With the Interoperability and Patient Access final rule of the Centers for Medicare and Medicaid Services (CMS) ultimately kicking in, data transparency and sharing in the US healthcare sector has ushered in a new era. The July 1 implementation is a major reform that would allow CMS to further build on its roadmap to improve interoperability and health information access for patients, providers, and payers.
CMS acknowledges that lack of seamless data exchange in healthcare has historically detracted from patient care, leading to poor health outcomes, and higher costs. The final rules undoubtedly have the potential to offer a win-win prospect for all three stakeholders of the healthcare industry (patients, providers, and payers). Interoperability can make several administrative processes smoother, such as prior authorization, and increasing competition.
Consumers, however, stand to gain the most by getting access to their medical data on their cell phones. The rule mandates companies to share claims and other electronic health information with patients using application programming interface (API) technology.
But let’s not jump the gun in drawing any conclusion. Mere implementation of rules is never sufficient to yield the desired results. It is compliance by payers and providers along with adoption by consumers that holds the key.
Interoperability and price transparency are the future of the healthcare system. Thus, the compliance also has to be future-centric. Payers and providers must look beyond the provisions of the rules to make the initiative a runaway success. Let’s have a glance at some measures that can take the rule’s implementation a notch up.
Consumer First
Consumers may not have much role in the implementation process of the new rules, but ultimately it’s their experience which is going to count for other stakeholders. The final rule delivers on the government’s promise to put patients first, giving them access to their health information when they need it most and, in a way, they can best use it. A consumer-friendly approach by payers and providers on mobile apps and websites will go a long way in ensuring the success of the initiative. Customer service personnel must be well-versed with the company’s pricing and service options.
Consumer Engagement
According to a recent Deloitte survey, companies should determine how they will better engage consumers as a result of data-sharing, interoperability, and price transparency and whether they will buy, build, or partner for capabilities they need. Companies should seek to understand whether consumers desire cost estimators, calculators, and other consumer-facing apps and then determine how to best add those capabilities.
Market Driven Decisions
The latest reform not just calls for sharing of data, but will also make a lot of information public. This leaves payers and providers with no option other than studying the market in order to stay in the competition by matching their chargers with the market rate. Companies will have to keep pace with the latest pricing and quality of service. This will allow them to offer their consumers the best service at competitive rates. Payers will start making decisions driven by Consumer Markets
Focus on Technology
Technology will have a big role to play in keeping companies competitive. Picking the right technology partner will be important considering that a big chunk of data will be in the public domain. Ensuring zero compromise on data privacy should be the top priority of companies. Besides, the latest technology can be pressed into service to annually publish the data and to communicate with consumers for timely responses to basic inquiries. The apps and tools have to be consumer- as well as user-friendly. The FHIR Standards are going to be the base on which Interoperability will be built.
Data Protection
Perhaps the best way to ensure data privacy is proceeding ahead only after having the consent to share health information. This is easier said than done given the different rules in states. Companies will have to work hard to meet different requirements of each state. Security measures like multi-factor authentication, analysis of network traffic, identification of sensitive information, endpoint patching, control of information flow between users and devices, and monitoring of data currently in use by users, will be required by companies to check data breach.
Conclusion: CMS has been emphasizing that the final rule establishes policies that break down barriers in the nation’s health system to enable better patient access to their health information, improve interoperability and unleash innovation, while reducing burden on payers and providers. Its meaningful and bona fide compliance will allow patients and their healthcare providers to be more informed, which can lead to better care and improved patient outcomes. In a future where data flows freely and securely between payers, providers, and patients, the US can achieve truly coordinated care, improved health outcomes, and reduced costs.