Payers Under Fire – Meeting FHIR Deadlines

Posted in GeBBS Healthcare Solutions, Inc.

As if 2020 wasn’t overwhelming enough for payers who are battling a global pandemic while navigating all the many changes it brings to policies and reimbursement – there’s also a mad dash underway to meet the deadline for Fast Healthcare Interoperability Resources (FHIR) exchange format standards which go into effect on July 1, 2021. This date marks a significant interoperability milestone that requires all insurers to provide patients with the opportunity to access their records through a member app or portal via computer or mobile device.

FHIR is an HL7 standard that allows organizations to exchange healthcare information electronically – and its goal is to ensure patient records are readily ‘available, discoverable and understandable.’ It aims to create a framework for adapting data elements (known as resources) so they can be interpreted by any system.

While the push for interoperability is a noble cause and certainly one worth pursuing, it’s not one that can be achieved with the flip of a switch. This fall, many payers are working tirelessly with the massive amounts of data to make this happen quickly enough to meet the 2021 deadline. Payers are working to go live with the two required APIs – one for member access of clinical and claims data and the other, a public directory that includes both drug formularies and provider networks.

While many payers have successfully gone digital with certain elements needed to make this happen, the toughest challenge of all is the issue of clinical data. With the proliferation of EHR technology and big data, the amount of incoming clinical data is massive to say the least – not to mention it’s often not fully accurate and it’s certainly not consistent or standardized.

Getting these huge volumes of data ready and in compliance with FHIR standards is a monumental undertaking. Information is coming in from numerous EHRs in various formats from both structured fields and free text notes – making it seemingly impossible to achieve interoperability. Efforts must be made to develop a data strategy that allows for standardizing it and making it ‘recognizable’ enough that it meets the FHIR exchange format requirements. According to a June report from Gartner, most payers aren’t ready – even as the deadline looms closer.

Don’t Go It Alone

As payers struggle and stress, vendors with expertise in embedded EMR solutions, data acquisition and integration, medical coding and billing, and revenue cycle management often have the tools already in place to help insurers find the path toward interoperability.

These organizations are often taking data from disparate systems, paper, and FHIR-integrated APIs – and can therefore help bridge the gap. Health plans need a sound data strategy to navigate this new world of interoperability – and doing so will take a village.  The moral of the story? Don’t try to go it alone. Insurers may need to partner with numerous organizations to tackle the shifting interoperability landscape and meet looming deadlines. Outsourcing some ancillary functions will allow payers to keep their eye on their core business while navigating the shift to value – an effort that requires an ongoing, uninterrupted focus.

GeBBS Healthcare Solutions offers flexible solutions and technology to help you get closer to full interoperability. Let’s connect soon to discuss your interoperability strategy and how GeBBS might be able to help you execute on your strategy. To learn more pleased visit: gebbs.com

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