Payer Data Exchange Implementation Guide 1 Da Vinci

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Payer Data Exchange Implementation Guide 1 #Da. Vinci. Project #PDEx | #Connectathon

Payer Data Exchange Implementation Guide 1 #Da. Vinci. Project #PDEx | #Connectathon

Mark Scrimshire CMS Blue Button Innovator Payer Data Exchange Co-chair 2 #Da. Vinci. Project

Mark Scrimshire CMS Blue Button Innovator Payer Data Exchange Co-chair 2 #Da. Vinci. Project #PDEx | #Connectathon

3 on 4 3 Payer Data Exchange (PDEx) Implementation Guides Based on HL 7

3 on 4 3 Payer Data Exchange (PDEx) Implementation Guides Based on HL 7 FHIR Release 3 #Da. Vinci. Project #PDEx | #Connectathon 4

PDEx Design Principles • Avoid Profile Proliferation • Prefer use of FHIR R 4

PDEx Design Principles • Avoid Profile Proliferation • Prefer use of FHIR R 4 -based version of US Core • Share Da Vinci profiles and methods in HREx IG • Leverage Standard Authorization Protocols • OAuth 2. 0 • SMART App Launch Framework 4 #Da. Vinci. Project #PDEx | #Connectathon

PDEx Design Influences • CMS Interoperability and Patient Access Proposed Rule • Blue Button

PDEx Design Influences • CMS Interoperability and Patient Access Proposed Rule • Blue Button 2. 0 5 #Da. Vinci. Project #PDEx | #Connectathon

3 Guides For Payer Data Exchange 1. Payer Data Exchange (PDEx) 2. PDEx Formulary

3 Guides For Payer Data Exchange 1. Payer Data Exchange (PDEx) 2. PDEx Formulary 3. PDEx Plan Net Directory 6 #Da. Vinci. Project #PDEx | #Connectathon

3 Scenarios supported by PDEx: • Provider originated request to Health Plan: “Tell me

3 Scenarios supported by PDEx: • Provider originated request to Health Plan: “Tell me about your member that I am treating” • Member Shares with New Health Plan • Member Shares with Third Party App 7 #Da. Vinci. Project #PDEx | #Connectathon

Provider <> Health Plan 1. 2. 3. 4. 5. 8 EMR SMART App calls

Provider <> Health Plan 1. 2. 3. 4. 5. 8 EMR SMART App calls to CDS Hook at Health Plan matches to member CDS Hook CARD response returned SMART App presents member info and provider selects data to commit to EMR #Da. Vinci. Project #PDEx | #Connectathon

Member Directed Sharing Modeled on Blue Button 2. 0 1. Member login to New

Member Directed Sharing Modeled on Blue Button 2. 0 1. Member login to New Health Plan or 3 rd Party App 2. Member Authentication to Old Health Plan 3. Member Authorizes sharing 4. OAuth 2. 0 Access Token issued 5. New Health Plan or 3 rd Party App query Old Health Plan API 9 #Da. Vinci. Project #PDEx | #Connectathon

PDEx Formulary • Making Drug Formulary available Via API to Consumers • Understand Copays

PDEx Formulary • Making Drug Formulary available Via API to Consumers • Understand Copays • Compare Across Plans 10 #Da. Vinci. Project #PDEx | #Connectathon

PDEx Payer Network Directory • Insurance Plans • Associated Networks • Organizations • Providers

PDEx Payer Network Directory • Insurance Plans • Associated Networks • Organizations • Providers • Services 11 #Da. Vinci. Project #PDEx | #Connectathon

Alternate Member Information Sharing Flow • Potential addition to Health Record Exchange IG •

Alternate Member Information Sharing Flow • Potential addition to Health Record Exchange IG • Member Match function • Pre-cursor to multiple Da Vinci Use Cases • Currently gathering data from payers to develop a suitable FHIR operation 12 #Da. Vinci. Project #PDEx | #Connectathon

PDEx Workgroup Meeting Fridays at Noon– 1 pm ET 13 #Da. Vinci. Project #PDEx

PDEx Workgroup Meeting Fridays at Noon– 1 pm ET 13 #Da. Vinci. Project #PDEx | #Connectathon