sb137

We've talked extensively about the problem with provider directories. It's a fundamental issue in healthcare administration and many of our processes are built on top of it. I've called it healthcare's ultimate death by paper cut. Now, we're starting to see new solutions in the market. Last week we looked at an open-source industry solution. This week we're looking at the statewide effort in California.

California's Senate Bill 137 (SB-137), the "toothiest" provider directory law to date, set the stage for a state-wide collaboration that would have been otherwise difficult to attain. Today I'm joined by Jon McBride, CTO at Integrated Healthcare Associates and Rajan Shah, VP of Business Development at Gaine Healthcare to learn more about California's Provider Directory Utility and find out what happens when you get the entire healthcare industry rowing in the same direction to solve a well defined problem.

 

3:25 The Integrated Healthcare Association convenes diverse stakeholders to solve industry-wide inefficiencies in a non-competitive environment to find common ground solutions. 

4:45 What is the California Provider Directory Utility (PDU) and how does it affect me?

7:13 How does Gaine Healthcare's data management solutions work with Availity and Integrated Healthcare Association (IHA)?

9:13 The plumbing of the data points, finding relevant data sources, and going to where the data already is.

11:44 Big launch or small pilots? How does IHA plan to take on such a big project?

14:35 How tough are the regulatory hurdles? Is California working with you or against you?

17:12 What are the key metrics to demonstrate that you’re making progress?

19:10 Were there any difficult or surprising issues in bringing stakeholders together? What was your approach to solving a common problem without doing the same old thing that got us here in the first place?

22:15 Now that regulators are serious about enforcing this law, everyone is rowing the same direction. This is collaboration like we've never had before. We're building an industry utility that everyone will benefit from.

25:35 The money set aside to be used for this project was from the merger of Blue Shield and Care First. What’s the plan to keep it funded as a utility in the long run?

27:55 An overview of the solution. What is the PDU? Architecture, components and points of interaction.

31:50 The integration model. Are you really going to go to every provider in the state 1-by-1? Do you have the staff for such a large operation?

34:00 How do you deal with over 300 large provider organizations, more than 50 different managed care plans and thousands of mom and pop practice with widely different EHRs and not a lot of technical support?

36:30 What are you doing that helps you manage mass integration with smaller staff? How do you scale high touch? The tech platform plays critical role. We do all the integration. Health plans and providers don't have to change their process and won't need additional staff.

43:01 The power of effective regulation.

44:41 Soft launch. What is it? The 3 phases are data integration, day to day operations, and attestation.

51:00 This was the right time to get the problem solved. We have 40M people waiting on us and the benefits of fixing this problem will be huge!

 

The PDU is in soft launch through the end of 2018 and will be available to providers and health plans across California in early 2019.

Sign up here to receive updates about our progress and launch.

Check out this CMA webinar about the PDU

 

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About Jon McBride, MBA, Chief Technology Officer at Integrated Healthcare Association (IHA) 

Mr. McBride is a business-focused technology executive who has spent the last 25+ years working in technology endeavors, startups and innovative healthcare teams.  Mr. McBride currently leads and builds mission critical systems as IHA's PDU CTO and as founder/CTO of Sunfish Health.

Mr. McBride previously founded Sunfish Health and Afoundria - and currently serves on both Boards; and served as startup CTO and CIO of Availity, building a technology platform that, at the time, grew to over 2 billion annual healthcare transactions and averaged more than US$1 billion per day in electronic healthcare claim submissions. Previously technology executive and software developer at several companies and ventures, including Lockheed/NASA, St. Jude Children's Research Hospital and Johns Hopkins.

Jon McBride on Twitter

 

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Rajan Shah, VP of Business Development at Gaine Healthcare

Mr. Shah currently serves as the Vice President of business development at Gaine Healthcare. His primary focus is centered around healthcare organizations, both payer and provider alike, looking to expand upon master data principles and healthcare interoperability. In the past, Mr. Shah has served as an Information Technology Director over clinical applications and innovation within a payer/provider delivery system focusing on electronic medical record solutions as well as health information exchanges. As a part of that, he focused heavily on analytic solutions that helped manage the health plan's population base.

Raj Shah on Twitter

http://www.gainesolutions.com/hc

 

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About Integrated Healthcare Association

Integrated Healthcare Association (IHA) is a nonprofit organization that convenes diverse stakeholders, including physician organizations, hospitals and health systems, health plans, purchasers and consumers committed to high-value integrated care that improves quality and affordability for patients across California and the nation.

With the support of industry leaders across California, IHA is leading the development and roll-out of a statewide Provider Directory Utility (PDU) to simplify the provider data management process, reduce administrative work, and make it easier for healthcare providers and health plans to meet requirements.

The California Provider Directory Utility Website

IHA website

IHA Twitter

IHA Linkedin

Upcoming events with IHA

 

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Related and/or Mentioned on the Show

 

How to Tap Existing Processes for Provider Data | Martin Dunn | Gaine Healthcare

A Provider-side Approach to Provider Directories plus SB-137 | Bill Barcellona (CAPG)

Provider Data: What is Known and What is Assumed? | Mark Martin | Availity

See all of The #HCBiz Show's extensive coverage of the Provider Directory problem

 

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The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.

Music by StudioEtar

The national provider directory discussion is clearly focused on the patients and health plans. It focuses on the patients because they're the consumer of this information and without it, they can't make educated decisions when buying health insurance. The conversation focuses on health plans because they're the ones being held accountable for making the information available to consumers. To effectively address this issue, we also need to take a good hard look at things from the providers' point-of-view. That's what this episode is all about.

We'll talk with Bill Barcellona, Sr. VP for Government Affairs at CAPG, which is a national association that represents physician organizations who practice capitated, coordinated care.  Bill does an excellent job of sharing the providers point-of-view on the provider directory issue and shows us how provider groups can take the lead on cleaning things up. Bill also tells us about California's SB-137 and explains how it's putting pressure on both health plans and provider groups. It's a fascinating discussion that will expand your understanding of this increasingly complex issue. You'll learn:

• What is SB-137? (1:20)
• Where do all the provider directory errors come from? (3:19)
• Who's responsible for provider directory accuracy? Who's accountable? (5:00)
• What does SB-137 call for specifically? (7:45)
• How have providers responded to the accountability placed on them by SB-137? (11:00)
• What is the SB-137 timeline (12:45)?
• Why can't health plans pull accurate provider demographics from the claims? (13:25)
• Why is it beneficial to address this problem on the provider side? (17:30)
• How else are providers impacted by this problem? (19:30)
• When should the health plan go directly to the provider for info? When should they go to the group? Why is there a distinction? (20:40)
• How can inaccurate provider directories lead to FTC/anti-trust scrutiny? 24:50
• How is CAPG working with Gaine Solutions (Sanator) to help providers address the issue? (26:45)
• What is the California Provider Directory Collaborative? (30:30)
• Can a California-based solution scale nationally, or are California's problems unique? (33:00)
• What are the risks associated with a state-wide or nation-wide solution? (34:27)
• How SB-137 and other rules have killed the idea that narrow network details are proprietary information (37:15)
• Defining a public API for master and metadata needed to share information about contracts, networks, products, and providers nationwide.

Or, listen right here:

Prefer to read it? Transcription coming soon!

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About Bill Barcellona

Bill Barcellona serves as the Senior Vice President for Government Affairs for CAPG, overseeing state and federal legislative and regulatory activities for the association in Sacramento and Washington, DC. Bill is the former Deputy Director for Plan-Provider Relations for the Department of Managed Health Care in Sacramento. In that capacity, he oversaw health plan operational issues and handled policy matters for the DMHC. Bill has a Masters in Healthcare Administration from the University of Southern California and serves as an adjunct faculty member at USC and also holds a B.A. in political science and a J.D. He enjoys teaching and lecturing across the country on health care management, operations and policy matters. He has practiced law for 28 years in California and prior to his service at the DMHC he spent 16 years at two major law firms in Newport Beach and Sacramento, primarily as a civil litigator. His current legal experience includes general health law matters with an emphasis in Knox-Keene Act and managed care issues.

Bill is a former Judge Pro Tem in the El Dorado County Superior Court and served as an appointed member of the California State Bar Association Insurance Law Committee. He was previously awarded the 2009 Alumnus of the Year by the USC Health Services Administration Alumni Association, and a 2-year term as a board member of the Health and Human Services Privacy and Security Advisory Board. He lives in Folsom, a small town in the foothills of the California Gold Rush. He has been active in the community for over 20 years, serving as a Planning Commissioner for the City of Folsom, chairing bond measure campaigns to build new schools, serving as an officer of the Folsom Economic Development Corporation and in the past as a Director of the Folsom Chamber of Commerce. Bill currently serves as a member of the USC Price School Health Advisory Board.

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About CAPG

CAPG is the leading association in the country representing physician organizations practicing capitated, coordinated care. Their membership currently comprises close to 300 multispecialty medical groups and independent practice associations (IPAs) across 42 states, the District of Columbia, and Puerto Rico.

Learn more:

http://www.capg.org

@CAPGVoice

Register now for the CAPG Annual Conference 2017 - June 22-24 in San Diego, CA - CAPG's Annual Conference attracts national industry leaders from top medical groups, independent practice associations, hospitals, health plans, and government who come together to learn about the latest and greatest in capitated, coordinated healthcare.

Also mentioned on the show:

California Provider Directory Collaborative - The California Provider Directory Collaborative Community of Practice is an online forum dedicated to supporting a statewide dialogue on critical provider data and directory issues and to inform regulators as they implement SB 137. Please contact us at ProviderDirectory@manatt.com if you have any questions or would like to learn more.

CAPG White Paper: Provider Directories - Driving Accurate Lists for Consumers

Sanator Provider Registry by Gaine Solutions

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About the Provider Directory Podcast Series

This episode is part of our ongoing Provider Directory series that aims to dissect the issue from all perspectives, including provider, payer, patient, and regulator. Our goal is to help facilitate an expanded national conversation that drives us towards an open, collaborative industry solution.

Check out all our Provider Directory posts and episodes here!

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Weekly Updates

If you like what we're doing here, then please consider signing up for our weekly newsletter.

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The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.

Music by StudioEtar