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CMS Payer Interoperability 2024
How Are Payers Optimizing the Use of Their Solutions beyond Compliance?
Author
Tyson Blauer
Author
Ruirui Sun
With the initial goal of meeting CMS requirements (e.g., CMS-9115-F), payer organizations have invested heavily in interoperability solutions to transform data into the FHIR format and provide APIs for member portals and other data exchanges. Still, industry-wide usage among patients for these types of offerings is low, with very few enrolled members asking payers for their medical information. As a result, payers need to determine how to utilize the solutions in a way that maximizes their value, especially as some payers report higher price tags from vendors for the technology to support more use cases. To help payer organizations navigate this field, this report examines the performance of CMS interoperability vendors as well as what current and future use cases are a priority for payers.
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Key Findings:
- Beyond Compliance, Current Uses of Solutions Most Often Revolve around Data Conversion; Future Use Cases Will Be Focused on EHR Integration & Closing Care Gaps
- Smile Digital Health Customers Report Highly Varied Use Cases
- InterSystems Builds Strong Customer Relationships but Has Opportunities to Provide More Product Value; 1upHealth Customers Only Report Compliance Work, with Some Considering Leaving
- Edifecs & Onyx Technology Customers Highly Satisfied Due to Strong Relationships & Expertise in Compliance
Writer
Carlisa Cramer
Designer
Jess Wallace-Simpson
Project Manager
Andrew Wright
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.