The Payer-to-Payer Data Exchange ruling can and will be a transformative mandate that revolutionizes members’ transitions between health plans to ensure continuity of care and improve the overall member experience. To do this, CMS authorities are challenging health plans to facilitate safe, secure and comprehensive transfers of patient health information through their transitions between health plans.

Although it may seem like an unnecessary hassle to adhere to the seemingly never-ending government mandates, complying with the Payer-to-Payer Data Exchange mandate brings significant value for health plans as they gain immediate access to new members’ health status and RAF scores upon the member’s consent. Not only will this reduce the administrative burden of spending time and resources assessing a new member’s clinical and risk profile, but it will also enable health plans to pro-actively identify opportunities for intervention earlier in the member’s care journey – creating a more engaging member experience from the time they are onboarded.

Establishing the infrastructure to support a mandate such as Payer-to-Payer data exchange can seem daunting and extremely costly for health plans. Payers must consider the complexity of establishing and maintaining connections to securely exchange member data with external Payers and invest in technology partners who can own the end-to-end process. Health Chain’s Payer-to-Payer platform facilitates connections with our network of Payers from which new members are being onboarded from, seamlessly integrates with the health plan’s environment and most importantly, captures member consent in an integrated workflow.

In just minutes, Health plans can obtain all available data for new members, all while avoiding the cumbersome process of having to communicate with their previous health plan(s) and various providers to capture the same information. By integrating Health Chain’s innovative solution, health plans will have the information necessary to provide immediate and personalized patient-centric care - ultimately fostering a more connected, efficient and effective healthcare experience for all members.