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. 

How can you get members to do what you need them to do? This is the number one challenge facing many Medicaid Health Organizations (MCOs). Member engagement is crucial for encouraging healthy activities that can improve outcomes and drive down costs for your organization. Plus, it’s the best way to make a positive impact in the lives of your members.

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.

For Medicaid plans, there has been a shift in the way members communicate. With a clear preference for texting over calls, it’s important to align with this preference. Further, SMS is an efficient channel of communication and can help your organization serve more members while improving quality. Whether it’s being used to send informational messages and reminders to the members, the benefits are numerous.

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.

The COVID-19 pandemic has driven more businesses online than ever before. With health care plans growing their number of older members, this may not be welcome news. Even though remote mobile service is a growing industry trend, a study from the Pew Research Center found only 26% of internet users aged 65 and over were “very confident” when using smartphones. Optimizing your plan’s mobile design to accommodate their needs should be a key focus heading into 2021.

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).

As we plan for the new normal, it’s time for Medicaid plans to evaluate the change in member expectations and behavior. People are now performing jobs successfully at home in record number, and a recent Gartner poll shows that 48% of employees will continue to work remotely in the future. In short, remote work and service are trends set to control the remainder of 2020 and 2021.

As a health plan, getting members to act on compliance requirements is a costly and time-consuming affair. It’s a key focus for Medicaid plans because non-compliance results in revenue loss and corrective action. Since member participation is voluntary, many Medicaid plans have tried different approaches to meeting this requirement. Incentivizing behavior change among their members has become the most popular route that many have taken – but this is far from the best option. The secret to boosting compliance lies in changing how Medicaid plans approach this problem.

Interview with Dawn Miller, Risk and Compliance Manager at Sagitec

We welcome Dawn Miller to lead Sagitec’s risk and compliance charter. Dawn graduated from Temple University and has obtained numerous risk and compliance professional certifications. She has over 25 years of experience in risk management, compliance, safety, data privacy, and emergency preparedness. Her experience includes workplace safety matters, emergency preparedness, and disaster relief, including playing a role in response to the September 11^th attacks. She has held leadership roles in federal and global healthcare programs as a Director of Risk Management and Compliance and Data Privacy Officer. She has been responsible for managing HIPAA, GDPR, and data privacy requirements.