Austin Dobson

3 paths payers can take to actualize value from the CMS interoperability rules

June 22, 2021

U.S. mandates for patient access to data are complex 

When the CMS Interoperability and Patient Access Final Rule that requires patients to access their data was passed in March 2020, it caught many U.S. payer organizations on their heels. It includes steep technical compliance climbs for teams that have never had to work with these standards or meet these requirements.  

It requires significant transformations for how patient data is stored, moved, and exposed. It also presents very difficult challenges for securing data since payers are liable if the data gets out.  

Even more challenging is that the rules are constantly changing and complying organizations will need to be vigilant to make sure they are up to date on the latest requirements. To comply, organizations have to improve their technical ability and increase team bandwidth almost overnight, contract with consultants to build the solution for them, or partner with organizations that are experts.   

How will you comply with the interoperability rules? 

As a payer organization, you need a strategy to comply with the CMS mandate. We’ve heard of several paths that payers are taking, and we believe there are pros and cons to each:  

Do it Yourself. Organizations that choose this route have a lot of control over their solution and they can develop deep technical expertise around these requirements. This strategy can serve you well if you are committed to developing APIs using FHIR for the long term. However, if this skill set is outside of your core competency, you are going to spend a lot of time and money for a very narrow solution.  

Hire a consultant. Development consults can come into your organization and develop solutions to comply with the mandate quickly without adding long-term overhead which can be really beneficial. Unfortunately, integrations are rarely one and done because of ongoing rule changes and complications with standards. Typically, consultant contracts end up extending repeatedly due to ongoing needs which can cost you far more in the long run.  

Partner with an expert. Integration experts that live and breathe healthcare interoperability can be a big benefit to your organization. They can help you comply quickly and then help you comply in the long term too. Plus, since they are focusing on helping you comply for the long term, you can focus on those projects that keep you competitive and innovative in your market.  

There’s a silver lining to complying with the interoperability rules 

Notwithstanding how challenging and complex it is to meet the Final Rule requirements, we believe that there are several exciting opportunities will come out of it. First, the number of API integration applications and connected devices will grow, making the technology even more useful across systems and platforms. This means data will be exchanged quicker, easier, and safer than ever before which will open doors to innovation.  

Second, specifically for healthcare payers, the influx of data available can truly improve healthcare through value-based care measures, clinical quality outcomes and social determinants of health. Imagine the ability to exchange patient data to create a longitudinal health record to manage cost, care and deliver better outcomes. Pretty exciting!  

Lyniate has your back  

We can be sure that the CMS Interoperability and Patient Access Final Rule will have a significant impact on the healthcare landscape over the years to come. Payer organizations that want to unlock value from these regulations need a comprehensive, long-term, product-focused vision.  

Lyniate provides the products and services for your organization to build this multiyear vision. Our solutions offer scalable infrastructure to create an API integration and internal data liquidity layers — unlocking long-term differentiated organizational value. Learn more about our new API Gateway and Manager, Lyniate Rapid.

Download our free whitepaper The Future of Interoperability: Web APIs & HL7 FHIR. 

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