Da Vinci Payer Data exchange Implementation Guide Release 0.1.0

This page is part of the Da Vinci Payer Data Exchange (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

4-1 Patient Persona

4-1-1 Provider to Health Plan scenario:

Lauren Dent is a 62-year-old female, living in Wisconsin but she spends winters in Tampa Bay, FL.

Lauren works on a seasonal basis and has just accepted a new position with her employer and has moved to Madison, WI to live with her daughter, leaving her previous home in La Crosse, WI. As a result of the move she has selected a new Primary Care Provider.

Lauren is in reasonable health but is managing a number of conditions:

  • She has been diagnosed as Pre-Diabetic and is being treated with medications.
  • She is taking medication for hypertension.
  • She had a knee replacement 5 years ago.
  • She had a procedure seven years ago to correct a problem with a disc in her lower back.
  • A history of a normal colonoscooy 5 years earlier
  • A history of a pneumovax and zostavax 4 years earlier.

4-1-2 Member/Patient-mediated Payer-to-Payer Exchange:

Arthur Dent is a 68 year old Male.

He has recently switched from Medicare Advantage Plan A and enrolled in Medicare Advantage Plan B.

In this scenario, Arthur has signed up for a new Medicare advantage plan with payer C during the open enrollment period. Before the initiation of his coverage beginning January 1, payer C has established communication with the patient and has provided the patient with a secure log in to the payer C patient portal. Patient continues to have an active login to payer B patient portal.