Presented by KLAS Research
Discover how the K2 Collaborative is helping facilitate partnerships of trust, collaboration and alignment between payers, providers and HIT vendors. Hear from organizations who have successfully reduced financial and administrative waste by creating mutually beneficial goals and driving to successful outcomes for all parties – including the patient.
11:00am - 11:05am: Opening remarks and KLAS K2 Payer provider collaborative introduction
Speaker:Aurene Wilford, Senior Insights Director, at KLAS Research
11:05am - 11:25am: Using FHIR Standards to Streamline Prior Authorization Management & Improve Patient Care
The manual nature of prior authorizations creates an administrative burden for provider and payer organizations and delays patient access to care. The stakeholders in this collaboration worked to automate the prior authorization process by using Availity to connect the payer and provider solutions, allowing data to be exchanged more seamlessly. This project led to a faster turnaround time for prior authorization approvals, a reduced administrative burden, and improved access to care for patients.
Speakers:
Mark Fleming, Senior Director, Product, Availity
Anna Slattery, Interoperability Product Management Principal, Humana
Gregory LeGrow, Executive Director Payer Product Market Strategy, athenahealth
11:25am - 11:45am: Reducing Costs & Adverse Patient Events by Closing Gaps in Transitions of Care
During transitions of care, payer and provider organizations have to manage several moving parts; if clinical data is lost or patient care coordination goes awry, it can negatively impact patient outcomes and the cost of care. In this collaboration, the stakeholders worked together to create a solution that identifies when care transitions are occurring and provides care teams with appropriate clinical information, allowing them to close care gaps.
Speakers:
Anna Slattery, Provider Interoperability Product Management Principal at Humana
Shivani Goyal, PhD (she/her), Director of Product Management, PointClickCare
11:45am - 12:05pm: Closing HCC Coding Gaps through an Information Retrieval Assistant
Hierarchical Condition Category (HCC) coding plays an integral role in assessing patients’ risk scores and contributes to quality patient care and appropriate reimbursements. However, provider organizations don’t always have the needed information or training to be able to accurately complete HCC coding and close coding gaps. The stakeholders in this collaboration worked together to seamlessly transfer payer information into clinician workflows, leading to improved data transparency and, ultimately, more accurate coding.
Speakers:
Jon Zimmerman, Chief Executive Officer at Holon Solutions
Kim M. Pierce, MD, MBA, Physician, Medical Director Ambulatory Quality & Population Health, Independence Health System
12:05pm - 12:25pm: Streamlining Prior Authorization through Comprehensive, Real-Time Data Exchange
The prior authorization process often causes friction between payer and provider organizations due to back-and-forth requests for data. In this case study, enGen worked with the collaborating payer and provider organizations to create a solution for utilization, case, and disease management, thus facilitating better data transparency. Use of this solution led to better turnaround times for prior authorizations and reduced manual tasks.
Speakers:
Tracy Saula, SVP, Product Health Experience at Highmark Health
Mike Stimpson, Chief Technology Officer, Product Health Experience at enGen
12:25pm -12:30pm: 2024 Healthcare Payer & Provider- IT Trends and Priorities
Speaker: Jennifer Hickenlooper, Senior Insights Director at KLAS Research
