Gartner recently listed HealthLX as a Representative Vendor in clinical data integration (CDI) in its Quick Answer: Use FHIR to Jump-Start Clinical Data Integration for U.S. Healthcare Payers.*
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. This research provides a framework for CIOs to jump-start enterprise CDI investment through mandate compliance.”
Gartner reports that many payers have been working for years on initiatives that depend on successful CDI, including building a longitudinal health record, improving revenue from risk and quality programs, or coordinating care. 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.
As Gartner explains, payers can use the U.S. Centers for Medicare and Medicaid Services (CMS) interoperability mandate to justify a strategic investment in Fast Healthcare Interoperability Resources (FHIR) and enterprise clinical data integration by taking the following actions:
Embrace FHIR as the new common language for healthcare data exchange, as established in the rules finalized in 2020 from the U.S. CMS and Office of the National Coordinator for Health Information Technology (ONC).
Utilize standards for exchanging clinical and administrative data using FHIR APIs among payers, providers, patients and consumers, as defined by these rules and recommended by CMS for compliance with future rulemaking.
Justify enterprise clinical data integration (CDI) investments using the high business value of use cases such as risk adjustment, quality measure improvement, care coordination and advanced analytics.
Leverage vendor partners to accelerate value realization from CDI initiatives.
“Lack of time, resources and in-house expertise have been the most common reasons payers are working with CDI partners like HealthLX on compliance initiatives related to the CMS mandates and ONC rule,” said Will Tesch, CEO of HealthLX. “We have always believed payers can realize exceptional value from enterprise CDI beyond compliance – that’s a conversation we have early on with every organization HealthLX works with. Gartner is on-point with the strategies suggested in this report.” As Gartner states, “By first emphasizing and delivering real value to providers, savvy payers will parlay these regulatory demands into a compelling business case for an enterprise-wide CDI program that addresses savings and business performance “lift” for their own organizations.
Gartner offers example outcome targets for high-value use cases that CIOs can use to justify CDI investments:
Table 1: Business Case for Enterprise Clinical Data Integration
“The payers leading the industry are those that have prioritized the provider, member and employee experiences,” said Tesch. “They’re using the current regulatory environment as a springboard to advance enterprise CDI in ways that elevate stakeholder experiences to new levels.”
*Gartner, “Quick Answer: Use FHIR to Jump-Start Clinical Data Integration for U.S. Healthcare Payers", Mandi Bishop, 11 January 2022.
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