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Consumer Health Gateway

Your Members Need Access. You Need a Secure, Compliant Solution. We’ve Got You Covered.

By July 2021, all Medicare Advantage, Medicaid, CHIP and ACA plans must provide a Patient Access application programming interface (API) and Provider Directory API, as mandated in the final CMS/ONC interoperability rule as part of the 21st Century Cures Act.

Where Does the Path to Compliance Start?

For health plans, there are many considerations when determining your API strategy:

  • Your data must be accurate, complete and easily accessible to rapidly respond to consumer requests.
  • Compliance requires the ability to integrate, merge and map clinical and claims data to industry standards.
  • Application authentication and consumer validation require adherence to specific security standards.
  • Health plans need to consider their role in defining the healthcare consumer experience.
  • Implementation deadlines are looming, and rapid responses to consumer requests are not just expected—they are required.

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With Inovalon Consumer Health Gateway™, an HL7 FHIR® v4.0.1 solution, you can provide your members the secure healthcare data access they need to easily comply with the new requirements. This consumer portal allows the FHIR®-based exchange of an individual patient’s claims and clinical data, securely and seamlessly with authorized third-party applications.

Inovalon Consumer Health Gateway™:

Offers a secure, extensible infrastructure
Provides real-time API responses
Is CMS compliant (FHIR® 4.0, Oauth2, OpenID Connect, CPCDS, USCDI)

The Inovalon Difference

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.
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Leveraging a Healthcare Data Lake for Your API

Inovalon’s Cloud-Based Healthcare Data Lake provides a comprehensive data and analytics ecosystem complemented by extensive data connectivity and reach to more than 700,000 provider EHRs in partnership with Carequality expanded access into new data sources including CMS’ Blue Button 2.0, and supports FHIR®-based data exchange models (e.g., Da Vinci’s PDex and the CARIN Alliance CPCDS). Health plans can leverage Inovalon’s Data Lake to align and comply with the Interoperability Rule and July 1, 2021, API requirements.

1 In partnership with Carequality


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