Preparing for the next wave of interoperability: Strategies for health plans

DOTmed July 29, 2024
Katie Devlin

Traditionally, payers have struggled to obtain clinical data in a structured format, which is crucial for determining appropriateness of treatment, utilization, and member engagement, and for capturing digital quality measures.

The 21st Century Cures Act established an ambitious vision for healthcare interoperability — the ability of two or more systems to exchange and use health information — but it wasn’t until recently that health plans had a clear path forward to achieve it, and to ultimately obtain the clinical data needed to support their strategic goals.

Now, the clock is ticking for payers to become compliant with the CMS Interoperability and Prior Authorization Final Rule. As payers prepare to meet these new requirements, which leverage industry best practices, they must...

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