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May 6, 2021

New rules would crumble “Berlin Wall” separating plan & provider data

Health plans and providers have traditionally operated in almost complete segregation, exchanging claims and authorization transactions but little else. Some of this separation stems from the adversarial relationship between “plans that pay” and “providers that cost.” This inherent division was expanded 20 years ago by the Health Insurance Portability and Accountability Act (HIPAA), shielding patient health information and demanding only the “minimum necessary” be exchanged between plan and provider trading partners.

Dec 30, 2020

Top blog posts of 2020: The year in review

2020 has been memorable, to say the least. As we reflect on all we have learned over the past 12 months, we invite you to read some of our most popular blog entries, presented here in chronological order.

Sep 21, 2020

Wealth solutions for today and tomorrow must focus on operational agility

With all of the day-to-day rigors of running an investment operation, it is difficult to devote the time to look at your overall operations, but it is important to pause and consider areas to improve and your longer-term future needs. In my role as a product manager, I often hear from wealth management firms that are struggling to optimize their operations and feeling they lack a compass to help them chart the path forward. As one firm representative told me, “We just don’t know what we’re looking for.”  I’ve seen hundreds of clients and implementations, and in this post, I share my perspective on some of the key aspects you should consider to grow and optimize your business.

May 19, 2020

Final interoperability regulations: five areas for compliance by Jan 2021

In 2021, health plans providing Medicaid, Medicare, CHIP and coverage under the Federal Exchange must expand the sharing of individual PHI data beyond written communication to provide electronic claims and clinical data to members’ phones, mobile devices and web applications.  The final CMS “Interoperability and Patient Access” rule released on March 9th is the first nationwide interoperability requirement for health plans and states administering coverage under government programs to generate individual and plan data in this manner

Feb 5, 2020

Five industry interoperability efforts every payer should know

Interacting with meaningful healthcare data to fix real-life problems should be your interoperability end-game.  Industry and government leaders have been hard at work identifying the most significant types of data and potential uses to solve the most common problems we have in healthcare.  Are you familiar with these efforts?

Dec 10, 2019

What I learned from trying to solve interoperability without a use case

I have worked in healthcare for close to 30 years, and like many of you, I have learned quite a few lessons along the way.  I have been part of the healthcare “crack the interoperability nut” generation that started in 2005 with a primary focus on moving data for coordinated care delivery, provider-to-provider.

Sep 26, 2019

Freeing health plan data using Trusted Exchange Networks

The U.S. invested over $35 billion in electronic health record (EHR) incentives, achieving adoption rates of 86% by physicians and 96% by hospitals, and creating massive amounts of data.

Jul 15, 2019

The game changer: 3 interoperable data types required of health plans

Government interoperability mandates are coming to health plans. Mobile and web access to individual health claims data, clinical data, and health provider information may finally be entering the 21st Century. 

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