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Interoperability Solutions

Getting Started and Finding A Healthcare Interoperability Solution

Healthcare interoperability has been an industry buzzword for some time, but upcoming compliance deadlines for the Office of the National Coordinator for Health Information Technology (ONC)’s Cures Act Final Rule – which implements interoperability requirements detailed in the 21st Century Cures Act – have created an imminent need for health plans to find a healthcare interoperability solution.

What Is Interoperability?

According to HIMSS, interoperability is the ability of various information technology systems and software applications to communicate and exchange data to advance effective healthcare delivery.

Let’s discuss your payer challenges and a healthcare interoperability solution

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 ONC CURES ACT FINAL RULE

The rule outlines healthcare data interoperability standards designed to promote data exchange and transparency across the healthcare ecosystem, with a goal of empowering patients related to their own healthcare.

Foundational Principles for Healthcare Interoperability Solutions

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IMPROVED DATA

Standardized APIs supported by FHIR®

FHIR® is an electronic data exchange standard adopted by CMS and the ONC for clinical data shared across platforms, organizations, and clinicians.

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CONVENIENT ACCESS

Healthcare information available by third-party apps

Patient access to healthcare information enables patients’ control  of their own healthcare decisions.

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TRANSPARENT INFORMATION

Visibility into holistic patient records, healthcare costs, and population trends

Expands patient and payer choices by delivering data to assist in care decisions related to quality and costs.

Benefits

Education from secure, instant access to health information via apps allows increased ownership of care decisions

Readily available, holistic patient and population data enables more prevention programs and patient education

Real-time availability of historical medical records enables timely and improved patient outcomes

3 Cures Compliance Requirements Impacting Health Plans

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Payer-to-Payer
Data Exchange

Effective 1/1/2022

As patients change health care plans and request sharing of their health information between plans, payers must be able to exchange all data within the standardized data requirements. Plans are responsible for a bi-directional data flow: (1) receiving and ingesting member data from another payer, and (2) sending former member data to other payers. All payer data must be accessible and available for exchange for five years.

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Patient Access
API

Effective 7/1/2021

Patients must have direct access via third-party applications to their healthcare information as of January 1, 2016. Healthcare information data sharing requirements are specified and include four categories: claims information, encounter data, clinical information, and formulary data. Plans must provide this data in the required, standardized specifications via API, providing API documentation and appropriate security and maintenance checks.

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Provider Directory
API

Effective 7/1/2021

Plans must make in-network provider directory information (e.g., provider names, network statuses, specialties, addresses, phone numbers) available via FHIR® API. Within 30 days of receipt of new data, that information is required to be available via the Provider Directory API.

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 HEALTHCARE INTEROPERABILITY SOLUTIONS

CAVO Connect Logo - Payment Integrity Access EMR

CAVO Connect enables health plans and review vendors – within configurable release rules – the ability to access medical records, itemized bills, and additional clinical data. Review teams then perform reviews without utilizing hospital and health system resources for release of information (ROI) requests.

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Access EMRs in Real-Time

  • Replaces resource-intensive ROI processes for plans and providers
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Increase Productivity

  • Mitigates redundancies in ROI process
  • Creates consistent user interface for all reviews
Advent Health Partners - Emily McMakin

Emily McMakin

Director – Product Development

“CAVO’s scalable, FHIR-based solution delivers confidence to our clients that they can maintain compliance with the interoperability guidelines set by CMS’ Interoperability and Patient Access API mandate – and proactively address any evolving requirements as the initiative moves forward.”

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WHY CHOOSE ADVENT

for healthcare interoperability solutions

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TECHNOLOGY
PLATFORM

  • Open API, no information blocking
  • HIPAA compliant and HITRUST certified framework
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CLINICAL & CLAIMS
EXPERTISE

  • Assist with data normalization and mapping between siloed systems, minimizing payer time investment
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FHIR®
EXPERTISE