Knowledge Center

This episode is sponsored by InterSystems, the leading provider of AI-enabled data management solutions for industries with complex challenges, including healthcare, financial services, and supply chain and logistics.

Michael welcomes Steven Berkow, Senior Advisor, Value-Based Care with InterSystems. The two discuss Steve's involvement at WEDI's Summer Forum in Chicago, where he served as a moderator for the payer panel on the CMS Interoperability and Prior Authorization Rule. The two discussed the challenges and potential solutions for improving interoperability within healthcare data, and the importance of standardizing APIs for healthcare providers.

Be sure to read InterSystems' latest white paper The APIs Are the Easy Part: Maximizing Your ROI While Meeting CMS Interoperability and Prior Authorization Requirements

Health plans should be able to harness the investment in IT infrastructure mandated by the latest CMS rule on interoperability and prior authorization to create the data liquidity needed drive top strategic goals, such as reducing provider abrasion, improving member experience, increasing productivity, and supporting value-based care. The scope of CMS-0057-F, however, is wide ranging. This white paper:

• Summarizes new requirements for the four types of information sharing addressed, namely payer-to-payer, payer-to-provider, payer-to-member, and prior authorization submission and determination.
• Analyzes processes and workflows impacted by the regulation and resulting opportunities for performance improvement.
• Provides key “Questions to Consider” that should inform plan investment decisions.

Designed to be shared with IT, clinical, and operational leaders, the paper will help your leadership team achieve larger strategic returns on mandated plan investment while meeting regulatory requirements.