View all blogs

CMS Interoperability and Patient Access Final Rule – Part 3

This blog was written by Juan Montanez, Principal, HMA, and Robert Chouinard, VP Public Sector, HealthEC

Where are you going to invest to maximize benefits?

In thinking about the value that can be derived from implementation of the Interoperability Rule, both payers and providers need to ensure their perspective of the rule positions them for long-term success.

The following key points of focus are critical when considering the rule:

  • First and foremost, articulate worthy use cases for the data exchange, which the rule is intended to facilitate. For a provider, these use cases can center on having more timely access to patient information that “rounds out” understanding of the patient’s needs and circumstances. For a health plan, these use cases can focus on improving the ability to develop targeted care plans that more effectively address member needs and circumstances. Health plans working in a true partnership with providers can concentrate on improving their ability to collaborate and coordinate services built into a member’s or patient’s care plan.    
  • Acknowledge that the rule opens the door for a greater flow of data from multiple sources including mobile health devices (such as Fitbits), remote patient monitoring devices, and numerous applications being brought to market. In turn, both payers and providers will need to  change thought processes and workflows in order to figure out how to make the best possible use of these new data sources.
  • Accept that interoperability is really a means to an end, not an end in and of itself. As such, interoperability will naturally improve and evolve over time. This means investing in improved interoperability will become a “cost of doing business” for both payers and providers, in the same way as electronic health records and care management systems have become essential for providers and payers, respectively.
  • Finally, and perhaps most importantly, embrace value-based care. This is crucial since (a) it is inevitable and (b) it can benefit both payers and providers financially, while also personally benefitting members and patients. Once value-based care is truly embraced, it almost automatically leads to acceptance of greater collaboration among payers and providers which – in turn – requires the level of interoperability which the rule promotes.    

The HMA and HealthEC team of experts has already helped several organizations incorporate the value proposition outlined above into their planning and execution of an interoperability strategy. Click here to connect with our experts.