InterSystems HealthShare® CMS Solution Pack™ helps payers and providers meet new U.S. government regulations requiring health plans to provide members access to their clinical, claims and pharmacy benefit data and hospitals to better coordinate care by alerting PCPs and post-acute care of a patients admission, discharge or transfer.
A new rule from the United States Centers for Medicare and Medicaid Services (CMS), known as the Interoperability and Patient Access final rule, aims to empower patients and improve interoperability while reducing the burden on payers and providers. It is slated to be rolled out in 2021 and 2022.
Deploy On Premises or in the Cloud
Deployed either on premises or in the cloud, the HealthShare CMS Solution Pack leverages our vast expertise in interoperability and bundles together solutions enabling payers to share required claims, clinical, and pharmacy benefit data, regardless of its format, and transform it into FHIR® 4.0.1 representations, so that members can easily access it using third party mobile applications. The solution will also meet the requirements that payers expose their provider directory via FHIR APIs for public access.
Providers
As another part of the same regulation, providers will be better able to coordinate care through the easy exchange of patient information and alerts as patients transition between care settings.
Based on the implementation guides referenced in the final CMS rules, the solution pack includes a FHIR 4 gateway, full support for the United States Core Data for Interoperability (USCDI) clinical data set, all relevant CMS implementation guides, and the required privacy and security standards.
Payers
For payers subject to the rule, the HealthShare CMS Solution Pack will provide a turnkey solution to support patient access and provider directory APIs next year, and payer-to-payer data exchange subsequently. For providers, the HealthShare CMS Solution Pack has the alerting capabilities hospitals must implement by next May.
A Path to Clean Data
“Payers, providers, and patients need reliable, clean, actionable data to achieve a high-value health system,” says Don Woodlock, vice president of healthcare solutions. “The CMS rules are a step in the right direction towards interoperability for all. With InterSystems HealthShare CMS Solutions Pack, payers and providers can meet the new requirements to access critical health information, make sense of the constant influx of data, and empower their staffs to put data in the hands of patients who want access to their data.”
This story originally appeared the HealthShare Connections News Flash No.5 - January 27, 2021