Claims from the Payer’s Perspective: Through the Looking Glass
Presentation Abstract: The role of the traditional health plan is changing. Long gone are the established practices of managing healthcare – resource-focused. Today, payers are shifting away from strict cost containment and focusing on managing health through member-focused and provider-aligned processes and data. Step through the looking glass as this session explores the importance of documentation and claims coding to communicating the nuances of your patients and care delivery to the people who pay you. You will be introduced to mega-trends underway due to expanding consumer expectations to have value in healthcare.
Educational Learning Objectives: By the end of the presentation, attendees will be able to:
1. Explain the operations of a health plan as a counterpoint to the medical practice and hospitals.
2. Identify emerging operations being designed to transform payers into health value management organizations.
3. Discuss the view of health care from provider-specific roles to harmonized objectives with health plans.
Speaker Full Name and Credentials: Adele Allison
Speaker Title / Company Info: Sr. Director of Economics and Digital Health Strategy
Speaker BIO: As the senior director of economics and digital health strategy, Adele Allison monitors healthcare economics, data interoperability and digital health for SS&C Health as a health data and interoperability legislative/regulatory subject matter expert. Having served as the co-chair of the HHS ONC Beacon-EHR Vendor Affinity Group, Adele currently serves on the HHS WEDI board of directors and is co-chair for the WEDI Payment Models Workgroup. Adele has nearly 30 years of healthcare experience and is an active participant with HHS’ HCPLAN and regional HIMSS interoperability education. A published author, Adele is a member of UAB’s health informatics advisory board on curriculum development and served on UAB’s HITECH Committee for health IT curriculum development; and, is president of Alabama HIMSS.
Advancing Leaders. Advancing Practices
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