As Interoperability Looms, Some Plans Might Get Left Behind

Sep 18
Sep 18, 2020

Experts say that many health insurers are not on track to meet the impending July 2021 and January 2022 deadlines for implementing HHS’s interoperability final rule under the 21st Century Cures Act, a problem that has been exacerbated by the COVID-19 pandemic. However, they also say organizations that have been proactive about building up their technological capacity are in a position to make substantial gains in their analytics capabilities and relationships with members.

The HHS final rule, which was published in May, requires insurers that sell Medicare Advantage, Medicaid and CHIP managed care, and Affordable Care Act exchange plans to launch an application programming interface (API) that will allow patients to access their complete medical and claims history on demand along with a continually updated provider directory by July 2021. Payers must also make all of their patient and claims data available to other insurers on a payer-to-payer data exchange, which must be in place by January 2022. Those deadlines were both extended this summer, as health care stakeholders have been overwhelmed by the COVID-19 pandemic.
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Peter Johnson

Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.