Posts Tagged ‘healthcare interoperability’

A New Era of Patient Engagement and Information Sharing

January 14th, 2021 by April Todd

Directory Assistance: The one thing payers and developers need before the full potential of the Final Interoperability and Patient Access Rule will be realized.

This summer, when the Centers for Medicare and Medicaid Services (CMS) issued the Interoperability and Patient Access Final Rule, they opened the door to a new era of patient engagement and information sharing.

The rule is designed to allow Americans to track their health insurance claims, prior authorizations, labs, scans and related information using commercially available mobile apps. Under the rule, when a member changes health plans, he or she will be able to use the app to share this information with the new insurer.

In addition to empowering patients with greater information about their claims, coverage and health history, the rule will facilitate better decision-making, care coordination and, in turn, health outcomes.

Yet, to make all of this a reality, one important piece is missing.

The CMS rule requires plans and app developers to use Fast Healthcare Interoperability Resource (FHIR) application programming interfaces (APIs) to share information. The FHIR standard was developed by the industry to allow thousands of disparate systems and apps to communicate with one another.

For this new ecosystem to work, payers and app vendors will need to be able to quickly and accurately find the digital address of the other parties with whom consumers want to share their health information. Today, there are more than 300,000 possible connections and, without a directory of FHIR endpoints, each plan or developer would have to find, catalogue, verify and maintain these addresses on its own.

The parties involved have recognized that this is a significant challenge, and the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) FHIR at Scale Task Force (FAST) determined an endpoint directory is needed to advance FHIR implementation.

CAQH, an alliance of plans and other healthcare stakeholders, was established 20 years ago to address just this kind of industry-wide challenge by streamlining and improving provider data management, coordination of benefits, health plan directories and other essential business functions. CAQH has also brought the industry together to develop the common operating rules that allow administrative information to flow seamlessly across the healthcare industry.

In close collaboration with a broad range of industry partners, including the technology company Edifecs, CAQH is developing an endpoint directory to build on the ONC FAST foundation and simplify the exchange of data between health plans and third-party app developers. CAQH presented a prototype at several recent industry events, including the HL7 FHIR Connectathon, to gather feedback and ensure that the solution effectively meets the task at hand.

At ONC’s “Accelerating APIs in Healthcare,” CAQH announced that it would continue to engage implementers and industry experts with the goal of launching a beta version of the directory in early 2021.

This timing is critical. Among other deadlines in the CMS rule, plans are required to implement the patient access APIs in January 2021 and a process for payer-to-payer exchange by 2022. The CAQH directory will enable plans to meet these aggressive deadlines.

It may be several months before consumers begin to manage their healthcare on their phones and claims history flows smoothly between health plans. However, with an endpoints directory at hand, that day is drawing near, and we may just be about to enter a new era in consumer-driven healthcare.

About the Author: April Todd, Senior Vice President, leads the CORE and Explorations initiatives for CAQH. She is responsible for leading multi-stakeholder collaborations driving the creation and adoption of healthcare operating rules for electronic administrative transactions, researching opportunities for further administrative automation, and establishing a common foundation for new interoperability initiatives.

Infographic: Tackling the Policy Challenges of Interoperability

September 18th, 2019 by Melanie Matthews

Interoperability is one of the keys to high-quality healthcare and enhancing the health of communities while lowering costs. However, there are significant financial, technical and cultural barriers to overcome to achieve interoperability, according to a new infographic by athenahealth, Inc.

The infographic examines ways in which healthcare organizations can navigate the policy and cultural challenges surrounding interoperability.

A New Vision for Remote Patient Monitoring: Creating Sustainable Financial, Operational and Clinical OutcomesAs healthcare moves out of the brick-and-mortar traditional setting into patients’ homes and their workplaces, and becomes much more proactive, the University of Pittsburgh Medical Center (UPMC) has been expanding its remote patient monitoring program. The remote patient monitoring program at UPMC has its roots in the heart failure program but has since expanded to additional disease states across the integrated delivery system’s continuum of care.

A New Vision for Remote Patient Monitoring: Creating Sustainable Financial, Operational and Clinical Outcomes delves into the evolution of UPMC’s remote patient monitoring program from its initial focus on heart failure to how the program was scaled vertically and horizontally. Click here for more information.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: How To Establish Your Healthcare Data Task Force

January 7th, 2019 by Melanie Matthews

Reaching electronic medical record (EMR) interoperability in healthcare begins with selecting the right data to share, according to a new infographic by HULFT.

The infographic illustrates the key players healthcare organizations should include on a healthcare data task force team to ensure that the data strategy gets the right data to the right people at the right time.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results Between Medicare’s aggressive migration to value-based payment models and MACRA’s 2017 Quality Payment Program rollout, healthcare providers must accept the inevitability of participation in fee-for-quality reimbursement design—as well as cultivating a grounding in health data analytics to enhance success.

As an early adopter of the Medicare Shared Savings Program (MSSP) and the largest sponsor of MSSP accountable care organizations (ACOs), Collaborative Health Systems (CHS) is uniquely positioned to advise providers on the benefits of data analytics and technology, which CHS views as a major driver in its achievements in the MSSP arena. In performance year 2014, nine of CHS’s 24 MSSP ACOs generated savings and received payments of almost $27 million.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results documents the accomplishments of CHS’s 24 ACOs under the MSSP program, the crucial role of data analytics in CHS operations, and the many lessons learned as an early trailblazer in value-based care delivery.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: 7 Steps for Healthcare Interoperability

June 29th, 2018 by Melanie Matthews

Healthcare interoperability will lead to a collaborative environment with accessible data for all users to gain meaningful insights, according to a new infographic by Liaison.

Healthcare organizations can move from an environment with siloed information and limited data access to one that is truly collaborative with accessible data for all user with the seven interoperability steps outlined in the infographic.

A New Vision for Remote Patient Monitoring: Creating Sustainable Financial, Operational and Clinical OutcomesAs healthcare moves out of the brick-and-mortar traditional setting into patients’ homes and their workplaces, and becomes much more proactive, the University of Pittsburgh Medical Center (UPMC) has been expanding its remote patient monitoring program. The remote patient monitoring program at UPMC has its roots in the heart failure program but has since expanded to additional disease states across the integrated delivery system’s continuum of care.

A New Vision for Remote Patient Monitoring: Creating Sustainable Financial, Operational and Clinical Outcomes delves into the evolution of UPMC’s remote patient monitoring program from its initial focus on heart failure to how the program was scaled vertically and horizontally. Click here for more information.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: The Pursuit of Healthcare Interoperability

December 13th, 2017 by Melanie Matthews

Healthcare organizations are working toward interoperability by investing in electronic health records, as a first step toward eventual data integration. However, the challenges to achieving interoperability go beyond EHR implementation, according to a new infographic by Transcend Insights.

The infographic examines five of the biggest interoperability challenges.

Trends Shaping the Healthcare Industry in 2018: A Strategic Planning SessionUncertainty regarding the future of the Affordable Care Act (ACA), combined with industry market forces, including consolidations and strategic partnerships, positioning for value-based healthcare, cost containment efforts, an emphasis on technology and efforts to understand and address the whole patient as part of population health management have been the key drivers in the healthcare industry this year.

With the efforts to repeal and replace the ACA now focused on the elimination of the cost-sharing reduction (CSR) payments to insurers and changes to regulations governing association health plans, short-term, limited-duration insurance and health reimbursement arrangements, the healthcare industry can put aside the uncertainty of this year and move forward with the market forces in play.

During Trends Shaping the Healthcare Industry in 2018: A Strategic Planning Session, a 60-minute webinar on December 7th, two industry thought leaders, David Buchanan, President, Buchanan Strategies, and Brian Sanderson, managing principal, healthcare services, Crowe Horwath, will provide a roadmap to the key issues, challenges and opportunities for healthcare organizations in 2018.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.