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5 Ways CMS Final Rule Can Change the Future of Healthcare

On March 9, 2020, CMS released The Interoperability and Patient Access final rule (CMS-9115-F) which requires CMS-regulated payers to make health information more easily available to patients by leveraging Application Programming Interfaces and Fast Healthcare Interoperability Resources (FHIR) technology. This rule is focused on driving interoperability and patient health data access for health plans including Medicare Advantage (MA), Medicaid, Children’s Health Insurance Program (CHIP), and Qualified Health Plan (QHP) issuers on the Federally-Facilitated Exchanges (FFEs). 

As the entire healthcare ecosystem continues to focus on enhancing the patient experience and improving the value of care, the importance of data cannot be underestimated. Healthcare consumers expect seamless, spontaneous and secure information sharing and access. Patients want the convenience of same-day appointments and on-demand availability of their records — and they expect providers to know their medical history and treat them in the context of a lifetime experience as opposed to a series of one-off interactions. 

CMS rule intends to advance interoperability and patient access to their cumulative health information, reduce the burden of providers, and improve prior authorization processes.  

Here are five expected transformational outcomes of the final rule. 

  1. Seamless Information exchange enabling better care coordination: With this rule the responsibility of sharing patient health records has shifted from provider to payer who is the source of all recipient’s data in a health programs. Information exchanged by payer with a comprehensive view of patient health history, makes it easier for health programs, providers, and patients to coordinate care, analyze population health trends, manage benefits, and track health outcomes and costs more effectively. This rule makes payers accountable for patient health records sharing. The information exchanged can provide a comprehensive view of patient history.  
  2. Set standards to integrate health information: The implementation of the interoperability rule promotes a resilient infrastructure that maintains all the necessary databases of the patients, providers, and payers. Healthcare organizations have faced huge pressures due to fragmented systems, nonstandard security and data exchange protocols — with no way to track and securely maintain data that can be shared seamlessly across or between the required stakeholders. The implementation of the interoperability and patient access rule will promote unified and seamless patient information sharing with stringent security protocols. 
  3. Better patient continuum of care: Access to patients healthcare information gives care givers more information for continuity of care.  Ensuring a better continuum of care through data enables better health outcomes to the patients 
  4. Lower cost of care: Better coordination of care will increase price transparency within the healthcare ecosystem, helping to keep costs lower, empowering patients to make better and more informed choices about their care. 
  5. Improved health outcomes: With the seamless exchange of patient data, providers can have quick access to a holistic view of the patient, enabling them to make better informed diagnosis and prescribe more successful treatments — supporting the trajectory to value-based care.  

In a recent LinkedIn event, I explained how interoperability will reduce payer and provider burden and change the healthcare landscape, when done right. This will bring greater safety and better outcomes for patients, along with increased efficiency and serious cost savings all around with right implementation. As a healthcare industry expert, Conduent’s interoperability exchange solutions support the standards-based exchange of healthcare data defined by the final rule. Get in touch with us to learn how we can help overcome your interoperability challenges. 

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About the Author

Raj is CIO – Healthcare at Conduent where he manages the entire portfolio for Government and Commercial healthcare clients. In this role, he is responsible for building new products based on market needs and maintain existing products on a growth trajectory. This includes MMIS, PBM, Care Management, Pharma & Life Sciences – Patient assistance system, Data/Analytics, commercial payer systems and many more. His extensive experience in the healthcare- Payer, Managed care, Medicaid and Medicare space has helped improve operational effectiveness and realize serious cost saving while accelerating growth.

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