Episode Topic: A Payer Perspective on CMS Mandates, AI, Data Quality and Patient Consent


On this episode of "The Dish on Health IT," hosted by Ken Kleinberg and Jocelyn Keegan from Point-of-Care Partners (POCP), healthcare technology enthusiasts were treated to an engaging discussion with a special guest, Alice O'Carroll, Interoperability Product Manager at Florida Blue.

Ken Kleinberg, the senior consultant and innovation lead at POCP, kickstarted the episode by extending a warm welcome to listeners, emphasizing POCP’s pivotal role as trusted and independent health IT consultants. He expressed their unwavering dedication to uncovering the latest healthcare technology news and milestones.

The episode promised an illuminating exploration of some of healthcare's most significant challenges and opportunities from a payer perspective including:

CMS Mandates in Health IT:

Ken introduced the episode by shedding light on the far-reaching impact of CMS mandates and other policy initiatives within the healthcare technology space. The hosts emphasized that merely adhering to regulations falls short; healthcare stakeholders must aspire to achieve more.

Artificial Intelligence (AI) in Healthcare IT:

The episode delved into the transformative potential of AI in healthcare but perhaps used in a more mundane way than expected.

Enhancing Data Quality in Healthcare:

The hosts underlined the paramount importance of elevating data quality standards within healthcare. They highlighted how this mission not only benefits healthcare providers and payers but also empowers patients and enhances overall healthcare outcomes.

Patient Consent Management in Digital Health:

Among the critical issues discussed was the management of patient consent not only across the ecosystem but he need for the patient to be able to grant access to pieces of information and not their full record. Most importantly, patients need a way to revoke consent at any time. Consent is a challenge demanding immediate attention within healthcare technology.

Alice O'Carroll's introduction was met with enthusiasm as she joined the podcast as a distinguished guest. She explained that she has donned multiple hats, including her role as the Interoperability Product Manager at Florida Blue and her status as one of the champions of the HL7 Da Vinci Project—a remarkable collaborative initiative.

Alice passionately shared her personal dedication to healthcare interoperability, tracing her journey into the realm of interoperability mandates and their profound impact. She underscored the unique role of these mandates in reshaping the entire business model of the health IT. She explained that she had a deep belief that interoperability can usher in meaningful change, benefiting not only patients but also all stakeholders in the healthcare ecosystem.

At Florida Blue, Alice and her team stood at the forefront of CMS mandate compliance, actively participating in industry workgroups like Da Vinci to ensure alignment with industry standards and drive positive transformation.

The discussion swiftly transitioned to the impact of policy developments, particularly CMS mandates, on payers in the healthcare technology landscape. Alice offered her perspective, tracing the lineage of mandates back to CMS's Meaningful Use initiative. She painted a vivid picture of a rapidly evolving regulatory landscape, touching upon mandates such as the transparency and coverage mandate and the no-surprises act. Alice emphasized the vital role of industry involvement in effectively influencing and navigating these transformative regulations.

Ken questioned the philosophy of merely checking the regulatory box and explored why organizations, including Florida Blue, should invest additional time and resources in healthcare technology. Alice passionately responded, underlining that the healthcare technology industry's business model is undergoing a profound shift. She explained that compliance with mandates like USCDI creates opportunities, such as payer-to-payer data exchange, but real value emerges from leveraging data to benefit members, lower costs, and enhance quality.

The trio ventured into the thrilling domain of artificial intelligence (AI) in healthcare technology. Ken and Jocelyn recognized the potential and challenges AI presents. Alice joined in, envisioning AI's role in transforming unstructured data into structured data, thus enhancing data quality and interoperability in healthcare technology.

Alice and Jocelyn delved deeper into the pivotal topic of data quality, acknowledging the healthcare technology industry's historical shortcomings. Alice stressed the need for a universal standard and the challenges posed by unstructured data. She discussed how regulations accelerated data exchange but also emphasized the significance of data stewardship and accountability in healthcare technology.

This dynamic conversation encapsulated these crucial healthcare technology themes, painting a vivid picture of an industry undergoing unprecedented transformation. As Ken, Jocelyn, and Alice shared their insights, they collectively illuminated a path forward—one where interoperability, data quality, AI and consent management converge to progress healthcare towards a more patient-centered approach. 

The podcast culminated with a valuable reminder from Alice and Jocelyn for healthcare technology professionals to actively engage in industry workgroups and partake in the ongoing transformation of healthcare data sharing and interoperability. They championed a collaborative approach, where both business and IT partners collaborate effectively to navigate the evolving healthcare technology landscape.

In closing, Ken expressed his gratitude to his guests, Jocelyn Keegan and Alice O'Carroll, for their passionate insights and engagement in the healthcare technology discussion. He also extended his thanks to the audience for tuning in and invited them to stay updated with future podcast episodes across various platforms as the dynamic field of health IT and healthcare technology continues to evolve.

Listen and Subscribe to Our Podcast

"The Dish on Health IT"

Engaging discussion around Health IT with perspectives from across the healthcare landscape. This informative and entertaining rotating panel of senior health IT consultants and their guests will keep you in the know about the latest innovations, policies and industry shifts impacting healthcare and point out the opportunities that lie within.

The Dish on Health IT

Subscribe on:
Apple Podcasts 
Google Podcasts