Transcript Evidence-Based Best Practices Work Group

Health Leadership Task Force
Administrative Simplification Project
Oregon Healthcare Financial Management
Association
Kah-Nee-Ta
July 22, 2010
Paul Krissel, MSOD, project lead
The Health Leadership Task Force
Commissioned by the business community in
the summer 2008
Goal—Develop solutions and actions to keep
health care costs and premium increases closer
to the CPI
Sponsors: Legacy, Kaiser, ODS, OHSU,
PacificSource, Providence, Regence
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Health Leadership Task Force
Oregon Health Leadership Council
Nonprofit corporation, spring 2010
Board: the former HLTF sponsors
Members:
7 physician representatives
9 hospital and health system reps
11 Health plan reps
Oregon Health Authority ex-officio
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How work is being accomplished
 HLC membership leaders to review and
support recommendations
 Four work groups with 120+ members
--Value Based Benefits
-- Evidence Based Best Practice
-- Reimbursement & Payment Reform
-- Administration Simplification
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Health Leadership Task Force
Accomplishments to Date
 Completion of a value-based benefit design for the large
group market, 5 payers introducing benefit plans in 2010
 Implementing an initiative in the management of high cost
imaging
 Developed a new payment proposal for the medical home,
2 year pilot being initiated
 Administrative Simplification…..today’s topic
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Administrative simplification structure
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Three work groups – over 100 participants
Claims
Eligibility
Have been combined
Credentialing
Work completed
Health Leadership Task Force
Administrative Simplification Executive
Committee
Senior level staff appointed by HLC
 Plan implementation of administrative
simplification projects
 Recommend future projects
 Participate in State of Oregon administrative
simplification work group
 Measure success

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Claims/Eligibility:
Accomplishments to date:
 Recommended single source authentication sign
on to payer sites by providers – HLC is
implementing through One Health Port
 Target roll out for November 2010 (to be
confirmed)
 Executive Committee established subcommittee
to plan roll out
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Claims/Eligibility:
Accomplishments to date:
 Recommended 75 payer web site best practices
Providers evaluating sites and providing feedback
to payers
 Metrics developed to measure success
 Baseline measures March 2010
 Next round of measures Sep 2010
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Claims/Eligibility: Next steps
 State of Oregon Admin Sim work group
recommended working on electronic transactions
 Executive Committee tasked with adapting
Minnesota practice manual to Oregon
 Executive Committee sets up calendar and plan
through 2010 to complete
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Credentialing:
Identified major headaches
Credentialing in Oregon has many
components which are duplicative and
confusing!
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Credentialing:
Steps taken
 Created a matrix listing credentialing
requirements of Health plans, Hospitals,
including sources such as TJC, NCQA and the
Oregon Medical Board
 Identified the highest standard for each of 23
required components
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Credentialing:
Steps taken
 Recommended that there be a single solution
in Oregon to provide centralized data collection
and verification
 Created a list of essential criteria and critical
elements that any credentialing solution should
be measured against
 Researched a range of options
 Presented research to HLTF
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Credentialing: steps taken
 HLTF selected Medversant as preferred vendor to
implement credentialing solution
 Executive Committee tasked with vetting
Medversant
 Co-chairs of Exec Committee met with members
of Credentialing work group to flesh out questions to
ask about Medversant capabilities
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Credentialing: next steps
 Medversant responded to RFI with additional
questions from Oregon and provided copy of
Washington state RFP response (June 2010)
 Executive Committee establishes vetting process
and subcommittee
 HLC agrees to continue vetting process before
making final decision later this year
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Your questions and input
 Discussion
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