The U.S. healthcare system is fragmented and disjointed, which makes it difficult for stakeholders (healthcare payors, providers, pharmacy benefit managers, life sciences companies and third party vendors) to safely share patient data. This has led to operational inefficiencies that negatively impact the patient experience and their quality of care.
Interoperability seeks to remove barriers and breakdown silos to facilitate the exchange of data, while still protecting patient privacy. The goal is to ensure that healthcare IT systems can improve their ability to exchange, process and interpret shared data between devices, applications and health systems. Ultimately, building a more connected healthcare system.
Centers for Medicare & Medicaid Services mandates for interoperability and access to health data can empower patients and create market opportunities for differentiation.
Members / Patients
Patients will be empowered to choose which entities outside of their care provider to authorize access to their medical information and history.
Providers will be required to make admission, discharge, transfer, and emergency visit event notifications available to the patient’s designated care providers, and make transparent their stance on information blocking.
Health plans will be required to share historic claims, clinical, and encounter data with member and other payers and expose their provider directories.
New Entrants / Vendors
Third-party developers will disrupt the ecosystem with data-powered innovations and new market plays with unprecedented access to patient / member / consumer data.
Organizations should use the regulatory requirements as a starting point to think through their own strategy to leverage and share data with other industry stakeholders as well as patients.
Partner, Advisory, PwC US
Principal, Digital Risk Solutions, Health Services, PwC US
Managing Director, PwC US
Health Services Principal, PwC US