What Actions Should Payers Be Taking Now To Meet ONC/CMS Interoperability Requirements?

By Mike Penich, Partner, Cumberland Payer Division

This is the second blog post in a three-part series on the new ONC/CMS interoperability rules and requirements. For details on the new rules, please read our first post “What Are the New CMS and ONC Rules for Payers?”

Are You on Track To Meet the Upcoming Interoperability Deadlines?

The clock is ticking on health plans to meet the Patient Access and Provider Directory API requirements with a Jan. 1, 2021, deadline for compliance and enforcement beginning on July 1, 2021. CMS estimates that it will typically take 6 to 18 months to implement a solution to meet the new requirements. (Translation – It’s time for health plans to make this a priority.)

So What Should You Be Doing Now?

In short, health plans should be actively assessing three areas.

Assessing the impact of the new rules to your organization. In order to know where to start, you need to have a strong understanding of the new rules and requirements. Then you can begin developing an organizational strategic alignment plan, as well as beginning to identify data sources and complete system(s) data mapping. As the rules were finalized in March 2020, Cumberland created a dedicated interoperability team to review and detail the 500-page requirements, as well as to begin data mapping from various commercial core claims systems to the USCDI data standard.

Assessing your current environment. After gaining an understanding of the new CMS regulations, it’s time to begin developing an organization-specific solution based on your current environment. Is it better for your organization to build an interoperability solution or to buy one? In order to determine what’s best for your organization, you’ll need to complete a review of your technology architecture, perform an analysis of your privacy and security controls, and define your requirements and process flow.  Cumberland provides interoperability assessments and can tailor the scope and timeline of an assessment to meet your requirements.

Assessing third-party vendors. A formal Request for Proposal (RFP) process may be the best option if your organization is seeking a third party to implement an end-to-end solution to enable patient access API, provider directory API and payer-payer data exchange, and to ensure privacy and security. Cumberland has extensive experience planning, managing and executing RFPs on behalf of our clients to achieve an objective decision on the choice of vendor. In addition, we can help you develop a total cost of ownership model to determine your total investment. We have also issued our own Request for Information (RFI) to leading vendors in the space and have completed an assessment process to identify interoperability software vendors that are best suited to meet our health plan client’s requirements.

Next steps?

In our next blog post, we’ll discuss what interoperability means for health plans beyond the upcoming deadline and how organizations can position themselves for future success. If you’re interested in learning more about Cumberland’s interoperability solutions, please email me at info@cumberlandcg.com.