Insight Paper 4.8.2021

Advancing Interoperability in Healthcare

Creating value for customers by going beyond compliance to transparency rulings.

Interoperability was the central topic at a recent AHIP Webinar on Transparency and Burden Rules on Health Insurance Providers (February 2021). Over the past decade, there have been major rulings that have attempted to advance interoperability and prevent data blocking within the Healthcare Industry. The CMS Transparency in Coverage is an example of such rulings, with immediate deadlines for compliance in less than a year (January 1st, 2022 for Machine Readable Files).* Specifically, healthcare payers will need to decide on what level of transparency in pricing they will provide based on compliance and staying competitive. These rules to enhance transparency and reduce data blocking are shaking up the healthcare industry at a rapid pace and forcing healthcare payers to implement critical business decisions that will impact the competitiveness of their services.

At the AHIP Webinar on February 17th, 2021, a roadmap was provided for how healthcare payers can utilize the new regulations to implement massive changes in how they do business, focusing on the end goal of the policies, to create a value-based care framework built on interoperability. This is how payers can differentiate themselves from competitors, creating real value for customers by going beyond compliance to transparency rulings.

*UPDATE: CMS updated the Transparency in Coverage ruling in August 2021, deferring enforcement of the first and second machine readable files to July 1st, 2022. Meanwhile, enforcement of the third file has been deferred pending further rulemaking.

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Tagged in: Healthcare & Life Sciences, Program Execution, Strategy & Innovation, Technology
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