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Interoperability & patient access rule
On May 1, 2020, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), issued a rule to improve secure, authorized access to health and insurance data.
Sharing of this information empowers our members with access to their health and insurance information through the device or app they choice, allowing caregivers and insurance carriers to work together to best serve our member’s healthcare needs.
Connecting multiple health record sources
In spite of advances in health care technology, including electronic medical records, there is not an easy or readily available process to connect multiple health care organizations (i.e. doctors, hospitals, clinics, health insurers, and pharmacies.) These new measures will open doors for options to enable health information systems to work together to deliver health care information for patients that can help ensure effective delivery of the best and most affordable care.
Improving health care
5 key benefits of achieving interoperability (Becker’s Health IT) include:
- Improved care coordination and patient experiences
- Greater patient safety
- Stronger privacy and security for patients
- Higher productivity and reduced healthcare costs
- More accurate public health data
How Sanford Health Plan is collaborating for interoperability
Sanford Health Plan is committed to ensuring interoperability links and the required data are available within the required application-programming interfaces, or API. Data within the APIs enables members to access their health data via a third-party application of their selection.
Medicare Advantage Formulary API
Prior authorization annual metric reporting
To comply with the CMS Interoperability and Prior Authorization final rule, Sanford Health Plan is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year. Publicly reporting these metrics promotes transparency and accountability, helps patients understand prior authorization processes, and enables providers to evaluate payer performance. In addition, metrics can be used to compare plans, programs, and payers.