The Wall Street Journal and other leading publications are reporting that plans are afoot in Washington to issue a pricing transparency mandate that will affect how Americans shop for, receive, and pay for healthcare services in America. According to the reporting, the White House is developing a strategy aimed at bending the healthcare cost-curve by giving consumers greater access to healthcare pricing before they receive services.

The mandate is expected to require insurers to publicize the negotiated rates they pay for services, and require hospitals and physicians to provide patients with a "total price for care" before consumers receive services. It builds on a mandate that took effect in January, which required hospitals to post their prices online. The goal: bring greater transparency to the healthcare market for consumers, so they can make better choices.

We asked Bill Krause, VP of Experience Solutions, to help us understand Change Healthcare’s perspective on this news, and on the issues of price transparency and consumer engagement overall. We also asked Bill to share his advice to payers and providers who are following this news and challenged by the increasing "retailization" of healthcare.

On today's show, we discuss:

• The connection between price transparency and value-based care (02:37)
• What healthcare transparency means and the issues it poses to consumers (04:24)
• Why price transparency and consumer engagement are inseparable (08:17)
• What solutions are available today to help payers and providers meet these anticipated requirements (11:38)
• Transparency and consumer engagement innovations Change Healthcare is working on (14:07)
• An update on the Change Healthcare-Adobe-Microsoft partnership (16:28)
• What the retailization of healthcare means for payers, providers, and patients (18:43)
• What payers, providers, and employers can do immediately to help move the needle on price transparency and consumer engagement (23:00)

Episode Resources

1. Contact Bill Krause
2. Price Transparency in Healthcare
3. Practical Innovation
4. Change Healthcare 2019 Consumer Insights Report
5. Change Healthcare True View
6. Change Healthcare Patient Access Suite
7. Change Healthcare Clearance Estimator
8. Change Healthcare Clearance Authorization
9. MDsave website
10. Change Healthcare makes strategic investment in MDsave
11. Change Healthcare partners with Adobe and Microsoft
12. Wall Street Journal: White House wants patients to know healthcare prices up front (5/15)
13. Wall Street Journal: Trump administration preparing executive order on health-cost disclosure (5/24)

Show Resources

• SUBSCRIBE to the podcast using any podcatcher or RSS reader
• Download the audio and listen offline
• Get the iOS app
• Get the Android app
• Suggest or become a guest

Today, over 12 million individuals are enrolled in both Medicaid and Medicare. These “dual eligible” individuals typically have high rates of chronic illness, many with multiple chronic conditions and/or social risk factors.

In a recent letter to state Medicaid directors, the Centers for Medicare and Medicaid services (CMS) outlined ten opportunities to better serve dual eligible populations. These opportunities are the result of new developments in managed care, Medicare data sharing, and reducing administrative burden for dual-eligibles and their providers.

CMS is encouraging states to take advantage of these opportunities to create more seamless experiences for dual-eligibles and to improve how both the Medicare and Medicaid programs work together.

In this edition of Episode Intelligence, Vicki Jessup, director of government relations for Change Healthcare, shares insights into what the opportunities outlined by CMS mean to states, health plans, and their members with Keslie Crichton, VP of sales for Change Healthcare’s member engagement and dual eligible solutions.

In today's show they discuss:

• How the opportunities outlined by CMS impact Medicare Advantage plans and members (02:10)
• How more frequent data exchange improves coverage and payment accuracy (04:37)
• The meaning of and opportunities surrounding Medicare Part A buy-in enrollment (08:33)
• How some states are simplifying eligibility and enrollment for Medicare savings programs (12:11)

Related Resources

1. SUBSCRIBE to the podcast using any podcatcher or RSS reader
2. Download the audio and listen offline
3. Get the iOS app
4. Get the Android app
5. Change Healthcare Fuses Artificial and Human Intelligence for Medicare Advantage Dual Eligibility and Enrollment
6. Blending AI and Behavioral Science to Improve Dual Eligibility Advocacy
7. Dual Enrollment and Recertification
8. Dual Enrollment Advocate™ & Recert Complete®
9. The State of Value-Based Care in 2018
10. Value-Based Care in America: State by State
11. Suggest or become a guest

Blockchain offers significant potential for transforming healthcare processes, but few concepts have moved from just a vision to a stage where true benefits can be realized. That’s about to change. At HIMSS, Change Healthcare will be introducing a new Payments Blockchain proof-of-concept (PoC) which was developed by our provider payments team. The re-engineered payment process is powered by a distributed ledger, and is designed to reduce the disparate entries that exist in today’s disconnected and legacy payment processes. The Payments Blockchain PoC kicks open the door for a streamlined, smart, and secure payment process that payers and providers can only dream about today. On today’s show, we interview the Change Healthcare and Digital Asset team that’s come together to build this new Payments Blockchain. On the panel: Gopi Devalcheruvu, the vice president of technology for Change Healthcare; Vinod Nair, the director of product management for Change Healthcare; and Dan O’Prey, chief marketing officer for Digital Asset. Listen now to hear what this group of experts has to say about blockchain for healthcare. The panel discusses: The backstory and development of the Payments Blockchain proof-of-concept How the Payments Blockchain works What the future of healthcare payment might look like Predictions for the evolution of blockchain in healthcare The payment blockchain’s potential for encouraging a wave of new capabilities for payers, providers, and partners How the Payments Blockchain is enabled by the Change Healthcare payment network Related Resources SUBSCRIBE to the podcast using any podcatcher or RSS reader Download the audio and listen offline Get the iOS app Get the Android app Infographic illustrating the Payments Blockchain process Change Healthcare facts (contains the metrics referenced in the podcast) Change Healthcare website Digital Asset website DAML website Suggest or become a guest

It’s no secret that healthcare costs are out of control for consumers. But what can get lost in the shuffle is how these costs affect employers, who want their employees to be covered with better healthcare. Some could argue that healthcare cost-containment is one of the most important pillars of the healthcare equation, and that employers can be a key factor in bending this cost curve. Yet it’s worth noting that since 2013, premiums for employer-sponsored healthcare coverage for families have escalated more than 22%, to reach almost $20,000 per year on average. This upward trend has renewed interest from employers in alternative payment models. The nonprofit Catalyst for Payment Reform (CPR), which provides guidance into the efforts of employers to drive increased healthcare value, is helping close that gap. And as some companies now opt to go directly to providers—bypassing health plans and cutting out the middleman—they certainly could benefit from an expert perspective. In this edition of Episode Intelligence, we spoke with CPR Executive Director Suzanne Delbanco, who expanded on her organization’s work with Rob Capobianco, Change Healthcare VP of Value Based Payments. In today's show they discuss: How working to promote payment reform is a means of improving healthcare value (01:08) How payment reform progress is measured (04:41) What healthcare purchasers want from their health plans (11:40) The transition from fee-for-service and progress of bundled payments (15:05) Related Resources SUBSCRIBE to the podcast using any podcatcher or RSS reader Download the audio and listen offline Get the iOS app Get the Android app The State of Value-Based Care in 2018 Suggest or become a guest

Representatives from CMS just announced a policy shift regarding mandated alternative payment models. HHS Secretary Alex Azar said the administration would “revisit” mandatory models that it had previously abandoned in cardiac care, noting the time had come for “exploring new and improved episode-based models in other areas, including radiation oncology.” To understand the impact this policy shift might have on payers and providers, Patrick McGuigan, Producer of Episode Intelligence, connected with Dr. Andrei Gonzales, who leads the product development efforts for Change Healthcare’s value-based payment solutions. In this interview, they discuss: What CMS is introducing and why it’s generating so much news [00:23] What this means for commercial health plans [02:40] What health plans should be doing now to prepare for this change [04:46] How providers are reacting to this news, and how they can prepare for a future that includes mandatory payment models [06:03] Related Resources SUBSCRIBE to the podcast using any podcatcher or RSS reader Download the audio and listen offline Get the iOS app Get the Android app Suggest or become a guest

Primary care physicians (PCPs) are in the best position to coordinate patient care, because they understand their patients' unique needs. But knowing which specialists can deliver the most effective care when a referral is required can challenge even the most experienced PCP. That's because PCPs rarely have insight into the costs and quality of care delivered by other providers. Lacking this evidence, they have no alternative but to base referrals on personal experience, professional recommendations, doctor ratings, and patient requests. This is changing, however, thanks to a new approach called “episode intelligence.” Using HIT analytics, episodes of care are analyzed to identify physicians and facilities that can deliver the most effective care throughout a course of treatment. One innovative organization using episode intelligence is Tandigm Health, a value-based healthcare company supporting primary care physicians. Heading Tandigm’s effort is Director of Informatics Tony Tedesco, an early adopter of the technology. Tedesco is using it to help PCPs improve patient referrals, measurably helping them deliver higher quality care at a lower cost. In this interview, Tedesco talks about: How and why Tandigm is using episode intelligence to put primary care physicians back in charge of patient care The primary care physician's evolving role in coordinating comprehensive care How episode intelligence improves utilization of specialists, which leads to higher-value care Related Resources SUBSCRIBE to the podcast using any podcatcher or RSS reader Download the audio and listen offline Get the iOS app Get the Android app Suggest or become a guest The State of Value-Based Care in 2018

The rise of value-based care and the ongoing evolution of healthcare technology are just two of the many topics the new CEO of America’s Health Insurance Plans (AHIP) says are front and center on his upcoming agenda. AHIP’s Matt Eyles takes a deep dive on those subjects and more while speaking with Rob Capobianco, the head of the Change Healthcare value-based-care analytics team, as part of the Change Healthcare Episode Intelligence podcast series. Matt has more than two decades of healthcare experience in both the private sector and in government. Before joining AHIP, he held senior executive positions at Coventry Health Care, Inc., and Wyeth, and has been a consultant to some of the largest global and U.S. healthcare companies and organizations. Matt began his career at the Congressional Budget Office where he worked on many issues, including healthcare, budget policy, and regulatory policy. Rob and Matt cover a wide range of topics, including: The biggest differences in healthcare policy Eyles has seen in the past ten years Short- and long-term priorities for AHIP The future of value-based care The healthcare technology evolution Related Resources SUBSCRIBE to the podcast using any podcatcher or RSS reader Download the audio and listen offline Get the iOS app Get the Android app Suggest or become a guest The State of Value-Based Care in 2018 Value-Based Reimbursement State-by-State HealthQx Provides Customers the Keys to Cloud Security