The scope of CMS’s most recent rule on interoperability, CMS-0057-F, is broad, ranging from payer APIs to bi-directional information exchanges needed for prior authorization to public reporting. So, InterSystems frontloads the inclusion of stakeholders from all impacted functions when working with health plans to maximize the ROI on IT infrastructure effectively mandated by CMS-0057.
To help our health plan partners identify key players within their respective organizations, we asked a cross-section of leaders at over 50 payer organizations which roles were most critical in assessing recent investments in interoperability regarding FHIR APIs, electronic prior authorization (ePA), and longitudinal health records (LHR). Below are the ten roles most frequently named by respondents as most influential.
At least two take-aways from these results merit mention. First, the most frequently cited role was not an IT leader but rather a senior clinical executive at 57%. Second, no other role was named by a majority of respondents. Put another way, maximizing the ROI on IT infrastructure mandated by 0057 requires upfront buy-in and input from a wide range of functions and levels, including clinical, IT, and UM leaders, and many plans may need to create new working groups and forums to unlock these cross-functional synergies.
Lastly, it is important to note that our survey focused on internal stakeholders. Ultimately, the return on payer investment called for by CMS will hinge in large part on provider utilization of the new APIs for prior authorization and care management and, in turn, how easily they can be incorporated into desired provider workflows.
To learn more about how to maximize ROI on IT infrastructure needed to comply with CMS-0057-F, download the new InterSystems white paper. Additionally, InterSystems will be leading an upcoming AHIP webinar on Maximize Your ROI on CMS Payer Mandates: Ten Key Questions. It is an open session welcoming both AHIP members and non-members alike.
Originally Published by Fierce Healthcare: Maximizing ROI on IT Required by CMS Rule 0057 Takes a Village | Fierce Healthcare
