Ecosystem Interoperability: American Healthcare Faces Another Major Federal Initiative

CMS gathered healthcare ecosystem stakeholders together on a call today for a hearing session around the major federal push to achieve interoperability in American healthcare technology. Interoperability and Patient Access Proposed Rule makes a historic push to sunset the area of information blocking, data silos, and discontinuity in knowledge (leakage of critical information) across the healthcare ecosystem.

Today’s session was indeed very interesting. CMS Administrator Verma opened the Session with far reaching statements around the Agency’s path towards Interoperability.

Here are some ‘high level’ items which particularly caught my interest:

  • Post Acute care information transitions are a major area of opportunity and gap.
  • Interoperability is here to stay; information blocking strategies are no longer tolerated–there will be political and financial price to pay for such practices.
  • Public Reporting: Interoperability metrics are proposed to be displayed publicly just like readmission data. These measures will become part of the Quality metrics reporting umbrella.
  • Provider directories continue to be a huge mess at 48% inaccuracy and CMS is providing policy levers to clean up data.
  • Requires that health plans develop and make available open APIs — retroactive 5 years. So, proposed rule takes eff. 2020, health plans are required to catch up and reconcile all claims data going back 5 years to then make it available by one API call. I’m very interested to see how this ask is to be achieved.

“We believe patients should have the ability to move from health plan to health plan, provider to provider, and have both their clinical and administrative information travel with them throughout their journey.”  – CMS Administrator Verma (3/5/19)

CMS proposes changes to the healthcare delivery system in an effort to increase the seamless flow of health information, reduce burden on patients and providers, and foster innovation by unleashing data for researchers and innovators alike.

For the first time, CMS is proposing regulations which would require Medicaid, Medicare Advantage, CHIP, and Marketplace plans provide enrollees with immediate electronic access to medical claims and other health information electronically by 2020.

When a patient receives care from a new provider, a complete record of their health information should be readily available to that care provider, regardless of where or by who care was previously provided. When a patient is discharged from a hospital to a postacute care (PAC) setting there should be no question as to how, when, or where their data will be exchanged. Likewise, when an enrollee changes health plans or ages into Medicare, the enrollee should be able to have their claims history and encounter data follow so that information is not lost. – Proposed Rule

This is a historic era and I’m very happy to be yet again on the ‘bleeding edge’ of large scale federal initiatives. From the ACA implementation across chain of clinics, to bundled payment (BPCI) implementation across acute and post-acute markets, and now to Promoting Interoperability across the ecosystem.

Read the Proposed Rule (Federal Register): Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans in the Federally-Facilitated Exchanges and Health Care Providers

Comment period on the Proposed Rule ends 05/03/2019.

Alex Yarijanian is the founder of Carenodes. For more information, feel free to head over to their website!

Alex Yarijanian
Alex Yarijanian
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