The Interoperability and Patient Access Final Rule isn’t a matter of choice to adhere to or not. It isn’t a matter of if you’re organization is ready with interoperability and FHIR – it’s that it better be. And although it’s been over two years since its announcement, it’s looking like 2023 is the year CMS will be fully enforcing the ruling. The question becomes how many organizations, payers and providers have Patient Access APIs and provider directories that are using the FHIR standard? Does everyone even know about this ruling taking effect?
Maybe you’re just learning about this now and wondering where do I even start?
With us.
Our software was originally launched as Halos Systems in 2015 as a healthcare technology company with the mission of putting real-time, actionable analytics into the hands of healthcare organizations. Our founder and CEO, Bruce Romanello, has worked in the healthcare market for over 20 years and has brought his wealth of knowledge to every facet of our software. He has consulted for many Medicare Advantage plans, ACOs, MSOs, as well as building five Medicare Advantage plans himself from the ground up. Seeing the pain points of health plans from every side and level inside of an organization, Bruce saw the needs and built a solution. While we were founded on providing analytics, over the last 7 years our platform has transformed into a turn-key solution, allowing you to run your organization from one place. As we walk into 2023, our newest version of the platform, Vernier comes from our new name Vernier Health.
With Vernier, we have created a one-stop solution for all your organization's needs, including ensuring you meet the Patient API’s and provider directory requirements with the new rulings:
Claims processing
CMS Interoperability
Credentialing
Enrollment
Correspondence
Premium Billing
Broker/Agent Management
Provider Portal
An organization could choose to use all if the components of Vernier when onboarding, or an organization could choose to only onboard with the CMS Interoperability component we’ve built. We tailor what you need to you.
We’ll deep dive into all these components of Vernier in a future blog – but let’s explore what the CMS Interoperability component does for you and how you would get that FHIR started in your organization.
Once you decide to onboard with the Vernier CMS Interoperability component, we begin implementation. In 60 days, it’s ready. Moving forward, we at Vernier Health maintain the component. There’s no heavy lifting on your end – your website plugs into Vernier, you add a button for your Member Portal and Provider Directory that links to us and we take it from there. It’s as easy an integrating a widget.
Once complete, you’re compliant, you didn’t have to spend tens of thousands of dollars on a system that had to be built from scratch, and you can take big exhale, because there’s nothing left for you to do.
Some payers and providers may be wondering, if it’s so easy, why can’t I just do this myself? In theory, you could. But the reality of building a CMS Interoperability component from scratch could be an expensive and challenging undertaking. The challenge of finding an expert that already understands the HL7 framework and the FHIR language can be instead immense task, as the language is not easy to learn and build with. Once you’ve found the developer, the time to build it, test it, refine it and implement it could take many months – months that organizations are running out of.
The cost of building the Patient Access API can feel shocking and unrealistic for many. CMS has estimated that cost for building and implementing it could be upwards of $1.5 million, maybe more, and those estimated costs don’t include ongoing maintenance costs. With Vernier, an organization pays an implementation fee and a per-member-per-month fee for maintenance that cost nothing close to the estimated $1.5 million of building it yourself.
Vernier already meets all the Interoperability and Patient Access Final Rule guidelines. It runs on all smartphones. It is High Trust Certified and hosted in Azure, where we have access to all of Azure’s data security. While we manage multiple clients’ data, every client has his own individual database and his own instance of the application. This means the database is never exposed to the outside world and breaches of information become impossible.
Ready Up
We’ve seen the writing on the walls since May 2020, but now as the reality of this massive shift in healthcare starts to take effect, choices need to be made and the right software needs to be in your corner.
We understand this new phase of healthcare technology can feel daunting. For patients to have more autonomy in their health journey, payers and providers have what could be an enormous undertaking ahead of them under the Interoperability and Patient Access Final Rule.
But it doesn’t have to be.
Our team is looking forward to connecting with you with the Vernier solution.
Sources
“Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, and Health Care Providers.” Federal Register: The Daily Journal of the United States Government, Centers for Medicare & Medicaid Services (CMS), HHS, 1 May 2020, https://www.federalregister.gov/documents/2020/05/01/2020-05050/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-interoperability-and.