HealthLX Mentioned by Gartner in U.S. Healthcare Payer CIO Top Actions for 2021 Report

Gartner recently listed HealthLX as a Representative Vendor in enterprise clinical data integration (CDI) in its U.S. Healthcare Payer CIO Top Actions for 2021: Clinical Data Integration via interoperability.*

According to Gartner, “CMS and the ONC recently finalized interoperability mandates that will transform clinical and administrative data exchange among healthcare payers, providers and patients. CIOs must capitalize on this regulatory requirement to jump-start enterprise CDI investment.”

The report noted, “Many payers have been working on CDI initiatives (such as building a longitudinal health record, improving revenue from risk and quality programs, or coordinating care) for years. However, the vast majority of payers have not achieved scale in either use case implementations or share of provider networks sharing clinical data electronically. Enterprise CDI has been elusive due to a number of factors, including a lack of:

      • Clear technical, content and vocabulary standards for clinical and administrative data

      • Provider trust in payer clinical data use beyond explicit attribute and use-case-level agreements

      • Financial incentives for providers to establish and maintain CDI interfaces with payer

      • Specific business value assessments and reasonable ROI targets for CDI initiatives

      • Strategic support for CDI use cases beyond compliance from executive leadership.”

“Gartner has articulated the challenges in prioritizing enterprise clinical data integration well,” said Will Tesch, CEO of HealthLX. “With the CMS mandates and ONC rule, it’s go-time for payers. We’ve seen a sharp increase in companies needing an enterprise CDI partner like HealthLX because they don’t have the time or resources to take this on, especially with the added demands of the pandemic.”

Gartner stated, “Recent interoperability-focused mandates from CMS (CMS-9115-F and CMS-9123-P), which reference standards established in a complementary ONC rule, are forcing payers to invest in development and vendor solutions that represent a significant departure from existing CDI and administrative data exchange methods. These new approaches substantially resolve the standards barriers to achieving CDI scale by:

      • Establishing FHIR 4.0.1 as the basis for data exchange among health ecosystem participants, with explicit technical, content and vocabulary standards defined and governed by the ONC’s rule

      • Defining OAuth 2.0 as the standard authorization framework governing entities’ data access via APIs and OpenID Connect as the standard authentication protocol for individuals permissioning access

      • Defining the U.S. Core Data for Interoperability clinical data requirements and associated codesets.”

“In our work with customers and as a founding member of Health Level Seven International’s (HL7) Da Vinci Project, time and again the efficacy of FHIR has been proven,” said Tesch. “Our FHIR Enterprise platform enables payers of all sizes to be ready for the CMS mandate while also leveraging legacy investments. This approach reduces risk and overall costs to meet the compliance objectives and enables a step into end-to-end enterprise CDI. On a daily basis we’re helping organizations deploy FHIR resources to transition successfully to more patient-centered, data-driven healthcare.”

And this FHIR train isn’t stopping based on a new proposed rule for Prior Authorization on FHIR. As Gartner explains, “With the imminent CMS rule on improving prior authorization, providers will realize workflow-easing value from clinical data exchange with payers. This will, in turn, help payers overcome the provider trust gap and negotiate broader data usage agreements. Although the rules do not directly address expected value realization for payers, they will drive cost savings as well as business “lift” across use cases, including:

      • Compliance

      • Risk adjustment optimization

      • Prior authorization and utilization management

      • Quality improvement

      • Care coordination

      • Advanced analytics

      • Provider experience

      • Member experience

      • Employee experience.”

“As an objective to provide our customers with the newest and solution appropriate needs, it’s crucial that HealthLX continues to stay in the ‘tip-of-the spear’ position by actively engaging within the standards ecosystem. said Tesch. “The potential to improve patient care and outcomes as well as the business of healthcare in so many ways is there – we just need organizations to get on board. The CMS Mandate gives purpose for organizations to think end-to-end on CDI as part of their business objectives.”

*Gartner, “U.S. Healthcare Payer CIO Top Actions for 2021: Clinical Data Integration via Interoperability,” Mandi Bishop, 3 February 2021.

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