How Payers Can Integrate Interoperability into Overall Strategy
Engaging in interoperability requires a concerted effort across the company—not just in the health IT department.
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- As the healthcare industry moves toward interoperability, payers are juggling numerous factors to both meet CMS requirements and further the aims of interoperability.
The industrywide movement toward interoperability involves multiple steps and factors. As payers prepare to conform to CMS deadlines, how can they juggle all of these pieces without losing sight of the big picture? In the first of our two-part conversation on the subject, Danielle Lloyd, senior vice president of private market innovations and quality initiatives for clinical affairs at AHIP, covers how payers can prepare for the immediate July 1 deadline and touches on next steps toward interoperability.
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“Not to speak in platitudes, but you can't boil the ocean,” Lloyd emphasized. “It's overwhelming on a good day, and we're in the middle of a pandemic where there are all sorts of constraints. So it's going to have to be a journey.”
According to Lloyd, the key to moving forward and incorporating interoperability into the payer’s processes and strategies is recognizing that interoperability implementation is not simply a health IT issue. Rather, it will require a concerted effort across multiple departments as well as multiple stakeholders.
Finance departments will need to be involved, as the movement towards interoperability will require fiscal investments from payers in the technologies and processes, Lloyd noted.
The fiscal output has already been a subject of controversy. When CMS originally published the rule, providing a single cost projection of $800,000 for payers nationwide, payers objected. Since then, CMS raised the estimate to $1.5 million. Some believe that payers will pass the cost of these interoperability adjustments on to members.
Human resource departments will also be involved, Lloyd noted. These departments’ functions will be more critical for payers that choose to bring their interoperability efforts in-house.
“Maybe long-term you want to build out your staff,” Lloyd suggested. “You have to think about: do you have the right people to do this?”
Payers will also need to lean heavily upon their legal teams, both for rule compliance and for a host of other challenges that they may face as they prepare for interoperability.
Lloyd will return to the Healthcare Strategies for the second part of this conversation, which focuses on the motivation behind why the healthcare industry is moving towards interoperability and how she anticipates the Biden Administration will handle this trend.
