Going Beyond Health Plan Data Interoperability Mandates

Earlier this year, CMS and the Office of the National Coordinator (ONC) released proposed rules governing interoperability, health data blocking, and use of the Fast Healthcare Interoperability Resources (FHIR®) API standard. Regence, like many health plans, is working to address this 2020 mandate. We look at interoperability as a way to provide more efficient care coordination with our provider partners for our membership. We also see an opportunity to advance some of the strategic initiatives for consumer experience we already have planned.

There is a lot to do, but we have a great team working to prepare. Regence is a member of the Da Vinci Project– a group designed to help payers and providers positively impact clinical, quality, cost, and care management outcomes. We believe that giving people more control and access to their own data will be a positive force in creating a better health care system for all.

I recently had the opportunity to share how we are thinking about interoperability at Regence during an AHIP webinar in conjunction with our partner, HealthSparq. HealthSparq is helping us make standardized provider and claims data available to meet the coming mandates. While there is some uncertainty for payers as to what will be the final impacts and scope of these proposed rules, we’re planning ahead for 2020 and beyond. Below are some of our key considerations.

Thinking Broadly About Consumer Access to Data

Payers have been obligated to share data with consumers in a readily reproducible format since the finalization of HIPAA rules back in 1996. Although this pre-dates FHIR restful APIs, or even the broad use of the internet in health care, that idea of readily reproducible format continues in these new rules and the use of a “Blue Button” for members to get access to that data with a consumer app of their choice.

We’re thinking about the impacts of this government plan mandate across our non-government plans. Once a payer supports a Blue Button for government business, such as Medicare Advantage, it’s going to be very tough to tell a commercial plan member they’ll get their data in 30 days. In other words, by having to support a Blue Button, real-time FHIR API for consumer access to their payer data, the floor for what is a ‘readily reproducible format’ is raised to that level. Even as we look at this purely from a compliance perspective, we’re planning to support commercial plan members.

Supporting Data Throughout the Ecosystem to Improve Outcomes and Lower Costs

At Regence, we don’t see this as a compliance burden. We’re giving members the ability to download and access their data in a format that they themselves, or through a consumer app, can make sense of. This access can be leveraged across the entire ecosystem of a member’s health care journey, and it will lead to better experiences for consumers. Access to data will help them make better choices about their health and that will certainly make them more engaged in our interactions with them. Supporting the myriad ways that we exchange data with members today is costly and complex. Driving to this common standard is going to be more efficient and less costly from an IT perspective.

We exchange data with our employer groups, our customers, certainly with our provider partners, and with our technology vendors. And today, those are done in very ad hoc ways. We don’t have a common way to exchange data in a common format, even among these different subgroups. So, one of the opportunities for us in complying with these rules, especially as it relates to business to business exchanges, is to standardize and implement this idea of a data distribution network. We’re working with HealthSparq to provide the gateway for data to our ecosystem. So, rather than our teams having to manage all this, we manage one connection, and point all our data partners and distribution partners to that one central point.

We’re excited to work with HealthSparq to streamline data access for our data exchange ecosystem. Get more insights in our lessons learned, payer coordination, and tips for other plans in the AHIP webinar with HealthSparq. Click to hear more.