Introduction
In the ever-evolving landscape of healthcare, interoperability remains a persistent challenge, with significant implications for payers. Despite efforts to address this issue, the complexity of healthcare data exchange continues to hinder efficiency, drive up costs, and limit the realization of positive returns on investment. Today, we delve into the pressing importance of interoperability for payers and explore how identity management holds the key to unlocking its potential benefits.
Importance and relevance
Interoperability is not a new problem in healthcare, but its unresolved nature is costing the industry dearly. Recent estimates suggest healthcare data interoperability costs the U.S. health system over $30 billion (about $92 per person in the US) a year1. For payers specifically, the stakes are high, with almost 60% of those who invest in interoperability failing to realize positive returns due to the low utility of the data2. These statistics underscore the urgent need for effective solutions tailored to the unique challenges faced by payers.
What has changed to make this problem harder to solve
Regulatory mandates, such as those driven by CMS and the 21st Century Cures Act, have intensified the pressure on healthcare payers to exchange information with provider partners. Consequently, payers are shifting their focus from compliance-driven initiatives to strategic investments in data and analytics. Moreover, advancing innovation in healthcare requires more sophisticated engagement strategies, which, in turn, rely on access to real-time clinical data. Traditional approaches to data exchange are no longer sufficient to meet the demands of a rapidly evolving healthcare ecosystem. Moreover, the shift towards value-based care models and the emphasis on population health management necessitate comprehensive and seamless data exchange capabilities across the care continuum.
Success with identity
Identity management is essential across all four domains of interoperability defined by the ONC. However, managing member, provider, and organizational data is inherently challenging due to various factors:
- Different data formats and sources, including clinical data, claims data, and third-party sources.
- Data stored in disparate locations, such as credentialing applications, EHR systems, and data warehouses.
- Numerous users interact with different versions of the data across various departments and teams.
As a result, effective identity data management becomes indispensable for payers. A robust solution enables organizations to:
- Connect to all data sources.
- Identify individuals accurately.
- Enrich data with additional information.
- Manage data across the entire organization.
- Activate downstream systems seamlessly.
Conclusion
By recognizing the critical role of identity in enabling seamless data exchange and care coordination, payers can chart a course toward a more connected and efficient healthcare ecosystem. Embracing identity as the missing ingredient in interoperability strategies holds the promise of unlocking new opportunities for collaboration, innovation, and improved patient outcomes.
The journey toward healthcare interoperability is fraught with challenges, but identity data management offers a promising solution for payers. By addressing the complexities of data exchange and management, payers can unlock the full potential of interoperability, driving efficiency, reducing costs, and retaining members. Embracing identity as a cornerstone of interoperability strategies is not just a necessity—it’s a pathway to transformative change in the healthcare ecosystem. Let’s navigate this journey together, leveraging the power of identity to drive meaningful outcomes.
Learn more about how Verato enables interoperability for payers.
Citations
1 HIMSS Technology and the cost of care convergence
2 Gartner’s Payer Interoperability Benchmarking survey from April 2023
