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.
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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.
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.
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.
Related and/or Mentioned on the Show
See all of The #HCBiz Show’s extensive coverage of the Provider Directory problem
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