Market Energy – Release of Information

Point of Light

Points of Light 2023 Case Study 15

14 April 23 | Aurene Wilford and Boyd Stewart

Patient data often exists in silos, leaving healthcare organizations with poor visibility into care given at other facilities and preventing payer organizations from being able to access a full view of their members’ clinical history. To give both parties a more robust clinical picture of each patient’s care journey, the collaborators in this case study invested in technology to map non-standardized CCD data into one unified medical record that gives both the payer and the provider the ability to track patients across settings and over time. The project has streamlined data-exchange processes and improved performance in quality measures.

To meet CMS requirements for the submission of risk adjustment data and ensure they are being fully reimbursed by CMS, payer organizations need increasingly specific coding information, and these requests for information can put undo administrative burdens on provider organizations. Seeking to increase the payer organization’s access to needed information without increasing the provider organization’s workload, the collaborators in this case study established an API that enables an automated, standardized retrieval process for records that the payer organization needs in order to complete managed care audits.

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