Digital Health Insights’ Post

In today's healthcare landscape, patients are asking for more control and transparency over their health data. The Patient Access API, part of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), is designed to make this happen. But what does it mean for payers? 🤔 In our latest blog, Rich Almeida breaks down the key requirements, deadlines, benefits, and industry trends surrounding the Patient Access API, and how it can transform compliance into a major opportunity for payers. ✅ Learn how the API empowers patients with real-time access to health information ✅ Discover how it can drive better member engagement, reduce costs, and improve operational efficiency ✅ Explore emerging trends like scaling patient access and boosting utilization 🔗 Read the full blog now: https://lnkd.in/e4EQPgXR #FHIR #PatientAccessAPI #CMS #Interoperability

What’s Healthcare Interoperability and its impact on the health ecosystem? This blog delves into the importance of healthcare interoperability, exploring its role in creating seamless communication and data exchange across various healthcare sectors. Join us as we examine how interoperability drives better patient outcomes and contributes to a more efficient and integrated healthcare system. Link:- https://lnkd.in/dHVk2Hws #HealthcareInteroperability #DigitalHealth #PatientCare #HealthcareInnovation #ConnectedHealth #HealthIT

Tech meets the real world. On some days I hear my colleagues talk and it is hard to imagine what the impact of all the code is for normal human beings. On other days the dots get connected by people like my colleague Rich Almeida who wrote a blog post about the Patient Access API, mandated by the CMS 0057 Final Rule in the United States. Already a FHIR expert and interested to read more? Just click on the blog below 👇 Interested in understanding more but not yet ready to read a technical blog? Here's my non-technical explanation: What is it all about? It's about the obligation for insurance companies (in the US they are often called 'payers') to give patients access to their health data. An #API makes it possible for computer systems to exchange this data and therefore make it available via portals or apps. And what about #FHIR? (FHIR experts: skip the following sentence please) That's kind of the format what healthcare data needs to look like in computer language. In the US they now mandate that insurance companies have this specific API so all systems can speak the same language and make this information available. Sounds easy? Well, unfortunately this is not the case. The good news is that Firely has product solutions and technical experts to support. For those who face a challenging implementation: check out the blog post below or just reach out for a chat!

We found this article very interesting. The new ruling establishes critical standards for information sharing among healthcare providers - check it out when you have time. https://lnkd.in/gQ86sj58

Struggling to better understand how pricing transparency data can be used in your practice? Let SumHealths comprehensive expertise and atlas of both hospital pricing transparency, and newly introduced payer data, provide a new means to serve your patients in this new era of pricing transparency. In today's healthcare landscape, transparency is not just a regulatory requirement but a cornerstone of patient trust and practice efficiency. At SumHealth, we provide comprehensive pricing transparency data, empowering practitioners to enhance their practice's transparency and develop detailed, itemized billing structures. Transparency in healthcare pricing is pivotal for building patient trust and ensuring compliance with industry standards. By leveraging SumHealth's extensive data, practitioners can gain insights into their service charges relative to other hospitals and practices. Our pricing transparency data offering is done within the following terms: (1) Comparative analysis platform which enables you to align your pricing strategies with market standards, fostering a transparent environment that patients appreciate. We share this comparative analysis through the SumHealth platform by giving you the ability to generate your own reports, OR our team at SumHealth can work together with you to create specific insights based on the services and prices that you would like to compare and contrast. (2) A web-based application for you and your patients to use at the point of care. Interactively search through all the prices available for services that you are prescribing for your patients to present prices that they can expect when receiving care at a practice different from yours. Patients are more likely to trust and remain loyal to practices that are upfront about their pricing. Transparent, itemized bills demystify healthcare costs, enabling patients to see exactly what they are paying for. This clarity can lead to higher patient satisfaction, positive reviews, and increased referrals, ultimately contributing to the growth of your practice. In a competitive healthcare market, practices that offer transparency stand out. Using SumHealth's data to develop transparent billing practices, you position your practice as a leader in ethical and patient-centered care. This distinction can attract more patients who value honesty and clarity in their healthcare providers. Embracing transparency through detailed, itemized billing aligns your practice with regulatory standards, builds trust, and enhances operational efficiency. SumHealth is committed to providing the data and support you need to implement these practices seamlessly. Join us in transforming healthcare transparency for the betterment of your training and the satisfaction of your patients. #pricingtransparency #healthcare #primarycare #medicare #medicaid

In 2020, CMS-9115-F introduced API-based information sharing by payers. Now, CMS-0057-F mandates the use of digitized data and APIs to advance interoperability among all key stakeholders and automate costly manual prior authorizations. While targeted at a specific set of federally funded “impacted payers,” it is expected to have a ripple effect across the entire health care industry. https://lnkd.in/gfkRznHV

This is from Alexandra Mugge, chief health informatics officer at CMS. Q: What has been the biggest challenge in improving data exchange to streamline prior authorization? AM:" The biggest challenge we've heard about from stakeholders is the sheer volume of diverse prior authorization policies across all the payers. Providers spend far too much time tracking down payer requirements and filling in the required documentation. Under our policies, each payer will be required to identify all of their policies and guidelines and then structure them to be incorporated into an API for use by the providers, through an EHR, using automated processes that save providers time and burden. There are thousands of these requirements, which must be identified and analyzed, and then the rules have to be computable. Every payer has to execute the same process on those different policies. Once that work is done, the process will be streamlined, but it will be a significant effort." Itiliti Health can help. Our platform takes all medical policies and exposes them to providers in a simple, easy-to-use format. Contact me to learn more. #priorauthorization #ItilitHealth

At the Becker's Healthcare Spring Payer Issues Roundtable, Milliman MedInsight collaborated with leading organizations to shed light on the pivotal factors influencing payer strategies. It was an engaging event that brought together industry experts to discuss the future of healthcare. Here are the key themes that stood out during the event:  🚀 Driving digital transformation and personalized care  🔍 Enabling greater transparency and trust in value-based care  🔧 Building a solid data infrastructure  🌐 Supporting payers' digital transformation journey To learn more, read our full blog post below.  #HealthcareIndustry #DigitalTransformation #DataAnalytics #ValueBasedCare #VBC #PayerStrategy #PayerAnalytics 

Observations from the Field: Understanding and Leveraging CMS-0057 for Strategic Advantage. The CMS-0057 rule brings forward a series of critical requirements designed to enhance interoperability and streamline prior authorization processes. These mandates are intended to improve data exchange between payers, providers, and patients, but they also pose challenges as payers adapt their systems and workflows to meet compliance. Point-of-Care Partners clarifies these challenges and corrects any misconceptions that might hinder payers from maximizing the strategic benefits of CMS-0057. https://lnkd.in/eFfrNxFK?

Just came across this enlightening piece on a critical issue plaguing the healthcare system – inaccurate provider directories. With 81% of entries showing inconsistencies, and billion dollar loss! It's clear that there's a pressing need for solutions to streamline data exchange and ensure patients receive the care they need when they need it. I think with the right technology solutions in place, we can simplify data management, improve data accuracy, and ultimately enhance patient care. We can work together to bridge this gap and improve healthcare outcomes for all! Let me know your thoughts on it. https://lnkd.in/dvUJXkkD