CMS’s New Rule Is Creating a New Future for Modernizing Health Data Sharing

For decades, our healthcare system has struggled to find ways to cut down on unnecessary provider tasks — from lengthy times to credential to prior authorization approval delays, valuable time better spent on patient care is being wasted. One of the driving factors right now for changing the landscape is meaningful technology integrations. A statewide rule that enforces this integration might just be the catalyst we need to establish a new standard of healthcare information exchange.

The Centers for Medicare & Medicaid Services (CMS) is taking a huge step forward toward eliminating antiquated data exchanges, such as fax machines, to reduce patient processing time and remove provider burdens. The Interoperability and Prior Authorization proposed rule (CMS-9123-P) was recently finalized, requiring payers in certain government programs to build application programming interfaces (APIs) to help facilitate the electronic exchange of healthcare data. This new rule will help to reduce decision time frames for prior authorizations, improve data sharing among payers and providers, and give patients more access to their health information. We are finally seeing much-needed momentum within the government to finally begin integrating modern, more efficient technology, both on the patient and provider side. 

The rule includes five sets of proposals and five requests for information, with APIs being the center point. The ability of APIs to enable information systems to communicate and transfer data between each other has continuously proven to be a large factor in health IT interoperability. We have already seen how valuable APIs are for improving healthcare processes. Nearly 90% of healthcare stakeholders believe that APIs are “mission critical” or “quite important,” and according to a recent Change Healthcare research study, 40% of providers and 60% of payers agree that APIs enhance productivity and help streamline patient data accessibility. This new rule also seeks to replace the use of fax with digital data exchange, which will have a ripple effect on the whopping 93% of primary care physicians who accept Medicare. A large portion of providers need to complete payer credentialing for Medicare and Medicaid, and as payers are now required to implement APIs for data exchange, providers who accept Medicare and Medicaid can expect their office workflow and credentialing turn-around processes to be drastically improved. This attempt to alleviate some of the administrative burdens of the prior authorization process is key to reducing provider burnout and improving the overall patient experience.

Although this proposed rule shows promise for where we are headed, there is still work to be done. California has garnered significant support for single-payer healthcare implementation for years. The benefits are undeniable; a single-payer healthcare system would allow for cost savings of approximately $150 billion on paperwork alone. However, when recently put to the test against the State Assembly, legislation to create a government-run universal health care system in place of private health insurance within California was turned down without even being put up for an official vote. If enacted, Assembly Bill 1400 would facilitate the standardization of care, making accessibility and affordability much more attainable than it currently is. The bill proposed the creation of CalCare, a publicly financed healthcare system that would remove private insurers and profit margins from healthcare, which, in turn, would create more comprehensive healthcare for all types of systems. Although we’ll have to wait until next year to see if AB 1400 has another chance to be passed, this bill is a sure way to provide coverage to all Californians that should continue to stay on our radar.

Is California ready for a radical healthcare system reconstruction? CMS’s recent activity suggests that making policy changes to update our outdated ways can be successful. However, if Assembly Bill 1400’s rejection is any indication, complacency with our current inequitable system may continue to hinder us from advancing meaningful healthcare reform and eliminating barriers to care in the future. Modernizing data exchange is the first leap of many to getting healthcare up to speed literally and figuratively.

Ready to modernize your organization’s credentialing? Connect with Modio today. 

Facebook Comments