Healthcare Technology Featured Article

February 27, 2015

At Last! A Compelling Business Case for Interoperability



Interoperability clearly is the word of the day as we begin 2015. Until now, it has been one of the “warm and fuzzy” words bantered about in our industry and often associated with health care reform or used as a reason for being critical of electronic health record (EHR) vendors that are not supporting interoperable health care (see our related HISTalk article). So, what makes 2015 much more compelling for interoperability? We finally have a robust business case as a true interoperability driver.

To be sure, newly announced initiatives by the Office of the National Coordinator for Health Information (ONC) are aiming to drive interoperability through harmonized standards itemized in its Advisory and the 10-year vision outlined in its Roadmap. They undoubtedly will move the ball up the field. However, the real game changer is the rapid movement toward value-based care, which creates the compelling business case we’ve been missing to date.

That business case is embodied in newly announced payment reforms by public- and private-sector payers. They feature reimbursement methods tied inextricably to health information technology (healthIT) and interoperability. Providers must seriously start to consider and act on these new payment models if they want to remain profitable, and even solvent, past next year. Medicare is planning to move away from fee-for-service (FFS) medicine within four years, with half of all Medicare dollars paid by the end of 2018 through such “alternative” reimbursement models as bundled payments, patient-centered medical homes and accountable care organizations. At the same time, 85% of all remaining Medicare FFS payments are expected to be tied to quality or value by 2016 and 90% by 2018. The result will be a renewed emphasis on pay for performance by linking reimbursement to quality measures and patient outcomes. Similar goals were enunciated by a coalition of private payers.  

This rapidly moving train of payment reform will drive true interoperability. In order for providers to survive and thrive in this new reimbursement environment, sharing of high-quality data will be a necessity. Providers will have a business case for interoperable systems to meet quality and outcomes goals on which reimbursements will depend. Vendors, in turn, will meet that demand — which will be driven by specific buyer needs predicated on defined and required interoperability. This demand will incentivize vendors to develop innovative products and meet short timeframes envisioned by Medicare, private payers and the ONC. While the Roadmap and Advisory represent valuable future guidance, the emergence of a robust business case is the strong motivator that will yield active interoperability among providers and vendor systems.

Stakeholder comments regarding the Roadmap are due April 3, with commentary due May 1 for the Advisory. 




Edited by Stefania Viscusi



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