Addressing CMS Interoperability Rules with iPaas

With the CMS Interoperability and Patient Access rule (CMS-9115-F) timelines approaching fast (effective July 2021,) health insurers and health plans require their multiple disparate applications to work together and comply with the complex Interoperability mandate.

As an example, because of disparate systems not “talking with each other”, it may take health plans’ customer service representatives, two or three days to respond to customer inquiries. This leads to poor customer experiences and does not support their mission of providing great care to the community. At the same time, the CMS is mandating HL7 FHIR interoperability APIs, for faster patient access to data.

The key Business Drivers for such initiatives are:

  • CMS Interoperability Rule Compliance for Member, Claims, Pharmacy and Lab data
  • Enterprise integration strategy across Healthcare systems, Salesforce / CRM 360 & Business applications
  • Member Hub – Single source of truth for Member data

Health insurers and health plans are now on the lookout for successful go-to implementation partners that provide:

  • Robust technology requirements to reach compliance,
  • Ready reference Healthcare Interoperability Framework, and,
  • A roadmap for implementation considerations

Considering the stringent timelines, health plans should team up with experienced system integrators like Sage IT, who can:

  • Implement a best of breed IPaaS, customized and configured to their specific needs;
  • Deploy the solution in a timely and cost-effective manner; and,
  • Ensure superior training to technical staff

Check out their 60 to 90 days accelerated migration program

TIBCO, an industry leader API Management and Data Management with their best of breed TIBCO IPaaS, and, Smile CDR, an industry leader in FHIR (Fast Healthcare Interoperability Resources) compliance with HAPI (HL7 application programming interface) library that accesses and converts source data into FHIR data, are a few of the prime technologies that Sage IT leverages to provide a robust solution for implementing IPaaS, as well as complying with CMS Interoperability and Patient Access rule (CMS-9115-F) effective July 2021.

Specifically, a solution that can:

  • Comply with HL7 FHIR & USCDI– Electronic Healthcare Interoperability
  • Integrate disparate data and systems
  • Resolve current architecture challenges and implement an API Driven architecture with Pre-built Patient and Provider API structures
  • Provide for plug and play integration
  • Improve data capture, access, integrity and sharing
  • Improve insights and reporting capabilities
  • Account for future state operability standards
  • Position your organization for future growth
  • Minimize Maintenance and Operational costs with managed solutions

Manish Mehndiratta
Director – Digital Modernization | Principal Architect at Sage IT Inc.

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