Transcript

Matt Becker (VP of Interoperability, NOTU — MC):

Well, good morning and good afternoon everyone. Uh, my name is Matt Becker. I’m the VP of interoperability at NOTU and I am proud to be your MC for this discussion. Uh, couple of logistics before we get started. We have muted the audience. You will see a Q&A section between the chat and the people on top of your team’s meeting and that is where you can insert your questions. We will have time for questions at the end of the event. Um so make sure as you go along and you think of things that you want to ask us or you want follow up on, please let us know within that Q&A section. Um we will triage and address that during the Q&A portion of the webinar. And the recording will be available for folks uh to review after this call. Uh if we can move to the next slide.

So today we’re talking about a really important topic which is the CMS digital health ecosystem uh which is your moment to lead. Uh I am joined by Teresa Bell who is our co-founder and president as well as Dr. Peter Shook who is our chief health officer at NO2. Um and you can move to the next slide.

Just a quick agenda for today. Um what is you’ve heard a lot of of about of about of about of about probably the events that have happened and the pledge itself. So we’re going to level set on what is happening and understanding the market forces that led us here. Um and then go into detail about what the CMS health ecosystem initiative is. Um so understanding that initiative and and what your role is in that uh why is it different than the things that have come before uh and what makes this important especially at this moment in time as well as the requirements for the CMS initiative for networks EHR vendors and HIT vendors. Uh then we will get into timelines and next steps and then Q&A.

With that, I’m going to hand it over to our co-founder and president, Teresa Bell, to talk more uh about the initiative itself and how we got here.

Teresa Bell (Co-Founder & President):

Thank you, Matt. And on behalf of NOTU, myself, and all of the staff at NOTU, we want to thank everyone for taking time today, especially on short notice to be here as part of this very important call. We are represented by a very large audience. We have close to 50 different EHR and health technology platform vendors that have joined us which indicates the support, urgency and obligation all of us feel towards our healthcare system. When I founded the company over 13 years ago, we were founded with the mission of democratizing healthcare communication. I always say to the team connect all four corners of healthcare. Democratization has been and continues to be realized by our technology, our focus to the overlooked markets, our go to market, our advocacy, and more. But most importantly, our focus has been to the provider. The broad definition of provider, including physicians, nurses, therapists, EMTs, paramedics, just to name a few. By our focus to the provider, the patient wins. And we have never lost sight of that mission. And now it’s more important than ever as we watch the industry quickly align to fixing our industry’s most expensive and difficult challenges and changing the trae trajectory of our healthcare ecosystem by unlocking opportunities and innovation we have never been able to realize without moving data at scale.

All of this work has prepared us for today. The most important event for healthcare and for our healthcare providers. Why do we say that? Because the group that has the most influence in the industry has joined the initiative. And not only have they joined, they are leading and leading with urgency and intention. And although this is not a mandate, regulation or the like, CMS is calling this a movement. The industry is joining in spades to push the movement and turn the tides quickly. On July 30th, NO2 took the pledge to become a CMS aligned network. Today we will review the details of this pledge and the pledge and the action we are asking you to take. But as our mission indicates all of this on all of us are not here on this call because of the CMS movement or because of some pledge. We are here for our providers and our patients. We are here to do all of our parts in saving our health care system. It is real and it is urgent. And to walk us through and remind us of why we’re on the call is our chief health officer, Dr. Peter Shuck,

Sorry, I’m going to interrupt for just a second. It can folks see the slides. I hearing reports that folks can’t. Um, and we will fit. Thank you. Okay, we’re good. Thank you.

Dr. Peter Shook (Chief Health Officer):

Well, Teresa, thank you very much. Thank you very much, Teresa. I appreciate the opportunity to be here um both at no and on a special day like today. What I can tell you from a provider perspective, um, I’ve spent 38 years now in healthcare, 20 of those as a provider on the front lines delivering care and being responsible for the care uh, of of patients. 18 of those um as a health system executive or physician executive leading health systems through transformations to value based care development of innovative care models connecting the post-accute uh space to the acute care uh facilities operating post-accute facilities and I will tell you as I’ve said before there is no more transformational event that will occur in my lifetime in healthcare than the ability to seamlessly exchange information at scale between providers, between providers and payers, and between providers and patients.

So I hope that while we talk about this on a regular basis and we can become somewhat deaf to the reality over the next 3 to five minutes, I hope that everyone on this call will find their personal mandate because as Teresa mentioned, this is not CMS mandating the need for connectivity, interoperability, data movement at scale. The market demands it. Next slide please, Jess.

The operational realities, the financial realities, um, and the human cost are staggering. Next slide, Jess. I’m going to take you through the big picture. If you look at the GDP, uh, projected for 2024, $28.6 trillion in the US economy. 5.3 trillion of those dollars were spent delivering health care services. CMS accounts for approximately 40 uh to 50% of that spend depending upon what source you look at. 25% of all health care spend is considered waste. Meaning that it has no impact on improving outcomes, improving lifespan, improving coordination of care, or improving patient or provider experience. That amounts to about $596 billion in waste in CMS alone. Next slide.

But just so that you understand that those big numbers are not paralyzing numbers that you can actually be part of a solution, there was an article in JAMAMA over the last several years that broke down healthcare waste into six critical domains. Two of the domains are more indirectly impacted by interoperability or communication at scale. Those domains are pricing and fraud and abuse. But the four main domains accounting for $298 billion of potential healthcare waste are care coordination, failures in care coordination, failures in care delivery, meaning care that should be delivered and wasn’t. Failures and overt treatment, meaning care that was delivered that didn’t need to be delivered. A CT scan that was reordered because the results weren’t available from the emergency room. And then administrative complexity. Administrative complexity being the manual workflows that burden our provers offices, our providers facilities, our agencies, our clinics, and the administrative burden between providers and payers for prior authorization, for payment of claims, for eligibility. And when you look at the purposes of use for clinical information exchange, treatment, payment operations, and individual access can solve care delivery failures and administrative burden in those four areas of significant healthcare waste. Next slide, if you would.

Okay. Apologies. Uh we’re trying to make sure can people see the slides now early indication I’m getting I’m getting thumbs up so it may be a local problem for some individuals. Let’s move to the next slide if we could.

So understanding that this huge problem and huge cost in healthc care waste can be impacted by better communication at scale between providers between providers and payers and providers and patients across those four domains. Additionally, the operational imperative is significant. Healthcare businesses have declining margins from reducing fee for service uh reimbursement and escalating workflow manual workflows that create significant administrative burden and significant unnecessary expense in their business. The movement toward value based care is going to demand connectivity in a way that we here to for have not known. As we increase our emphasis on outcomes reporting to ensure that we’re delivering all the care that needs to be delivered and none that doesn’t, we’re going to need to have a more fasile and complete data exchange. There is lost productivity due to manual workflows that we’ve just come to accept as standard, but we no longer have to accept that. No longer can we afford to. And then perhaps the most profound and troubling for me as a provider, and I use the term provider here not to mean doctors or MDs. I mean everybody who is involved in the front lines taking care of you and me. 6.7 million people providers are expected to exit the industry permanently over the next four years with only 1.9 million providers stepping in to replace them. The number one cited reason is administrative burden. Think about the ability to reduce the administrative burden and address significant provider shortages by improving communication between providers, between providers and payers and between provider and patient. Next slide, please.

Why is provider communication everything? 80% of what I need to make a diagnosis may not even reside in the clinical record that I maintain in my office. It may be siloed in another provider’s record that I need access to. Why is that important? Because now an average Medicare patient sees five to seven providers annually. Some can see up to 20 providers depending upon the severity and complexity of their illnesses. So we’ve got a much more fragmented health care ecosystem that puts a premium on communication at the point of care. The average Medicare beneficiary is on five plus medications. So there is an unbelievable burden to understand a complete medication and allergy list in order to avoid adverse drug events that actually cause morbidity and mortality. So let’s move to the next slide.

And if you haven’t yet found your mandate as a business leader, as somebody providing assistance to businesses through technology, as a provider, I hope you’ll find it here as a patient. The human impact is overwhelming. Not only are we talking about a poor provider experience or poor patient experience and patient frustration, we’re actually talking about at the most conservative end of the scale 15 to 30,000 preventable deaths directly attributable to failures in communication. Meaning I don’t have the entire clinical record or the critical clinical record I need and someone dies as a result of care not given care given that was not appropriate or care given that caused significant harm. More less conservative estimates have that ranging between 50 and 175,000 because it includes a number that are indirectly attributable to failures in communication. Adverse drug events alone cause 7 to 20,000 deaths per year. These are failures to have a comprehensive medication and allergy list present at the point of care leading to prescription errors, drug drug interactions that drive in addition to 7,000 to 20,000 deaths a year, 500,000 unnecessary admissions, and over 600,000 unnecessary emergency room visits. And remember, I’m talking about the human cost here. And I’m not talking to you about the financial impact of this. I’m talking to you about lives that are lost. People that pass prematurely because providers can’t talk to one another because we don’t have the ability to share information at scale at the point of care when critical decisions need to be made.

To make this a bit more real for you, you are 2,000 times more likely to die from a preventable cause related to communication failures in healthcare than you are to die in a plane crash. A 100 times more likely to die a preventable death in health care related to communication failure than you are to be struck by lightning. And you’re about at equal risk to die a preventable death in health care as you are of getting in a car and not making it home. One in 30 131,000 one out of every 131,000 outpatient deaths is attributable to an adverse drug event because a comprehensive medication list was not available. There are more than 131 people on this call. That means one of you may not be here next year because your providers didn’t have a complete comprehensive clinical record inclusive of a comprehensive medication list.

So as I close my comments, it’s clear to me as a provider and I hope clear to you that while CMS is calling this a movement, this data is the mandate. This data is the mandate. If you’ll close your eyes with me for 30 seconds, and I want you to picture that warm holiday gathering for Thanksgiving, where the kids are coming home from college, the kids are coming home from far away and bringing the grandchildren, and you’re having an opportunity to sit with people you haven’t seen for the longest time. Which one of you is going to have an empty seat at the table this year and in the years forthcoming because we didn’t take our opportunity to correct this problem. It’s completely preventable. The technology exists today and I am thankful for the CMS initiative to be a convenor, an aligner and an accelerant to the work that we’ve been engaged in for some time. And I hope that you will feel equally impacted and mandated not by CMS but by the data we’ve presented before you that we can’t ignore, namely the human cost. Terresa

Teresa Bell:

And I’m mute it. U next slide Jess.

The as Dr. touched on although this is a this is a movement by CMS and not a mandate that’s a question that’s been asked of me is this going to be a regulation are we going to get incentives and understand why those questions get asked that the healthc care is requiring this as a mandate we have to do we have to make changes but there are also other reasons why this initiative is so different obviously CMS’s involvement for those that have been in the industry long enough uh with the cures act and with conditions of participation and other activity where I would say CMS has lightly dipped their toe into the activity. This is completely different. And as the largest payer controlling over 50% of the reimbursement in healthcare, they have the ability to move an industry and move an industry very quickly. And clearly by the speed in which they moved just in 2025, they have the political will, the will to push this forward and see the change because they know it has to occur. We will run out of money in Medicare in the in 2030. If we do not address this and address it head-on. In addition, they are bringing forward huge resource unlike we’ve seen before to create infrastructure changes on the CMS side. We’ll touch on those to show their commitment to leading this industry through. What I will say that’s most important is this isn’t a technology initiative. Unlike the important work we’ve done and continue to work do in TEFLA like unlike what we’ve done in carrot quality and other initiatives, this isn’t a technology initiative. CMS recognizes that about 90% of the technology already exists and they’re going to bring 10% to bear and it’s a big 10% to finally remove the barriers that stand in place today in presenting transparency. So this initiative is very different and it’s here to change here to and it’s here to stay. Excuse me. It’s not going to change. It is pushing forward. Next slide.

So what is CMS doing? What are they focused to? As I mentioned, they’re not focused to the technology. They’re not even focused to themselves. They are focused to provider and patient access and transparency. It was very clear in all of the message. This is their focus. What I call the bill of rights, the provider’s bill of right to be able to gain access to clinical information at the point of care across the continuum. No more portals. They call it axe the facts. Get rid of this. Give it to me at the point of care at the time that I need it. Also allow me to choose whatever systems I want to use as a provider to deliver clinical care. But the obligation by the provider is that they must open up their system. So through their electronic health record, through the other technologies, they must open it up to other providers, patients and payers and valuebased care programs to be able to access clinical information on demand for the patient because it’s all about the patient at the end of the day. By focusing to the provider, we fix the challenges for the patient and the patient’s bill of rights. They will have complete and unrestricted access to their clinical information across the continuum. They won’t have to log in individually to patient portals to go gain access to their information. They will also be able to have visibility to who has seen their information across the continuum. So these are the two things driving I’ll say access and transparency. Those are words you’re going to hear hear me use, not about technology that CMS is pushing hard on for the patient and for the provider. Next slide.

This slide is meant to show how CMS is looking at building out this digital ecosystem. They are putting a huge amount of emphasis on CMS aligned networks. NO2 is one of those and took the pledge to become a CMS aligned network. Through CMS online networks, EHRs, hit platforms, patient engagement platforms, payers gain access to the rest of the ecosystem. Providers and patients through the technologies that they choose such as the EHR vendor that they choose gain access to a CMS aligned network to gain access to the rest of the ecosystem. These are the fundamental building blocks that CMS has put forward. These are requirements for everyone in the ecosystem, including patients. Choosing applications that are connected to a CMS align network. Next slide.

No two is at the table on purpose. CMS has recognized and I had the privilege of presenting on June 3rd and then again taking the pledge on July 30th because NOTU is recognized as the largest communication network in the United States. It has to do with our core mission that we’ve been purposely pursuing for 13 years and getting to representing over 15 million providers and 150,000 provider organizations through our EHR and HIT partnerships. That is a huge number and it represents about 78% of the patients records for Medicare and Medicaid patient. So today, if a Medicare patient was going to go query for their records, they would see a large set of records from health systems, they would see a subset of records from their physicians and they would not see the results from the audience that’s represented on the phone today. Thus, the reason for our call to action is we have to break down those barriers and we have to break it down quickly. That is why no CMS has continued to be invite no to sit at the table and why we continue to extend that to our partnerships to make sure we’re advocating at the highest level. Next slide.

So to get more in specific on what CMS is doing, CMS is very intentional in what they’re bringing forward. They’re moving fast, but it is very deliberate to access and transparency for patients and providers. So first of all, they’re overseeing the initiative. We’re actively working into workg groups to see this initiative roll out over the next year and a half. They are enabling a provider directory at scale. This is not a replacement for the directories that exist in the networks as you guys know them today for TEFA Care Quality. This is an aggregated directory that sits at the national level through CMS that lists out providers, which we’re gaining definition to that lists out providers nationally so patients can track their information and providers can find other providers to be able to know how to communicate with them. This is not a new initiative for a new technical framework or or network framework. This is an aggregate directory of communication endpoints that providers have today. They’re also committing to expanding their data sharing through if for those that are familiar with blue button that is a patient’s right and access to their claims data through CMS they’re going to continue to expand that and CMS officially stated they are going to choose a trust framework to connect to which that means through a CMS aligned network you will have access to a trust framework in which CMS has connect has chosen to be able to query and be able to communicate ate with CMS at scale. Lastly, and possibly the most important is they’re revamping and enabling a digital market ecosystem for Medicare and Medicaid patients to be able to go to medicare.gov and be able to get access to their clinical information, be able to locate their clinical information, and also be able to identify things such as digital health apps that help them to navigate their care. They will list it. So, no longer going out to my app store on my Apple phone to hopefully find an app. CMS for those CMS approved applications will be making this available to to Medicare Advantage patients as long as those uh as long as those technologies are connected to a CMS online network. So, they’re putting huge resource behind all of these different movements again to bring transparency and access to patients and providers across the ecosystem. Next slide.

What are we doing? So when we took the pledge, we reviewed the details in consideration before taking the pledge to make sure that we could take it on and we quickly saw that as part of our commitment to futurep proof our partners, we would have to do this and bring it to bear quickly. So what are we already doing? These are the things that you are familiar with through our communication API which we very much focus to making things easy as our futurep proof commitment through the communication and directory APIs. No already supports patient access via our partners for 2. We also pro support provider and patient access or individual access services through find and respond at a national level. We have a privacy first record locator service called precheck. We also have directory integ integrations to every network that we’ve connected to, making them available to you and to your providers to be able to locate other providers. We also support plug-and-play facilitated fire. Today, we do that for the patient. And of course, we have audit transparency and audit logging that sits throughout the system. Next slide.

What are we going to do as part of our pledge? Where is where is no to expanding? But through our communication API and as our commitment to to the extent we possibly can, we will normalize every connection we make and every feature we bring forward through the noto communication API and our directory. First of all, as you may have seen the announcement, we have a very unique relationship with Clear, which will likely be one of Medicare’s approved identity verification vendors to meet the IAL2 requirements for patient and provider identity verification objectives. We are we are working closely with CMS to understand the definition of provider and how expansive that is. But what we do know is that it will go beyond a physician requirement for identity verification. It will go beyond that. And as we learn to understand more and we expanded our relationship with clear, we will bring these services to our providers and to our partners. Secondarily, we will be expanding our find and respond part of our communication API to support payer and operations purposes of use. That is specifically called out in the interoperability framework from CMS that payers BBC organizations will have access for care gaps quality measures and 60 days in a rear of claim support to be able to query EHR vendors thus providers for this information. Third, we will also expand out our data sources. So, as we look at the expansion of the blue button and other opportunities with payers making claims and clinical data available to patients and providers, you will find the expansion of this through our find and respond API. CMS also called out real-time encounter events. They call it signals for inpatient, outpatient, and teleaalth events. No two will enable the submission of these events from your EHR through our send and receive. We call them notifications that will come through the platform. We also support we also support our CMS directory expansion. As mentioned, we already support direct access to the directories of the networks. As CMS brings their directory forward, we will provide quick and easy access to the CMS directory through the NO2 API. We’ll expand our fire support both directly and through partnerships to support the fire initiative as CMS brings more definition to these. Of course, expand our audit transparency. For example, patients being able to access through their partners on demand, being able to see everyone who has access to their records and providing this back through an API. And we will review we will also review the opportunity to bring in the requirement that patients have on their EHR vendors that at the time they they come in for an encounter or they leave a visit that they can hand off clinical information from a local app on their phone their patient record and be able to also get their patient record at the end of an encounter. These are the continued future proofing that we will bring to the communication API and to our directory support to our partners to take the load off you in our in our future proof commitment as a partner of NOTU. Next slide.

So now to get to the details of what are required for EHR partners. So what EHR and we touched on a number of these but these are very specifically called out for support by EHR partners is one the identity proofing of providers through IAL or AAL2 and enabling your providers to be able to use query find through their EHR enable find and respond key for your providers patients for external providers for patients and payers through pre-check to be able to query for their clinical information that is maintained within your electronic health record support as I’d mentioned at the time of an encounter at the close of a visit being able to support the onboarding and offboarding of patient information back directly back to the patient. You also have the requirement to make all of your data available. All your clinical data that that fits within the USCDI version 3. Make it available no matter what the format whether it’s PDF, CDA, fire or some other format. Making that data available through the networks for query and access by the external parties and as mentioned is making encounter events available within 24 hours of the event occurring. So whether it’s a scheduled appointment or a completed event for outpatient, inpatient and teleaalth, making that event aware to the network to make it avail to the broader ecosystem as more details come out for the encounter events. We have a number of partners uh that provide this type of service and these subscription services at scale. We will work closely with CMS and our partners to be able to support these encounter events as we understand more for that for that information. Next slide.

What about the patient? CMS as mentioned is very very focused to patients gaining access to this digital market ecosystem and being able to navigate for applications that they prefer to use that gives them access to their clinical records and also engages in their own personal care coordination letting them take control of their own health. So there are some fundamental requirements for patientf facing apps. They have to support identity proofing again through a through group like clear. They have to meet some of the CMS requirements for things like trial access and at least choose one of the use cases that you see listed below. So kill the clipboard is the ability at the time of check-in. We’ve touched on this multiple times now. At the time of check-in and the time of completion of a visit. Being able to onboard and offboard my clinical record directly with my provider through their EHR conversational AI assistance that patients can go navigate for an AI assisted tool that helps them to personalize based upon their clinical records that they’ve gained gained access to their own care plan and manage their own care. And then of course because of the epidemic that we’re facing into diabetes and obesity prevention and management, the ability to use tools that help me not only manage but prevent diabetes and and obesity, the things that are costing our healthcare ecosystem huge amounts of money. But you’ll notice a common theme between all of these is that they must align to a CMS aligned network and connect through a CMS aligned network on behalf of the patient. Next slide.

So, as we touched on, no two is very committed and remains very committed to making sure that we meet our pledge on your behalf and we continue to work on your behalf. And you’ve seen it through our core principles. We we normalize all connectivity. We talk about democratizing healthcare communication or bringing healthcare communication to all four corners of healthcare. That requires a lot of thought, intentionality in our technology, how we go to market, the types of connectivity and content that we support, making sure we’re affordable to everyone, meeting you where you’re at, because many of our overlooked markets have never received incentive dollars. They’ve never received the kind of incentives that we’ve seen in health systems and so forth. But we are meeting you where you are at to make sure that you can participate. And we continue to uphold our futurep proof commitment that no matter what the industry moves to and as it expands in initiatives like this, we will make sure you are covered. In addition, our advocacy, especially in the last two years, as led by our chief health officer and and Matt Becker, our our vice president of interoperability, is always advocating for our overlooked markets at the national level. We will continue to do that. Continue to do that through our advocacy in this program through education and education events that are that are soon forthcoming to keep you and your teams up to speed to keep your providers up to speed. And we will continue to be the experts so you don’t have to be and we can give you time back to focus to your clinical workflows and bringing your solutions to life on for the benefit of the patients and the providers. Next slide.

So what is the pledge that we actually took underneath it by the end of this year and and the timelines that were outlined by CMS were very specific to CMS aligned networks and we take we are taking those very seriously. So by the end of the year we anticipate having the full purpose of use for treatment payment operations and individual access available through find and respond part of the communication API. In addition, we will begin to review the identity directory events and value ad access that CMS has outlined so we can quickly bring those forth and educate you and understand the full breadth and depth of what CMS is looking for. By July, and they specifically called out July 4th of 2026, which is the 250th anniversary of the United States, we will make available the CMS directory, identity proofing for providers and patients, event notifications, and value ad access through things such as QR code support through our APIs. All of this to enable our partners that are sitting on this call today and take as much of the burden off your network, off your environments and your technology and your road mapaps and bring it forward through the noto CMS aligned pledge for our network as it continues to expand through the end of 2026. We’ll continue to stay engaged and this is not just a technology play for us. This is advocacy. This will lend itself to legal education and support and we will make sure we continue to fulfill our support of you as a partner and make sure you are well aligned so you’re able to take the pledge. Next slide.

But it’s important to mention that our advocacy in the last 13 years has brought us to where we’re at today. However, we cannot do this without you. This pledge, your pledge, each one of your pledges, your commitment to action is critical because without it, it is hollow. No two’s advocacy can only take us so far. We have to have your participation to maintain our front seat with CMS. If you want to be able to shape the standards and not just follow what is handed to you, you have to take action. We are calling on you to take action today and begin your path forward. Many of you are already well down this path in pushing forward. It’ll also mean your survival competitively as we watch the industry shift and we watch the industry shift in July very very quickly to align themselves to CMS. Your action is required to push forward. We can no longer do this without complete participation from you. Next slide.

So what is our ask of you? Whether you’re an EHR vendor or you’re a technology vendor, patient engagement application, whatever you may be, we are asking for this timeline for engagement. By the end of the year, you have production availability of find and respond for treatment and individual access. Many of you are well down, if not past this path and making this available to your providers. By Q2 of 2026, expand your find and respond to include payment and operations as we provide you more guidance for this. By the end of Q3 of 2026. Support identity identity verification for patients and providers brought to you by NOTU and for directory entry and retrieval for transparency and access by patients and providers by the end of the year. Support events or signals as CMS calls them and value add access as we get more definition by the end of 2026. And then of course in late 2026 moving into 2027 watch our health care system transform. It will be transformational. It will be groundbreaking. This is why this is a movement and not a mandate because it requires every one of us to do it and save our healthcare ecosystem. Next slide.

For those that are considering inaction, you have huge risk with inaction. And this is not fear-mongering. It is because of the amount of movement that we’re already seeing not being included in the CMS directory, meaning not being aware to patients and providers across the ecosystem. It will question your relevance as a technology vendor. It will also question the relevance of the providers that have chosen your technology. It will absolutely impact the referrals as many of you are dependent upon referrals from health systems and providers. And although it’s not stated today, we fully anticipate there will be reimbursement disadvantages that come forward. We don’t know what they are and that shouldn’t be our movement today, but we fully anticipate that the largest purse strings will absolutely start to pull on this. So as we move forward, the risk of inaction is tremendous, including the impact to the healthcare ecosystem. Next slide.

So with that, I’ll hand this to Matt to walk through what are next steps for call to action and want to thank everyone for their time today.

Matt Becker:

Yeah, thank you so much, Teresa. Um, just logistics on next steps. Um, we do have a call to action here. It is to email the email emails you see there, both of those, uh, both health techch RFIHhs.gov and CMS pledge at no um, with an indication of your pledge through the NO2 CMS line network. Um, email us your primary contacts for the initiative. We want to make sure we’re engaged with you throughout the process and as you identify those key stakeholders, we will make sure that we will begin engagement with those teams as we get moving on uh that side of the initiative. Uh so those are your immediate call to action and next steps. Um and if there are questions, please again make sure that they’re in the Q&A uh part of uh teams right now. And we can go to the next slide for Q&A.

And so just some key reminders on the screen. Um some ways to connect with us on the right side. Um and uh just a reminder of no.com and and how to take the pledge. Uh with that we will start the Q&A section.

Q&A

Matt Becker:

Uh and so just to kind of go through this I think one one question is uh for Dr. shook probably. Uh the focus seems to be on Medicare and Medicaid through this. Um what what words do we have for folks that that aren’t necessarily on Medicare and Medicaid or or billing Medicare and Medicaid at this point?

Dr. Peter Shook:

Yeah, I think two things there are of paramount importance. Number one, CMS funds Medicare Advantage plans. Um so the payments not come may not come directly from CMS. They come through a commercial payer that’s administering the Medicare Advantage plan and they are included in this process. Secondly, um they’re looking at at all provider level. Um and um generally speaking, um and I can cite a number of other discreet initiatives uh in my 38 years in healthcare. As CMS moves, so does the rest of the market and private payers, whether it’s related to coverage determinations, um quality measures, those types of things. So I think there is um real impact in the Medicare advantage space right now uh that even though it’s coming uh through private insurers and I think in the future we will see uh other private insurers um kind of follow in line. Um why wouldn’t they want to use a national directory that’s already available of all providers uh uh in the country uh those types of things. So um that that would be my take on it.

Teresa Bell:

Just add to that um and at the event in in Washington DC as part of the pledge uh multiple payers did take the pledge uh so Humanana United Health Etna uh a number of private payers have already taken the pledge to move forward.

Matt Becker:

So going a level deeper into the the pledge itself um in terms of what all data means I think it would be helpful for the audience to understand uh what we mean by all data. The question was specifically around DICCom imaging data, but how that is actually uh going to be adjudicated or if that hasn’t yet.

Teresa Bell:

Yeah, Matt, I’m going to turn to you a little bit on this one. Um, so what’s identified in the interoperability framework is the USCDI version three, uh, which is a core set of data elements. For those that aren’t aware, we can send that out after this. It’s the core set of data and the data that pertains to the care setting in which you have. So it doesn’t mean that you have the complete set of the US CD CDIV3. It’s the care setting in which you pull certain data elements. But if you have it, you need to make it available and it needs to be available in any format. So they’re not dictating it needs to be discrete fire resources or a certain terminology set. Not yet. Uh but they’re dictating that it needs to be available. And maybe you can take the DICOM part, Matt.

Matt Becker:

Of course. I wanted that big picture before we went into specifics, but the DICCom imaging is a little bit more complex and it is not part of USCDI version 3 or any any future version of USCBI that has been published. The reason for that is that uh diagnostic quality imaging is really expensive to transmit at scale. And what we’re seeing on these frameworks is a large large amount of records uh in the billions uh overall being transmitted. And so the expectation is that as technology improves and as we uh are able to do that in a more efficient manner that we would send things like broader imaging studies and things like that but that is not a requirement yet.

So moving on um can we expand on the no portals expectation that we said a little bit earlier?

Teresa Bell:

Yes. I assume that means that the patient because it was both for patients and providers. They mentioned it uh for patients uh they are removing the requirement that patients would have to either by directly logging in or having to use their credentials, their portal credentials through uh like our find API being able to just simply get access to their records after they identity verify using 2 like a clear verification of who they are. Um that that would be sufficient to then send out into the ecosystem be able to query for clinical data. Um but the removal of individual portal requirements or those loginins uh is foundational to patient transparency and access. Um they also mentioned that for providers uh without quite the same definition of patients that providers would not have to log into portals to gain access to clinical information maybe at the time of referral or transition of care uh or for other needs uh that they would be able to do that and access clinical information through the system that they chose including their EHR or some other type of system.

Matt Becker:

And then a question I think that’s spring on a couple folks minds is how does this align with TEFLA or where are the intersector aspects of this?

Teresa Bell:

Yep. Great question. So um I I’ll start out with what they did not say. Uh CMS did not say that they have selected TEFLA as their trust framework. However, all the indications are that it is likely TEFLA, including uh as of most recently on Friday, uh Health and Human Services and and the ASTP, which was formerly the ONC, was fully funded. Um and maybe Matt or Dr. Shock, you guys can you can touch on this, but ASP sits as part of Health and Human Services. CMS sits as part of Health and Human Services. Uh and it went remember for a period of time at the beginning of the year there was question on whether TEFA would even survive. Clearly it did. It did not get cut uh including it got fully funded uh as of last Friday.

Dr. Peter Shook:

Yeah I not too much to embellish on that other than it was specifically called out and the chief technical officer uh in ASP was charged with furthering the and accelerating the imple implementation of TEFA. Um, so, uh, I think there is, um, a great momentum in that regard. Again, um, and all indications that I’m hearing, uh, from where I sit are that CMS is likely, uh, to use that, but again, nothing has been definitively decided.

Matt Becker:

So, the the last question in here uh, focuses on smart on fire for uh, patient access and app launch capability. And for folks that just to set set the tone for the question um smart on fire allows uh authentication through the EHR directly like uh like somebody’s uh patient portal um to actually get access to their record through that mechanism through a third party. Uh I think the question if I’m understanding the question correctly it kind of relates to um what does the method look like for patient access under this model and does that include things like authenticating with portal credentials things like that uh to for patients to get access to their data?

Teresa Bell:

Yeah, no comment on that. Um no comment yet forthcoming from from CMS. Um, one thing again I’ll I’ll mention that they’ve been very clear to supporting multiple technologies as the initiative uh for patient access um including things like individual access services through through TEFA. Um but no comment yet as it relates to Smart on Fire. More to come.

Matt Becker:

All right. Um and Jess, if you could move back to the previous slide so folks can see uh how to pledge. Um, and if there are any more questions, please put them in the Q&A, but that is the the number of questions that we have received so far. We will also be sending out a um follow-up email uh so you don’t have to try to featurely write these uh long email addresses down. We’ll be sending out a follow-up email um for your details on how to take the pledge because wording in the pledge is very important uh so you get listed correctly on the on the CMS website.

Uh thank you. And I think the the other question that just came in is are are all vendors going through NO2 and not and working not working directly with this integration. Does that include uh major EHRs are going through NO2 or is NOT2 essentially uh pushing our partners to pledge through NO2? How does that actually work?

Teresa Bell:

Yep. Uh great question. So uh across the industry partners are going through their CMS aligned network. So whatever CMS aligned network uh they have chosen and the majority of the group on this call have have selected. We do have some some new folks to the call uh but through their CMS aligned network. So for instance uh Epic Health Systems that have Epic uh as their Qen and Epic as their interoperability provider. Epic did take the pledge as a CMS aligned network. Uh they would go through Epic for for that participation. So it’s through your CMS aligned network.

Matt Becker:

All right, I think that is the rest of the Q&A. So Jess, if you could move to the next slide, we’ll wrap this up. Um again, thank you all for joining. Uh you can see ways to connect with us on on your screen here. Um, like Teresa said, we will be putting out an email with a call to action as well uh to make sure that you all have not only the email addresses correct, but also uh kind of recommendations around um how to how to frame that and and how to frame that within your organization and outwards. So again, thank you all uh for for joining us today. Uh we really appreciate the engagement. We really appreciate the questions. Uh and we will look forward to working with you as you appoint point appoint people to this on uh the next level down and next steps to actually make this in this movement into reality. So thank you all.

Teresa Bell: Thank you.

Dr. Peter Shook: Thank you.