ONC & CMS Proposed Rules – Part 6: Payer Data Requirements

Nikki Kent Dave Levin By DAVE LEVIN, MD and NIKKI KENT The Office of the National Coordinator (ONC) and the Centers for Medicare and Medicaid (CMS) have proposed final rules on interoperability, data blocking, and other activities as part of implementing the 21st Century Cures Act. In this series, we will explore ideas behind the rules, why they are necessary and the expected impact. Given that these are complex and controversial topics are open to interpretation, we invite readers to respond with their own ideas, corrections and opinions. Interventions to Address Market Failures Many of the rules proposed by CMS and ONC are evidence-based interventions aimed at critical problems that market forces have failed to address. One example of market failure  is the long-standing inability for health care providers and insurance companies to find a way to exchange patient data. Each has critical data the other needs and would benefit from sharing. And, as CMS noted, health plans are in a “unique position to provide enrollees a complete picture of their clams and encounter data.” Despite that, technical and financial issues, as well as a general air of distrust from decades of haggling over reimbursement, have prevented robust data exchange. Remarkably, this happens in integrated delivery systems which, in theory, provide tight alignment between payers and providers in a unified organization. With so much attention focused on requirements for health IT com...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Data Health Policy Health Technology CMS Dave Levin Health Data Interoperability Nikki Kent ONC Rules Sansoro Health Source Type: blogs