CMS Mandate for Health Plans

For far too long, e-health information is stuck in silos and inaccessible for consumers. With Value Based Care, CMS is pushing towards a patient centric model involving patients in their own care. This has motivated ONC release rules to promote e-HI sharing, increase patient access of their e-HI, & restrict information blocking. If a patient requests their record, and it’s not given electronically and for free, that will be considered Information Blocking.

The regulations of the past, came with incentives for proactive payers. The new Interoperability and information blocking final rule comes with a clear message containing heady warnings of penalties instead.

Impacted
Entities

Payer business challenges

Patient Access
using API

Will require all the affected plans to implement & monitor FHIR-based APIs to make health information (including claims) available to patients

API access to
Directory data

Plans are expected to make ‘provider directory data’ available to patients (using APIs) within 30 days after changes to the provider directory are made

Cross-Payer
Coordination

Payers need to exchange data with one another as patients transition between plans. Datasets include diagnoses, procedures, providers seen, etc.

Trusted exchange
networks

Requires the ability to participate in a trusted exchange network to take better decisions, enhance safety, and avoid data duplication.

Public Reporting
(Wall of Shame)

Plans that limit the availability, disclosure & use of health information and undermine efforts to improve interoperability, will be publicly listed.

The required recipe!

What next?

Drop us a note to understand how we make this endeavor a cakewalk for you!

Cookies help us deliver our services. By using our services, you agree to our use of cookies Privacy Policy I Accept It!