Launched by the Centers for Medicare & Medicaid Services (CMS), the Patient Access Final Rule CMS-9115-F was officially introduced on May 1, 2020. At its core, this mandate aims to improve interoperability, ensuring that patients can access and use their health data through the 3rd party applications and technology platforms of their choice. The Patient Access API mandate may seem like a costly mandate to many payers, but the CMS is indeed effectively pursuing their vision of putting members more in control of their care journey. In doing so, the CMS has rightfully put Payers at the center of the mandate as the most eligible entity, as well as the entity that can benefit the most from supporting this mandate.

In supporting members with digital access to their health information, Payers are not only empowering their members with access to a consolidated, longitudinal health record, but the Payer is simultaneously empowering their entire organization with access to the most comprehensive member records they have ever had access to. In establishing the health plan as the central entity, the CMS had the foresight to recognize the value that this would, in turn, bring to the providers as well in the form of more accurate reimbursements, less administrative burden, we could go on for days.

In order to keep up with this mandate, health plans are looking for ways to incorporate and leverage these APIs and third-party developers in a way that not only brings value to their patients, but the health plan itself. An example would be Health Chain’s Omega Patient Access App, which provides a member-facing application through which the payer, patients and providers can increase collaboration, patient engagement and transparency, while simultaneously complying with CMS’ Patient Access Final Rule. The question is – how does a health plan get to a state in which they are able to serve up all the data that is included in the Patient Access API mandate as outlined by The Office of the National Coordinator for Health Information Technology (ONC)?

Health plans must consider investing in technology, such as Health Chain’s Centaur Data platform, to facilitate the ingestion, integration and curation of data from across the various data sources in scope to support the mandates. However, any health plan approaching the mandates as ‘checking a box’ will not be able to unlock the value the CMS intends for the mandates to bring. When investing in a technology partner, health plans should look for an end-to-end solution that can not only meet the mandates, but ultimately enable stakeholders across the business to unlock the value from the data being made available to create a more resourceful experience for their members.