During our Las Vegas visit to the HLTH 2023 conference, the Health Chain team noticed several themes about health plans’ technology investments for interoperability and advanced health data analytics. Below are the top 3 issues we heard when speaking with payer and health plan collaborators at HLTH 2023

1. Medicare Advantage (MA) plans are seeing little ROI on interoperability investments. It appears that more than a few payers took a compliance-centered “check the box” approach in the rush to meet the 2020 CMS interoperability mandates. Although health plans started the journey of making patient health data more accessible and easier to exchange between care delivery stakeholders, Payers did not always implement solutions that truly harnessed the value of this data being unlocked. As a consequence, there were little to no operational or financial benefits and many health plans are recognizing poor ROI from their interoperability projects.

2. Health Plans are not yet unlocking the full value of health data. While plans are making strides in gathering health data from an increasing number of provider, partner and patient sources, plans are not truly tapping into the data’s value. These missed opportunities are manifesting as “implementation speedbumps” in plans’ ability to leverage the data to improve patient outcomes and enhance value-based care programs. As a result, many MA plans are completely rethinking their approach to interoperability. Rather than continuing to invest in stopgap solutions, plans are now taking a broader view and evaluating end-to-end solutions that ingest, curate and make enriched FHIR and non-FHIR data available to internal users, providers, care partners and patients.

3. Integrated data platforms are key. Now that plans are increasingly focused on “data value” and not “data interoperability”, Medicare Advantage plans recognize that viable solutions can’t be effectively developed ”in-house” and must:

• Align with their evolving technology strategy
• Provide options for cloud-based processing and storage of enriched data in their own environment
• Effectively distribute curated data to internal users, care partners, providers and patients using FHIR-enabled technologies

To learn more about how our insights from HLTH may be applicable to your Medicare Advantage plan’s health data technology strategy, contact Health Chain.