Terry Miller

Earlier this week I had the privilege to speak at the Economic Alliance of Michigan and share some insights about trends we're seeing in health benefits, specifically around high-cost and complex care. One such trend is biosimilars, which have the potential to save the U.S. health care system $1.2 billion over the next decade. So, what are they? Biosimilars are medications that are clinically similar in composition and health outcomes to FDA-approved, patented prescriptions — but they cost much less. In fact, UnitedHealthcare clients experience an average savings of 53% when they offer biosimilars. And because these prescription drugs can help lower health care spend, they can also help improve access to vital medications for members.    Currently, 40+ biosimilars are available to treat conditions including cancer, diabetes, inflammatory diseases and more. And in the next few years, we expect to see even more introduced into the marketplace, further reducing costs and improving access so people can receive the care they need.     That's just the tip of the iceberg on this topic. To learn more about biosimilars and the benefits they bring to consumers, read this article: https://lnkd.in/dR3wgJG3   

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HTI-2 is here. Laboratories will want to take note as there are requirements for use of Laboratory Orders Interfacing (HL7 version 2.5.1) and Laboratory Results Interfacing (HL7 version 2.5.1) for public health reportables (ELR). If you don't yet have HL7 2.5.1 interfaces with trading partners (paper, fax, HL7 version 2.3.1, etc) you should make plans to update interfaces soon. This impacts both senders and receivers of laboratory data. If you are a pathology laboratory, this may impact you if you perform any public health reportables like Creutzfeldt-Jakob Disease(CJD) as it is reportable in many jurisdictions. ONC has webinars. EHR vendors, providers, and those performing specimen collections will want to ensure they send complete information such as Specimen Type, Specimen collection procedures, Specimen Source site and other Ask at Order Entry (AOE) details required by the performing laboratory and/or public health for reportables.

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https://lnkd.in/eTy3Tp_B Intimate partner violence (IPV) is a primary care issue--but primary care needs access to confidential parts of the EHR to manage it. We developed the first EHR application that segments IPV data into a privacy-protected domain

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📢 Exciting News! 📢 The July/August 2024 issue of the North Carolina Medical Journal has just been published, and it highlights the opportunities and challenges of adapting to Artificial Intelligence in healthcare. I’m pleased to have joined my Acentra Health colleagues Melissa Leigh and Daniel Hallenbeck, along with thought leaders from across the state and nation, in contributing to this important discussion. Check out our article “Applying AI to Care Management and Claims Processing” to explore how AI is reshaping the landscape of healthcare administration. Access the full issue here: https://lnkd.in/g5A5SyB6 View our article here: https://lnkd.in/guiVsXkh #Healthcare #AI #Innovation #ArtificialIntelligence

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The power of Advanced Analytics

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If you're looking for an informative session to wrap up your week, consider registering for this Technology Community of Practice session that will talk about driving better outcomes, overcoming data obstacles, and applying trauma-informed principles to your data practices. See you there!

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Powerful insight- check it out

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Just submitted 3 comments to the ONC's HTI-2 Proposed rule. Quick summary of our points: 1. The public health reporting workflows need to have a defined path for handling data validation error reporting. The proposed shift towards bulk FHIR export (a pull model) does not account for data recipients (public health authorities) to provide feedback on data validation errors to data submitters (provider EHRs). 2. The collaboration between ONC and CDC to advance public health interoperability is extremely encouraging, and we encourage ONC to build on that model by partnering with SAMHSA to similarly advance behavioral health interoperability. Specifically, we advocate for ONC/SAMHSA to align required SAMHSA reporting fields to a FHIR standard that corresponds to a behavioral health reporting certification criteria. 3. Not directly related to the proposed rule, but we advocate that the federal government provide sustainable funding to public health authorities to purchase, enhance, and maintain certified public health HIT over time. We advocate they avoid the cycle of panic and neglect that has historically harmed public health preparedness.

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It's been 8 months since CMS announced its final rule on prior authorization (PA) and interoperability. As we come closer the implementation deadlines, it's crucial to assess our readiness and understand the broader implications. The CMS rule on PA requires some key things: 1️⃣ Faster PA decisions (72 hours urgent, 7 days standard) start in 2026 2️⃣ FHIR-based Prior Authorization API implementation 3️⃣ Expanded Patient Access API and new Provider Access API from 2027 4️⃣ Affects Medicare Advantage, Medicaid, CHIP, and certain QHP issuers 🔗 The FHIR APIs Required by 2027: Enhanced Patient Access API: Now includes prior authorization data Provider Access API: Allows providers to access patient data from payers Payer-to-Payer API: Facilitates data exchange when patients switch payers Prior Authorization API: Streamlines the prior auth process 🔍 What's Missing? 1️⃣ FHIR Standard Adoption: Payers must use FHIR standard queries, but EHR changes aren't mandated. 2️⃣ EHR Integration Gap: The rule doesn't require direct EHR interrogation for PA requests, which could have eliminated most administrative friction. 3️⃣ Digital Endpoint Challenge: Payers need to discover digital endpoints for each entity, but there's no centralized database yet. 4️⃣ Medication-related PA inclusion 5️⃣ Other revenue cycle FHIR standards: While the rule addresses PA, it doesn't tackle the myriad other reasons for claim denials (e.g., coding errors, eligibility issues, medical necessity disputes). 🔍 Where are we now? - Many organizations are in the planning or early implementation stages - CMS is exploring a National Directory of Healthcare Providers and Services, potentially including payer endpoints. (https://lnkd.in/ghf28bDF) - Prior Authorization support has been built in to some of the most common implementation guides for FHIR (https://lnkd.in/gKP4Qdzn) 🤔 Critical questions at this stage: 1. How far along is your organization in preparing for these changes? 2. What unexpected challenges have you encountered in the implementation process? 3. How are you balancing these PA improvements with other revenue cycle optimization efforts? Let's share experiences and best practices. What insights can you offer to peers navigating this transition? #HealthcareIT #PriorAuthorization #Interoperability #RCM #RevenueCycle #CMS https://lnkd.in/gHB_i9Gu https://lnkd.in/gjegKF4g

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Are you curious about the future of primary care? This podcast episode discusses the anticipated changes in 2024 and how they will impact health care providers and patients alike. Don't miss out on this insightful discussion!

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Discover the latest health care trends from Q1 2024 earnings calls and what they mean for the future of health care delivery and management in this informative blog post that covers: 1.    Expansion in care delivery 2.    Medicare Advantage stars risk adjustment 3.    Health plan dual eligibility focus 4.    Medicare Advantage utilization trends 5.    Dynamic payer strategies

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This week on Sg2 Perspectives, we’re focusing on data storytelling—a concept we’ve been talking about with Sg2 members that’s gotten a positive reception. So host Trevor DaRin has invited two Sg2 leaders working in this space, Senior Director Janelle Kwan and Principal Rebecca Limestall, MBA, MHSA, to discuss the core steps of data storytelling and its challenges and best practices. https://bit.ly/3VZEPA9

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As policymakers consider changes to the Medicare Advantage (MA) program, it's essential to acknowledge the diversity of D-SNP and MA-PD plans. A one-size-fits-all approach may fail to address the unique needs of these plans and lead to unintended consequences for Medicare beneficiaries. Thoughtful and tailored policy decisions can help ensure that all beneficiaries receive the care and support they desire and deserve. Our new Association for Community Affiliated Plans (ACAP) report shares specific policy recommendations and options for consideration: https://bit.ly/4dHIpWj #MedicareAdvantage #DSNP 

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I did a webinar for our clients at Milliman IntelliScript about ONC’s Cures Act Final Rule and broke down accessing data with an IAL2 workflow vs. OAUTH workflow! I made some mistakes and got some facts flipped but overall I think I did a good job. Take a listen and share your feedback with me directly. I would love to build out the concepts of this webinar into more deep dives!

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#ICYMI: Last month, #FEHRM Data Integration Solutions Director Crystal Baum talked about #FederalEHR Advancements in Population Health at #DHITS. She detailed the federal EHR's implementation of population health applications like HealtheRegistries to identify gaps in patient care, HealtheAnalytics to provide aggregation of data to offer different levels of reporting, and HealthRecord to offer a complete view of the longitudinal record. Learn more at https://lnkd.in/eqGY-9qC. 

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Didn't make it to the HLTH conference this year? I just published a recap of the #HLTHUSA event from last week, noting what stood out to me. From rising health costs, to AI, to women's health, and even the evolving role of employers, there is a lot of action but even more talk about the change that needs to happen across the industry. We’re at a critical turning point for the healthcare industry, and I walked away with the sense that attendees believe that we need to act before it’s too late. Let's get bold! #bebold #HLTH #HLTH2024 #healthinsurers #healthproviders #futureofhealthcare #ICHRAs #cybersecurity #genAI #AI #employeebenefits #forrester

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The data science team here at N1 Health recently showed me some interesting results with a significant revenue impact. They were able to use AI-powered insights to target individuals with direct mailers and increase AEP Medicare enrollment rates. The small test campaign, which was conducted in a southeastern state at the end of 2023, found that personalization resulted in a 6x increase and hundreds of additional enrollees compared to the control. The incremental premium revenue is between $1-$2 million per year.   Traditionally, outreach was generic. Today, consumers expect a tailored message. A healthy 64-year-old might learn about a preventive care program, while an 85-year-old gets info on one of their specific needs. As we approach AEP this year, don't miss a chance to drive a consumer-oriented approach that will improve your enrollment rates. To learn more, send me a message to chat!

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Interoperability standards continue to shape the #healthcare industry from #CMS regulations to #HEDIS reporting. To set themselves up for continued success, payers must anticipate the coming shifts, and stay ahead of the ever-evolving landscape. 💭 A recent byline in DOTmed.com, Inc from our client Cotiviti dives into the necessary steps payers must take to ensure these standards are met for seamless #dataexchange: https://lnkd.in/ghGB_txj #interoperability #datasharing #FHIR 

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Are you familiar with data storytelling in health care? Tune in to this interesting conversation to learn the core steps of data storytelling for health care leaders, along with its challenges and best practices.

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