Getting ready for payer-to-payer data exchange as part of the CMS Interoperability mandate? If so, your priority as a payer is to address the need to aggregate your members' data from various former payers. While this mandate focuses on empowering members, it also makes payers rethink how member data needs to be aggregated and distributed. 

API Management is a critical component of the payer’s FHIR infrastructure. It helps in fulfilling the security requirements of the CMS mandate and business services integration requirements to orchestrate with enterprise systems and services. Further, effective management helps you comply with the security requirements for monitoring, reporting, and managing access to the FHIR resources by external stakeholders, including third-party apps and health plans. We will briefly touch upon how this API management functionality is implemented within Sagitec’s HealFHIR in this blog.

CMS Interoperability compliance is a long-term journey for Payers. IT systems and processes not only have to be realigned to meet the requirements of the new mandate but also must be nimble enough to adapt quickly to changing business models as patient adoption increases. To best meet these demands, payers should focus on putting together an FHIR infrastructure that complies with the mandate and provision it to extend and scale as the mandate as patient adoption evolves.

In an effort to provide members with access to their health data, government sponsored health plans are required under the new CMS mandate to better support interoperability and access to patient data. With the mandate coming into effect in only a few months, payers need to act quickly on ensuring their organization's compliance. One of the key steps in ensuring ongoing compliance is to evaluate and choose the right type of cloud deployment model for the FHIR server. The choice comes down between two options: cloud-hosted open-source system (OSS) FHIR server and managed FHIR server offered as Platform as a Service (PaaS).