H ealthcare Payers are increasingly guided by new government regulations and compliance concerns, and amidst these changes, there is also a great opportunity to accelerate value by integrating interoperability strategies.

The Centers for Medicare & Medicaid Services (CMS) has announced a new Patient Access Final Rule in September, 2021 highlighting interoperability policies for burden reduction, regulatory standards around patient access, transparency and data sharing that will broaden the horizons for newer opportunities in connected care.

However, Payors are faced with tremendous data sharing challenges in terms of structuring and streamlining massive volumes of data to meet with the Fast Healthcare Interoperability Resources’ (FHIR) evolving regulatory standards. This was also fueled by the changing healthcare landscape in 2020, specifically due to the Public Health Emergency (PHE) that has realigned strategies to meet the growing needs of the healthcare system.

This blog outlines proven strategies and techniques that can help Payors unlock new possibilities by harnessing the power of interoperability in healthcare.

Let’s dive in.

Proven Strategies for Healthcare Interoperability

1. Data Exchange between Payers

Payers need to integrate new interfaces that support the interoperability updates made by the FHIR and regulatory guidelines—that facilitate the culmination of data for improved quality and access. Payers need to take a more collaborative approach to transparency and accessibility, thereby enabling a paradigm shift towards a cohesive healthcare environment that optimizes the capabilities of big data. This enhances the overall quality of data, while giving a comprehensive and a 360-degree view on complete patient data—for a more holistic approach to coordinated care.

2. Next-gen Technologies

While data standardization is a priority for Payers, they also need to look at ways of adopting innovative technologies and advanced analytics that can eliminate data silos and support frictionless, regulation-driven data integration. These collaborative efforts with strict adherence to FHIR policies will ensure higher-quality of structured data that can be streamlined to gather invaluable insights—that unlock great potential.

Healthcare systems can combine these strategies with Artificial Intelligence (AI), Deep Learning (DL), Internet of Things (IoT), wearables and other solutions to be strategically blended with digital care coordination solutions for superior Patient Experiences (PX).

3. Embracing Value-based Care Models

Healthcare interoperability, when strategically intertwined with standardization and exchange can unfold new opportunities to mitigate cost impact, enhance patient experience, drive engagement and Patient Satisfaction Index (PSI), while ultimately improving the health outcomes and the bottom-line growth. Consider that about fifty percent of the U.S healthcare spending is from just 5 percent of the nation’s population. This number in turn highlights the significance of having high-quality real-time data—to facilitate timely interventions, improved patient adherence, continuous guided care pathways, transformed member experiences that spur growth and outcomes.

Healthcare systems should also leverage critical data gathered from Patient Reported Outcomes (PRO), Hospital Reported Outcomes (HRO), Patient Generated Health Data (PGHD), Social Determinants of Health (SDOH) to cohesively enhance data quality to achieve sustainable results in terms of population health management in the world of value-based care.

4. Enhance Member Experience

Healthcare systems can orchestrate a proactive strategy towards managing and accelerating the value of interoperability. Healthcare organizations can enable AI and automation-driven tools like chatbots, self-service applications that can be integrated into the digital patient management platforms and care coordination solutions to significantly reduce no-shows and missed appointments, enable interactive and automate patient education, patient billing, patient referrals and other features that work together to support continuous care throughout the pre, during and postoperative care journeys.

Also Read:

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To learn more about how interoperability techniques can help build robust healthcare network for a hyper-connected healthcare ecosystem, Give us a shout!