Tag: GuidingCare

3 Interoperability Considerations For Health Plans

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Bobby Sherwood

By Bobby Sherwood, vice president of product development, GuidingCare.

A lack of interoperability permeates U.S healthcare. Despite the rapid adoption of new technologies, we have failed to fully realize some of the most impactful opportunities they present. Data silos that hinder collaboration, efficiency, and innovation stubbornly persist across the industry. For health plans, embracing digital transformation to digitize process and improve member experience pays dividends, but can come with difficult integration and interoperability challenges if not done properly.

There has been a recent spotlight on government initiatives and regulations to address these growing concerns. Take the new CMS proposed rule on interoperability and prior authorization, which will require payers to implement an electronic prior authorization process, shorten the time frames for payers to respond to prior authorization requests, and establish policies to make the prior authorization process more efficient and transparent.

In a world where nearly anything can be instantaneously ordered from your mobile phone or laptop and delivered overnight, it seems inconceivable that prior authorizations – something so critical to member and population health – is managed by an antiquated system. This seamless exchange of data will reduce provider abrasion, improve the member experience and potentially their health outcomes, and ultimately decrease the cost of care, as the manual effort and time linked to prior authorizations markedly decreases.

As we execute on the year ahead, interoperability remains top-of-mind for stakeholders: a new report suggests that barriers such as poor data quality and information sharing remain challenging to over 60% of healthcare executives. For health plans prioritizing interoperability, consider these three areas of focus:

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