Step Back To Move Forward on Interoperability

By Mike Penich, Partner

We’re only days away from the July 1 enforcement date for CMS interoperability mandates related to patient access and provider directory APIs. Let’s face it – the process hasn’t exactly been easy. It was more complicated and more challenging than many vendors and payer organizations originally thought. Most payers have been hustling to meet requirements before the enforcement date.

Now that you have cleared the first hurdle, what do you do next?

Hit the Reset Button

With additional mandates on the horizon, what should you do now to move forward? Take a step back.

I know it sounds counterintuitive; but at this point, it’s important to step back and look at interoperability through a strategic lens. Refocus your team’s efforts on the long-term goal of creating a portable, comprehensive, longitudinal health record for individuals to improve the quality of care they receive.

Payer organizations should be asking themselves two questions in order to reset their strategy.

How do we ensure members take advantage of these tools?
Member education and outreach are more important than ever. Now that you have created patient access tools, are your members using them? If not, why? Are there barriers to access based on demographics that should be considered?

Now is a good time to refine your strategy on member engagement and determine how you’ll educate members and ensure access equity across all demographics. Enhance your member experience beyond what the rule requires, build loyalty, and differentiate your organization by enabling new capabilities for your members.

How are we going to leverage the data to add value?
Interoperability creates a huge opportunity for health plans to see real value if implemented with the long view in mind. Interoperability business objectives and opportunities can and will change over the coming years. Care coordination can be greatly improved as new members bring their data with them as they switch health plans or providers. New data collected can expedite analytics, population health management and even process improvement. Interoperability is a building block for these and other capabilities. It’s important to begin strategizing now about where you want to be and how achieving a portable patient record for your members will lead to cost savings and quality of care improvements.

Looking Ahead

Interoperability mandates and regulations have just begun. We believe change will be the new constant, and we are here to help you navigate the process. The Payer-to-Payer Data Exchange deadline for compliance is around the corner on Jan. 1, 2022. In our next blog, we will outline some of the lessons learned from the sprint to meet the initial mandated requirements and will share tips on how to ensure that your organization is on the path to compliance.

Interested in learning more about interoperability? Join us for a live panel to discuss the Technology and Financial Considerations for Interoperability. Save your seat by registering today.

If you’re interested in learning more about Cumberland’s interoperability solutions, please email me at