Donald Rucker, MD is Chief Strategy Officer for 1upHealth, where he is helping to set the direction for the company’s ongoing innovations in FHIR-enabled computing and bring these to customers to help them meet the evolving clinical, technical, and reimbursement demands for modern data. Prior to 1upHealth, Dr. Rucker was the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, where he led the formulation of the federal health IT strategy and coordinates federal health IT policies, standards, programs, and investments. As part of his tenure with ONC, he led the development and issuance of the 21st Century Cures Act Final Rule, a pivotal mandate supporting patient access and interoperability of health data.
The go-to mechanisms for differential payment – network design, case management, quality measurement and prior authorization – increasingly rely on APIs capable of handling not only claims data but, more importantly, the clinical data critical to intelligent decision-making.
Picture each patient with a computational model of their health where each treatable parameter (like weight, blood pressure, heart rate, exercise, inflammation, and blood chemistry) serves both as a marker for diagnosis and as an opportunity for treatment.
Zelis highlights how employers, payers, and consumers are integrating digital tools to manage healthcare costs.
We know from everyday purchasing of goods and services that you have to combine what you’re getting with what you’re paying for that good or service. But how does this basic consumer supplier concept play out in US healthcare?
As the industry embarks on this fundamental transformation, a few key questions must be answered.