How health plans can adapt their core strategies and turn regulatory challenges into new interoperability opportunities

How to turn new regulations into opportunities

The Centers for Medicare & Medicaid Services (CMS) recently issued the Interoperability and Patient Access final rule to increase consumers’ access to their healthcare data. But the benefits of meeting interoperability standards go beyond compliance; IT infrastructure transformation can help organizations unlock siloed data and improve outcomes for members.

The data transparency brought on by the Interoperability rule is creating a new collaborative dynamic between payers and providers, improving patient experiences and health outcomes. Payers are using data analytics, machine learning, and artificial intelligence (AI) to gain real-time member health insights and share them with network providers to improve health plan performance.

Opportunities for payers

Under the new CMS regulations, states will be required to start sharing Medicare and Medicaid enrollment data with beneficiaries daily. Increased data accessibility will not only ensure better care coordination, but it will also allow patients to monitor the services they receive and the costs they incur.

The new mandates will help healthcare information flow more freely between payers, providers, and members, and increased data fluidity helps payers in multiple ways:

• Payers can identify member health trends, perform risk-based segmentation, and create interventions to proactively meet healthcare needs.
• Nearly two-thirds of U.S. physicians feel burned out and distracted from providing direct patient care. Interoperability means payers can offer intelligent, actionable insights to providers at the point of care, improving the quality of interactions between providers and members and reducing burnout.
• Payers can support more member education and outreach initiatives to improve health outcomes.
• Improved care coordination and care management can improve quality measures such as HEDIS and Medicare Star Ratings. Higher ratings can make health plans competitive, and increased reimbursements from improved performance can be invested in new infrastructure which can further improve enrollments and member experience.

How can payers achieve true data interoperability?

Payers can leverage the momentum from the move towards interoperability to drive additional improvement in the data exchange process. They need easy access to integrated, standardized, and high-quality clinical data. Innovaccer can help payer organizations achieve true interoperability and increase access to healthcare data with its one-of-a-kind enterprise data platform. The platform can help payers accomplish:

• Interoperability beyond compliance: In addition to patient access, provider directory APIs, and CMS payer-to-payer data exchange requirements, the platform supports customized workflows and cross-system connectivity.
• Fully managed, developer ready deployment: The platform’s managed services model includes an interactive developer sandbox and a marketplace hosting environment to ensure that desired outcomes are achieved.
• Two-way interoperability: Payers can directly integrate data from EMRs and export it through FHIR—or any standard format—for bidirectional exchange of high-quality data.
• Enterprise security: Payers can leverage PHI/PII security beyond OAuth and OpenID authentication, including ACL and security-specific attribution for access control, as well as HIPAA and ISO compliance with regular vendor validation.

Health plan members ultimately want high-quality care at low costs. With the new CMS regulations, patients will now have more control over their personal data and overall care journeys. As a result, value-based quality and cost objectives will be fulfilled.

The Interoperability and Patient Access final rule is more than another compliance checkbox; it’s an opportunity to overcome the preventable challenges of siloed data and healthcare redundancies. Innovaccer’s Enterprise Data Platform meets the new CMS standards, and in doing so, it increases data liquidity so payers can give patients and providers secure access to health information and more control over their healthcare.