By Leslie Small
Recently, the Trump administration issued new proposed
regulations that aim to promote interoperability in the health care industry.
But industry experts tell AIS Health that task might be easier said than done,
and it could come with high costs for smaller health plans that lack hefty IT
budgets.
One provision in the new proposal would require Medicare
Advantage (MA) organizations, state Medicaid and Children's Health Insurance
Program fee-for-service programs, Medicaid managed care plans, CHIP managed
care entities, and qualified health plan issuers in the federally facilitated
exchanges to implement, test and monitor application programming interfaces
(APIs) "to make patient claims and other health information available to
patients through third-party applications and developers."
Levin, M.D., chief medical officer of Sansoro Health, says the
first challenge for insurers to comply with the new requirements is that
organizations will need to understand where to go get the data, "and my
guess is that varies quite a bit, and there's probably the usual data
governance and data quality issues around that."
Second, some entity has to find a software solution that will
create an API, populate it and share that data. Larger insurers might have the
ability to do those tasks on their own, but it would be a challenge for smaller
plans, Levin says.
Managed care expert Peter Kongstvedt says his "biggest
worry" is that complying with CMS's proposal will strain smaller insurers'
IT budgets. "If it's something that we want to do, we should find a way to
protect the smaller plans if we want to have a competitive marketplace,"
he says.
From
Health Plan Weekly
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