For the first time in the past two years, we’ve seen API requirements apply to providers, hospitals, and other entities in the healthcare system. If you think about the way the US complies with regulations, it is unlike any other country:
- The government has set a mandate.
- Government ministries develop policies aimed at making these tasks a reality.
- Then the private sector decides how These policies will be implemented.
- Companies create tools and products that take advantage of these new policies and approaches.
For hospitals and payment institutions, Interoperability and Patient Access Final Rule Set January 2022 as the deadline for allowing patients to access their data. Today, the healthcare industry is kind of stuck between steps 3 and 4.We know the rules, we know the policies, but how It’s still under discussion as we interact and build on these new policies.
Innovative care costs and better outcomes.
Innovation is starting to play out around value-based care, as VBC is heavily dependent on quality care coordination. New independent records give risk-bearing groups the opportunity to obtain near real-time longitudinal data about their populations. Armed with this information, any provider can find and stay ahead of their most at-risk patients by calculating better risk scores, spotting gaps in care, or simply getting their patients’ latest lab results. The end result is treating sicker patients earlier…with fewer resources…and it’s a win-win.
Suppliers have taken notice.
There are substantial incentives on the provider and patient side to use patient data APIs. Innovative health companies are adopting technology to buffer their risk-taking behavior. For example, several VBC providers are better treating high-risk patients by extracting health records and using them to provide early personalized care.
The size of the company will affect their API adoption.
Large payers will take this opportunity to focus on cost savings by switching data collection from fax to API. It’s natural to relate these rules to how they can save administrative burdens, but more flexible players can do more.
Smaller organizations are already thinking with a data-first mindset. In general, ancillary payer solutions that focus more on innovation than cost-cutting will more quickly recognize the changing environment and create a unique value proposition. Organizations that leverage innovative solutions and access patient data early in the game will inevitably find a way to transform the way clinicians and patients interact by bringing data-driven decision-making to the forefront.
We are still developing a national payer data exchange.
In this case, ensuring the least necessary data access is made in a trusted network is the sticking point.
Each new rule for mainstream data sharing increases the incentives and pools of interoperability. Every accessible record lowers the barriers to interoperability bit by bit. But getting suppliers and payers to work together is not that simple. Until we see ubiquity, it’s going to be a chicken-and-egg question.
Requests for data by healthcare payers often fall under so-called operational use purposes. Under HIPAA, this is a protected data exchange category that can be anything from claims adjudication to risk adjustment. As other key interoperability rules (TEFCA and anti-blocking) mature, the friction in fulfilling these requests will decrease, and payers will benefit from moving to APIs from fax-based data collection.
There is still plenty of room for payers and startups to build solutions. According to Change Healthcare, only 24% of leading healthcare organizations use APIs by 2021 studyThe authors speculate that one of the reasons many healthcare organizations do not use APIs is that the primary driver of healthcare technology adoption is compliance. The main driver for other industries (perhaps those that are more competitive) is to improve efficiency and customer experience.
Well, the regulatory change is here.
So, instead of just managing these regulations, organizations that take advantage of them early can start to differentiate themselves—by creating new value propositions, lowering the cost of care, and improving outcomes across the board.
Consider what we know about interoperability – from Apple devices to Plaid banking application with API support — We can be sure that the API is just getting started. If you understand the potential of APIs, you will be able to have your own market.
intention of Interoperability and Patient Access The rule is not to wash your hands. A more telling point is that they give organizations the opportunity to support patients and improve healthcare.
