Just like other segments of the financial industry, insurance services providers have been severely shaken by the COVID-19 pandemic. The increasing rate of unemployment in many places and the rise in claims have contributed to a significant misalignment of premiums collected and claims paid. In addition to the lingering level of uncertainty surrounding premium collectability, the current disruptions are also making it difficult for companies to calculate premiums for years to come.
On the other hand, the ongoing crisis has also served as a wake-up call for many insurance companies. It’s a must for insurance providers to fully make use of the latest health insurance technology at their disposal if they want to minimize the negative impacts of the pandemic on their business. Access to real-time information and making data-driven and timely business decisions are keys to ensuring that the company will remain afloat despite the currently unstable business environment.
One of the resources that many health insurance companies underutilize is patient data. This valuable resource, when managed by digital solutions and used properly, can assist health insurance providers in many ways, including:
Delivering Better Outcomes for Individual Patients
Consolidating information gathered from different medical facilities and practitioners has always been a challenge for more traditional health insurers. The lack of both a unified information repository and open yet secure channels for exchanging data prevents medical care providers from consolidating patient information. In turn, this makes it more difficult for medical professionals and insurance companies to ascertain the patient’s condition and the treatments they need to effectively and quickly address or manage their health issues.
By Scott Galbari, chief technology officer and CISO, Lyniate.
Scott Galbari
For as long as healthcare data has existed, so has the healthcare industry’s challenges with interoperability. The pursuit of healthcare data interoperability has been a longstanding industry challenge, and with the recently finalized interoperability rules from the ONC/CMS going into effect at the end of this month (though deadlines will be extended until mid-2021), interoperability yet again is at the center of many healthcare discussions.
The rules, which aim to provide patients with greater control over their health data and eliminate information blocking, has not been without its critics. Some argue this rule will put patients at risk by inadvertently exposing patient health data to security breaches. However, the spread of the coronavirus pandemic across the United States has underscored the dire need for seamless, bi-directional data exchange. The new rules’ focus on FHIR and APIs to enhance electronic health information sharing are proving to be exactly what we need in the current crisis.
The coronavirus has necessitated all kinds of changes — from rapidly escalating the use of telemedicine, to standing-up temporary testing sites and care centers, to meeting enhanced public health reporting requirements — all of which would have been much more easily addressed if the new rules’ requirements were already in place, and all of which have presented significant challenges amid the COVID-19 crisis.
Because of these unprecedented circumstances, healthcare stakeholders are being required to share health information and data at increasingly high volumes, emphasizing the importance of strengthening the internal infrastructures of these organizations to ensure they can properly send, receive, and analyze health information. However, because of the strain COVID-19 has put on healthcare organizations, the Department of Health and Human Services (HHS) has decided to push out the timeline for meeting the rules’ requirements. While the reasoning for this is understandable, in many ways it is unfortunate that these requirements were not already in place prior to the pandemic.
For decades, the use of paper medical records was the “norm” and the sharing of those records with another provider typically involved a photocopier and a briefcase for the patient to carry them to the next doctor. Today, electronic medical records are becoming the standard, but the exchange of health data between disparate networks and software systems has remained elusive.
While some data exchange is taking place in health care today, it’s only occurring in isolated pockets, typically within one region or health system, making it largely ineffective. Solving this challenge requires transparency, collaboration and innovation for continued success–attributes CommonWell Health Alliance embodies.
Transparency across the Industry
Competition in almost every sector thrives on keeping information separate and technologies proprietary. However, for many industries – like banking, telecom and internet, working across competitor lines to exchange data has enriched and expanded their reach. Health care needs to take a lesson from these industries.
Working in data silos will not improve the exchange of health data; rather, it will create friction in the industry. Patients expect their doctors to have the information they need to provide them with the best treatment. Doctors struggle to access this important data outside their four walls. The industry has an opportunity to step up and make it possible for providers to access a three-dimensional view of the patient’s health history, and in turn, create a new wave of opportunities for the health IT industry.
Collaboration among Health IT Industry Players
Collaboration throughout the IT industry is essential to creating a ubiquitous nationwide interoperable Health IT Infrastructure. This focus on infrastructure will drive standard adoption and open up the gates to national record sharing. Electronic health record (EHR) vendors offering services across the healthcare continuum are a key piece of this puzzle, which is why CommonWell formed to join forces with all health IT stakeholders dedicated to the vision that patient data should be accessible no matter where care occurs.
Collaboration with the public sector is also crucial. The government plays a strong role in narrowing the technical standards in health IT, but the bar must be raised on leveraging real-world data exchange. Additional ONC activities are complementary to the existing Federal Advisory Committees (FACAs) as noted below:
Bipartisan legislation known as the 21st Century Cures Act—which passed in the U.S. House of Representatives this past July—includes mandates that systems be interoperable by the end of 2017 or face reimbursement penalties.
In early October, the Office of the National Coordinator for Health IT (ONC) released its final draft of “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap.” The three overarching themes of the roadmap including:
Giving consumers the ability to access and share their health data
Ceasing all intentional or inadvertent information blocking
Adopting federally-recognized national interoperability standards.
The ONC has also formed a Health IT Policy Committee and Health IT Standards Committee which each include smaller workgroups that meet to ensure ongoing collaboration among the private and public sector. In fact, many members of CommonWell and other private-sector interoperability initiatives participate and/or lead these committees and workgroups.
