Connecting Healthcare

The Future of Clinical

Interoperability
Eric Sullivan, Senior Vice President of Innovation and Data Strategies – Inovalon
Paul Wilder, Executive Director – CommonWell Health Alliance
Yogi Hernandez Suarez, MD MBA FACOG, Vice Provost for Population Health and Well-being, Associate Dean
for Clinical and Community Affairs – Florida International University, Herbert Wertheim College of Medicine
Chad Brooker, Associate Principal, Policy – Avalere Health, an Inovalon Company
 Today’s Panel

Eric Sullivan Yogi Hernandez Suarez Paul Wilder Chad Brooker

Senior Vice President, MD MBA FACOG Executive Director Associate Principal, Policy
Innovation and Data Vice Provost for Population CommonWell Health Avalere Health, an
Strategies Health and Well-being, Alliance Inovalon Company
Inovalon Associate Dean for Clinical
and Community Affairs
Florida International
University, Herbert
Wertheim College of
Medicine
The data generated in the healthcare
industry increases by 48 percent every
year.

The amount produced in 2020 alone

could exceed 2.3 zettabytes, or 2.3
trillion gigabytes.

That’s the amount of data it would

take to watch 262 million years
straight of HD movies.
How did we get here?
With payers continuing to feel the top down pressure from federal, state and
other regulatory bodies to improve outcomes and quality while reducing
avoidable costs – the quest for a functional, timely approach to sharing data
with their providers, other payers and their members (i.e., consumers)
continues to be a paramount issue.

• Sharing data with providers that

leverages true interoperability
• Agreement on how and what
data should be shared with
providers and others in the
healthcare ecosystem
• Breaking down barriers of trust,
transparency – “data use”
• Decreasing claims and clinical
data lag; ensuring accurate
“insights”
Question for the Audience
What would you identify as your biggest
payer/provider data sharing challenge?
A. Lack of technical interoperability
B. Lack of data standardization, measure standardization
C. Lack of trust between payers and providers
D. Integrity, quality and timeliness of data that is shared
E. Key information such as prior auth. requirements, benefits,
eligibility not available
F. None of the above
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CommonWell reach is growing
nationwide every day

Acute Ambulatory

Critical Access Rehab/LTC

16,000+ provider sites

85M+ enrolled people
344M+ health records retrieved Home Health Patient Access
* As of March 27, 2020
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Healthcare Is Being Digitized;
However, Little of It Is Interconnected
There are another
2010 2014 2015 1,100 EHR systems
2009 available. Average
Blue Button EHR ONC Hospital Systems
HITECH Act launched for Certification establishes have over 10 systems
incentivized VA Care and Standards; Common
healthcare Medicare; Nearly all Clinical Data Set
providers to ONC creates hospitals and to establish
develop HealthIT 80% of a common
1987 electronic Certification providers language within
health records Process adopt EHRs Health data
Health Level 7
founded to
address
standardization
issues as EHR
development
 Payer/Provider Data Sharing:
Success Factors
Key payer processes* are
Payers and their providers
informed by the latest
have the same “view” of
patient clinical data found
the world.
within their provider’s EHR.

 The data is accurate, complete and  There is alignment in what measures

timely are used (i.e., how diabetes control is
 There is automation in the overall measured and what represents
process, less human intervention, compliance)
manual processes – avoiding human  There is alignment on how to address
error risk adjustment requirements for visit
coding and data reporting

*such as medical and pharmacy prior authorization, care management and quality gap closure.
Question for the Audience
What would you identify as your biggest
obstacle complying with the final rule?
A. Limited funding
B. Lack of clarity on requirements
C. Short timeline
D. Lack of in-house technology experts
E. None of the above
What is the Interoperability Rule and
What Does It Require?
• MA organizations, Medicaid and CHIP FFS • Payers must allow 3rd party apps to access
Patient programs, Medicaid managed care plans, data including: adjudicated claims,
CHIP managed care entities, and QHP encounter data from capitated providers,
Access issuers on the FFEs clinical data, drug/formulary claims and
API • Required by July 1, 2021 data
• HL 7 FHIR Release 4.0.1

• MA organizations, Medicaid managed • Data sharing required between payers

Payer care plans, CHIP managed care entities, • USCDI Version 1
to Payer and QHP issuers on the FFE
• Claims dating back to 2016 and
Data • Required by January 1, 2022 transferable for up to 5 years
Sharing

• MA organizations, Medicaid and CHIP FFS • Provider names, addresses, phone

Provider programs, Medicaid managed care plans, numbers, and specialties
and CHIP managed care entities
Directory • Pharmacy directory data (name, address,
• Required by July 1, 2021 number, network, and type)
API
• Via a public-facing digital endpoint
CMS Interoperability Rule:
How will payers approach upcoming mandates?
 Top-down, mandated “Use Cases”
P a tie nt
Acce s s AP I  More than just a technology play –
how are Payers approaching this
J ULY 1, 2021 holistically
 How can a healthcare data lake be
leveraged to meet the requirements?
P rovide r
Dire ctory AP I  What technical and SME expertise is
required (i.e. FHIR®)?
J ULY 1, 2021
 How does this model be leveraged to
improve payer-consumer
P a ye r to P a ye r engagement?
Da ta Excha nge  How can the 3rd party, provider and
payer authentication and data
J ANUARY 1, 2022
exchange approach be further
leveraged by a payer?
 Payers, providers, hospitals, and health systems are all seeking
innovative and yet practical approaches to work across organizational
boundaries to improve patient care and experience.

 Interoperability and real-time data exchange of relevant healthcare

information between payers and physicians improves not only the
quality of care provided, but also the efficiency with which it is
delivered in value-based healthcare ecosystems.

 FHIR® is providing greater opportunities for data sharing across the

care continuum and enabling organizations to leverage their existing
systems to improve care delivery and patient outcomes.

 Healthcare interoperability will continue to evolve and improve as new

technological advancements are made requiring organizations to keep
pace in order to succeed in the new interoperability driven, patient-
centered world of healthcare.
 Questions?

Eric Sullivan Yogi Hernandez Suarez, Paul Wilder Chad Brooker

Senior Vice President, MD, MBA, FACOG Executive Director Associate Principal, Policy
Innovation and Data Vice Provost for Population CommonWell Health Avalere Health, an
Strategies
Inovalon Health and Well-being, Alliance Inovalon Company
Associate Dean for Clinical paul@commonwellalliance.org cbrooker@avalere.com
esullivan@inovalon.com
and Community Affairs
Florida International
University, Herbert
Wertheim College of
Medicine
yolahern@fiu.edu
THANK YOU