President and CEO, Blue Cross Blue Shield of Massachusetts; Thomas Keene, MD, ASTP/ONC; and Paula Stannard, Office of Civil Rights. On the final day of the conference, the CMS National Standards Group will provide an update on revisions to the standards adoption process and will conduct Listening Sessions on the recently-developed X12 Version 008060 HIPAA Electronic Transactions-providing attendees a unique opportunity to share their organization’s perspectives on these critical business standards. Also, don’t miss the live WEDI workgroup and subworkgroup meetings on November 3 where attendees can sit in and experience the multi-stakeholder collaborative work that is the foundation of WEDI’s advocacy work and educational content. Additional speakers and sessions are being added daily to the agenda. Check out WEDI’s Event page for the updated list of events and to register.
This line up of education takes me back to my college days. Now, excuse me while a head out to a football game.