How Payers Can Keep the Big Vision of Interoperability in Sight
In order to effectively comply with interoperability, payers must keep in mind the overarching vision of this effort, which involves building a data exchange ecosystem.
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- As payers prepare to comply with specific CMS interoperability deadlines, it is critical that they keep in mind the overarching goals of interoperability, not just the compliance details.
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To Danielle Lloyd, senior vice president of private market innovations and quality initiatives for clinical affairs at AHIP, the overarching goal is clear.
“We're all consumers of healthcare, at the end of the day,” Lloyd explained in her second episode with Healthcare Strategies related to interoperability.
“And so the perspective is: how do we make sure not only that the consumers have the information they need easily at the ready, but that their providers have the information they need to advise them on their care and their health and wellness? And by doing so, how do we enable the healthcare system to improve access to services, quality of care, equitable care, and affordability?”
As consumers of healthcare themselves, those who work in the payer industry can lean into their own experiences of healthcare and interoperability—or the lack thereof—to keep in sight the overarching vision of this endeavor.
The goal of interoperability involves providing broader access to quality and pricing information and building an ecosystem—not just a pipeline—of data exchange among healthcare stakeholders.
Casting a vision for any endeavor also requires thinking about the future of the movement. Lloyd shared that the future of the movement toward interoperability might incorporate heavier use of artificial intelligence and natural language processing, which has proven useful to information exchange tasks such as prior authorization in the past.
“This notion of transparency and interoperability is not going to go away,” Lloyd said. “It's here to stay. It's going to grow over time—especially as we have new technology enabling more change in the area—and we'll see policies to that effect moving forward.”
Lloyd also shared about the complications that various major regulatory efforts surrounding interoperability pose.
While at the time of this recording the interoperability strategy of the new CMS Administrator, Chiquita Brooks-LaSure, remained uncertain, Lloyd provided an overview of how the Biden administration might move forward. She also shared how other regulatory movements—such as price transparency—might impact the industry’s progress toward interoperability.
