Health Connectivity for Health Plans & Payers in Value-Based Care

Interoperability in healthcare will offer seamless, secure access to electronic health information that will allow providers and payers to practice effective care coordination for better patient outcomes. Leveraging health information technology platforms and implementing data standards are necessary for improved health connectivity and data exchange throughout the care continuum. As the industry moves towards value-based care models as the standard, interoperability will become a foundational element of healthcare – as indispensable as the doctors and nurses delivering care. In this third blog of our series on how health plans can support the transition to value-based care, we will look at the importance of interoperability and data exchange as the cornerstone of any successful strategy for improving healthcare.

What is True Interoperability in Health Systems?

Interoperability begins with the premise that information should flow freely, facilitating data to travel from point A to point B. Yet, while the discussion around interoperability often centers around electronic health records (EHRs), true interoperability extends beyond that.

True interoperability includes all collective information pulled from disparate sources, such as outpatient rehabilitation facilities, community behavioral health centers, or the public education system. It reflects the ideal of seamless connectivity, regardless of technology and platforms in use. In the coming years, this true interoperability will be necessary to function — not just a “nice to have.”

The transition away from the analog age of patient information exchange that involved paper health records, mailing, faxing, and calling to collect a holistic view of patient medical history has been accelerating towards a totally digital and interoperable data ecosystem. It is clear that this level of interoperability holds the key to a higher performing healthcare system that reduces the administrative burden on providers and payers while supporting more informed decision-making patients and their care teams to improve outcomes and cut spending.

Interoperability and Patient Access Rule

In April 2021, the CMS Interoperability and Patient Access rule went into effect, kicking off the official transition of EHR specifications to the HL7 Fast Healthcare Interoperability Resources (FHIR) standard. The goal of this new rule was to facilitate the transmission of data to the point of care through standardization and to ensure that individuals can access their own health data regardless of their health insurance provider. While the payer responsible for managing a member’s resources may change, they should always be able to access their health data to support more informed healthcare decisions. In addition, under the Conditions of Participation (CoP) requirement within the 21st Century Cure Act, hospitals are required to alert downstream providers — primary care providers, post-acute facilities, etc. — when a patient has been admitted, discharged, or transferred to another facility to support safer transitions of care.

Payer Technology Platforms for Data Sharing

Health IT infrastructure must be nimble enough to work across all platforms used by care partners. To support true interoperability, data can’t just be accessible — it must also be actionable. Payers shouldn’t have to seek updates on high-risk members — they should be able to identify and track them easily with customizable cohorts and reports that are automatically generated. Hospital ED staff should be alerted to an individual’s police record or emergency utilization patterns when they exceed a certain threshold to know when more targeted outreach, social support, or other community resources may be needed to support better health outcomes.

Moving forward, payers should ensure their technology platforms are updated to align with new standards, and that they are leveraging technology networks to aggregate and share data with their care partners. In this way, health plans and payers can move the needle on interoperability and support enhanced payer-provider collaboration to drive more value in the healthcare system.