Since 1996, with the introduction of HIPAA, interoperability has often taken center stage in the healthcare arena. Today, amid new federal regulatory requirements and an unprecedented global pandemic, the importance of – and need to accelerate – the industry’s journey to achieve a truly interoperable and connected healthcare delivery system that supports better patient care and outcomes has never been clearer.
Providers and payers have been working together, alongside healthcare interoperability collaboratives such as The Da Vinci Project, CommonWell Heath Alliance, Carequality and The Sequoia Project, for years on the most effective ways to collect and share data. However, payers have never before been mandated to exchange claims and clinical data with members – that is until March of this year when CMS released its Interoperability and Patient Access final rule doing just that. By July 2021, all Medicare Advantage, Medicaid, CHIP and ACA plans must provide a FHIR-based Patient Access application programming interface (API) and Provider Directory API, as mandated in the final rule as part of the 21st Century Cures Act. By January 2022, health plans must also have in place an API in place to support Payer-to-Payer data exchange.
As we move further in December and toward the end of what has been a year without compare, the next destination on our interoperability journey is clear; however, for many health plans, the path may be less so. An industry readiness survey conducted by the eHealth Initiative in September 2020 found that 43 percent of respondents representing payers, providers and vendors indicated they were most concerned with implementing and maintaining a Patient Access API. Further, a majority reported foreseeing major challenges associated with managing multiple APIs connected to different systems, as regulatory timelines progress. Underscored by the COVID-19 pandemic, there was also consensus among respondents that having too many competing priorities was a top challenge impacting readiness to comply with the upcoming mandates.
While many health plans are still grappling with critical considerations around ensuring data accuracy, completeness and mapping to required formats; security issues related to application authentication and consumer validation; the need for deep expertise in FHIR-based API development, maintenance and integration; patient engagement and the user experience; and much more – the clock continues to tick toward the first regulatory enforcement deadline in July.
The Inovalon Consumer Health Gateway™, a FHIR-based API solution, helps health plans meet ALL major provisions and standards requirements of the Interoperability final rule mandates – safely, rapidly and cost-effectively.
Unlike other solutions in the market, the Inovalon Consumer Health Gateway™ is backed by more than 20 years of experience managing the nation’s most comprehensive dataset, now including more than 58 billion medical events and 324 million unique patients. With deep expertise in clinical and claims data integration and FHIR®-enabled, real-time clinical data exchange models, and proven success delivering innovative, data-driven analytics and technologies, Inovalon delivers a streamlined solution that is easily integrated into the health plan workflow, enabling compliance with all three of the CMS’ data-sharing API mandates while providing a foundation for future consumer engagement and data-sharing initiatives.
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