The CMS Interoperability Rule, scheduled to go into effect July 1, 2021, has challenging patient-access requirements for health plans. It also requires state Medicaid agencies, Medicaid managed care organizations, qualified health plans in ACA exchanges, and Medicare Advantage plans to provide a public provider directory application programming interface (API) as a condition of participation. Health plans are starting to explore platforms and approaches that will help them meet the provider directory FHIR API requirement.
The State of Maryland's Medicaid program is using a new tool called Convergent from a company called Leap Orbit to comply with the CMS Interoperability Rule. The provider directory is being deployed in partnership with CRISP, the state-designated health information exchange.
Convergent is also being used to deliver more actionable provider information to the point of care, to support COVID-related clinician workflow, and to enhance reporting by the state’s prescription drug monitoring program. CRISP has contracted with MedChi, the Maryland State Medical Society, to provide data stewardship services for the provider directory.
Acting as a cloud-based “thin layer” on top of existing sources of provider data, Convergent handles FHIR 4.0 mapping, data ingestion, and data stewardship to deliver health plans a compliant provider directory, Leap Orbit said.
“Having accurate primary care provider and care team information at the point of care is vital to the role that CRISP plays in care coordination,” said David Horrocks, president of CRISP, in a prepared staement. “Given the fragmented and often incomplete provider information that accompanies data like encounters and lab results, HIEs have historically struggled in this area. Now we are finally making meaningful progress.”
“Keeping physician information up-to-date and consistent across organizations is a monumental challenge,” said Gene M. Ransom III, CEO of MedChi, in a statement. “There is a lot of duplicative effort, and no one seems to ever get it right. The State of Maryland has chosen an innovative, unified approach with Leap Orbit’s Convergent provider directory front and center.”
By Jan. 1, 2022, payers also will be required to exchange patient data at their member’s request so that members can take their data with them as they move between payers.
