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Marilyn Tavenner says AHIP stands behind CMS plans for better interoperability

But while she agreed claims data should be available to patients, the devil's in the details.

Susan Morse, Senior Editor

LAS VEGAS – America's Health Insurance Plans CEO Marilyn Tavenner on Tuesday called on all insurers to give patients their claims data electronically.

"I totally agree patients should have access," Tavenner said.

Her statement came in response to an earlier announcement by Centers for Medicare and Medicaid Services Administrator Seema Verma that the agency has plans to improve interoperability.

"I'm 100 percent behind what she had to say," Tavenner said during a lunch at HIMSS18.

But while there remains to be seen exactly how that will play out, Tavenner said health plans such as Blue Shield of California are already working on improving that kind of transparency.

Blue Shield of California on Tuesday announced that beginning this year it will require network providers, including participating accountable care organizations, to agree to participate in Manifest MedEx, a nonprofit health information network that is creating comprehensive, real-time digital health records for all Californians.

Blue Shield is asking its ACO providers to sign a participation agreement with Manifest MedEx by Aug. 31, and for other network providers to do so as a part of their next contract renewal. 

The employer market is stable, Tavenner said, with about 160 to 180 million consumers. But that segment is also changing in approaches.

For example, employers are moving beyond gym membership for wellness initiatives to biometric screenings and having on-site nutritionists, she said. There is also a great deal being done with stress management.

The agenda for the next two years includes promoting value-based insurance design, expanding telehealth, health and wellness benefits in employer-provided coverage, the expanded use of health savings accounts, increased drug price transparency and greater cost transparency.

Prior authorization is another area needing work, she said. The prior authorization process should be simplified in the move to value-based care, she said. If an insurer gives X number of dollars for a surgical procedure, then it doesn't matter if one or four MRIs are ordered. 

"They are doing what is appropriate for the person," she said. "Then you don't need historic prior authorization."

Anthem is currently working with the American Medical Association on a project involving prior authorization she said, without elaborating.

Another area of focus is the opioid epidemic.

"From an economic perspective, the sound bite for me is why does the U.S. have 90 percent of the opioid use?" she said.

Centers for Disease Control and Prevention guidelines on opioid prescribing that have been out for 18 months should be followed, she said. 

Tavenner was a key administrator for the Obama Administration in running CMS as insurers grappled with the Affordable Care Act market.

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