Helping healthcare payers prepare for CMS’ final Interoperability and Patient Access rule

February 2021

In March 2020, the Centers for Medicare and Medicaid Services (CMS) released its final Interoperability and Patient Access rule (CMS-9115-F), which places new requirements to facilitate the electronic exchange of healthcare data. This has created rapid change across the healthcare industry, with payers and providers, among others, looking for ways to interpret and prepare.

PwC has identified leading practices and perspectives on critical components and considerations for successfully implementing the new requirements laid out in CMS’ final rule. Our framework addresses questions and challenges that payers face as they navigate complexity and build out their broader strategy, target state and overall interoperability roadmap.

Our comprehensive framework assesses a payer’s interoperability efforts across five dimensions:

  1. Strategy and governance
  2. Program design
  3. Operational readiness
  4. Technology and data
  5. Compliance, security and privacy

Gain insights into your interoperability readiness

PwC's short assessment tool helps payers prepare for CMS' final interoperability rule. Our readiness assessment accounts for the capabilities a payer must establish as well as broader people, process and technology changes necessary to support those new capabilities.

The assessment takes less than ten minutes to complete. Upon submission, your responses will be compared against other healthcare payer organizations and industry leading practices PwC has identified.

Within one business day, we will share a high-level snapshot of your overall interoperability readiness and make recommendations for your organization. We will help you better understand the opportunities and risk areas your organization may encounter moving forward towards compliance.

Contact us

David Curé

David Curé

Partner, Health Services Risk and Regulatory, PwC US

Kelly Tsaur

Kelly Tsaur

Principal, Health Services Payer, PwC US

Fran  Grabowski, Jr.

Fran Grabowski, Jr.

Director, Risk and Regulatory, PwC US

James Lin

James Lin

Director, Health Industries, PwC US

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