Healthcare Interoperability is a framework where systems are coordinated to provide standardized methods of interacting with patient data.

In recent years, Health Information Exchange (HIE) capabilities have helped mobilize patient data allowing clinicians and healthcare managers to provide near real time diagnosis closing the gap on member care.

In late December of 2020, bi-partisan legislation known as the No Surprises Act was passed by the U.S. government. The main purpose of the bill is to eliminate surprise medical costs for out-of-network services.

One of the best practices learnt during my military service and applied to my Business Analyst career was the importance of collaborative outreach and thorough communication with key stakeholders.

Siloed data hinders collaboration and can cause serious downstream issues affecting multiple departments such as enrollment, claims and reimbursement. This data fragmentation stops the payer’s ability to get a 360° view of their customer, making it difficult to provide a more personalized experience.

In order to implement automation applications and other machine-based processing, data must follow an agreed-upon structure and standardization. The global healthcare community believes they are close to achieving this with Fast Healthcare Interoperability Resources (FHIR).

It is important that payer organizations continue to seek ways of improving their HEDIS scores year-to-year. One certain way of doing this would be to implement a proper data management system.