Inovalon, a Bowie, MD-based provider of cloud-based platforms empowering data-driven healthcare, announced the launch of its Consumer Health Gateway™, a Fast Healthcare Interoperability Resources (FHIR®)-based solution Module of the Inovalon ONE® Platform that enables health plans with Medicare Advantage, Commercial ACA and Medicaid/CHIP insurance products to easily and efficiently comply with the new Patient Access Application Program Interface (API) requirement of the 21st Century Cures Act, effective July 1, 2021, while also paving the way for applications empowering consumers to access and benefit from their own personal healthcare data in real time.
Impact of 21st Century Cures Act
Under the 21st Century Cures Act, organizations engaged in supporting and providing care within the United States are required to support increasing interoperability and access to patient-level data as the Centers for Medicare and Medicaid (CMS) focuses on empowering improved quality and efficiency of patient care. A key aspect of the Act pertains to supporting consumers’ access to their own patient-level data and the requirement of all health plans to support API access to the data in real time. Reflecting the technology requirements of such capabilities, on March 9, 2020, CMS released the Interoperability and Patient Access final rule (CMS-9115-F) providing insight into the costs expected to be incurred by health plans to achieve and maintain compliance, estimated to be on average approximately $2 million in the first year for health plans operating in the United States.
Leveraging Patient Access APIs
In addition to supporting healthcare organizations’ compliance with the Act, the mandated availability of Patient Access APIs is projected to usher in a new ecosystem of patient-focused personal healthcare apps, powered by the easily accessed, real-time availability of detailed patient-level data authorized by the individual consumer. Apps ranging from personalized diabetes management apps and mobile health coaches, to advanced healthcare organization engagement platforms and clinical trial recruitment tools, are just some of the hundreds of patient-focused consumer offerings that the patient data access marketplace is expected to empower.
As part of its Inovalon ONE® Platform, Inovalon maintains one of the nation’s largest networks of healthcare data connectivity and the nation’s largest primary-source healthcare dataset containing deep, longitudinally matched data pertaining to more than 315 million patients and 55 billion medical events, empowering a significant breadth of the U.S. health plan marketplace, including 24 of the nation’s largest 25 health plans.
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Through a FHIR®-enabled, real-time clinical data exchange, patient authentication toolsets, and easy to configure interfaces, clients can readily leverage their existing engagement of the Inovalon ONE® Platform with Inovalon’s Consumer Health Gateway Module to cost effectively achieve compliance with the 21st Century Cures Act. The combination also enables the delivery of highly personalized consumer-facing offerings to further engage their membership base and differentiate their organizations within the marketplace.
FHIR-Enabled Consumer Health Gateway
Inovalon’s Consumer Health Gateway is a consumer portal allowing the FHIR®-based exchange of an individual patient’s claims and clinical data securely and seamlessly with authorized third-party applications. Powered by a robust patient consent and authentication platform, Inovalon’s Consumer Health Gateway™ provides an industry-leading capability to authenticate any third-party app the consumer is using to access their healthcare data, as well as authentication of the consumer themselves to prevent fraud.
The capability set delivers a seamless approach to compiling and validating the comprehensive set of the respective patient’s clinical information (inclusive of all elements of the United States Core Data for Interoperability (USCDI)) and claims data (inclusive of all components of the Common Payer Consumer Data Set (CPCDS)) and providing such information back in real time through FHIR® 4.0 Resources in accordance with the specifications of the Interoperability Rule.
Role of Inovalon’s Healthcare Data Lake
APIs such as Inovalon’s Consumer Health Gateway™ are just one of the capabilities offered through Inovalon’s Healthcare Data Lake, which delivers user-friendly dashboards, exportable data extracts, and advanced query tools to support advanced analytics initiatives and help healthcare organizations solve complex business and clinical issues. Inovalon’s Healthcare Data Lake plays an integral role in helping health plans align and comply with the Patient Access API requirement and the broader Interoperability Rule. It provides a comprehensive data and analytics ecosystem complemented by extensive data connectivity and reach to more than 700,000 provider EHRs, and expanded access into new data sources including CMS’ Blue Button 2.0.
Source: HIT Consultant
