4 Insights From Our CAB

With a continuous wave of health data regulations, exciting advancements in technology, and ever-evolving patient needs and expectations, it’s a pivotal moment in healthcare’s trajectory and digital transformation. How we navigate the next few years together will be crucial for our industry’s future, and collaboration is key. 

At 1upHealth, we have the distinct privilege of working as the health data interoperability partner of over 80 enterprise organizations. We recently formed a Customer Advisory Board (CAB) comprised of dynamic, forward-thinking industry leaders from health plans, including Mass General Brigham Health Plan, AIDS Healthcare Foundation (AHF), Cigna Healthcare, Fallon Health, MMM, and MCS.

The purpose of our CAB is to foster collaboration and allow us to better understand the challenges our customers face, so we can refine our solutions accordingly. Our latest discussion centered around pressing topics, including preparedness for the CMS Interoperability and Prior Authorization final rule (CMS-0057), enabling technology and requirements for a health data management platform, and leveraging data to drive business value. Here are 4 key takeaways from that session:

#1 Organizational alignment & competing priorities 

While health plans realize the complexities of CMS-0057 and the need to begin building cross-functional alignment and making key decisions by the end of 2024, many have been focused on meeting more immediate requirements, such as the Medicare Prescription Payment Plan (MP3) and other state regulations. It's crucial to develop a robust plan that can be implemented not only for immediate CMS-0057 compliance needs, but also for broader use cases that extend beyond regulatory requirements.

#2 Balancing compliance & innovation 

With the 2020 CMS Interoperability and Patient Access final rule (CMS-9115-F), the term interoperability was synonymous with compliance. Fast forward to today, health plans are starting to equate interoperability with business value. That said, meeting basic regulatory requirements still remains the top priority as health plans look to craft strategies that balance compliance with innovation for long-term success and business value. 

#3 Simplifying the process for stakeholders

Health plans need straightforward, actionable guidance to streamline their interoperability journey. They’re seeking “playbooks” and other resources that provide clear, step-by-step instructions and timelines, including discovery work, implementation plans, and key checkpoints. By offering a flexible, adaptable framework, these playbooks will help stakeholders effectively manage compliance complexities and ensure seamless integration across various use cases.

#4 A scalable technology approach

Organizations are seeing the need to shift from disparate, use-case-specific technology applications to a more streamlined, platform-based approach. They are inquiring about health data management platforms that are designed for efficiency and scalability, and that are flexible enough to handle a variety of use cases – all with data quality and data governance at the core. The key challenge is to enhance the capabilities of these platforms to accommodate multiple use cases without introducing unnecessary complexity.

Setting the foundation of continuous learning & value creation

In just a short amount of time since its inception, the 1upHealth CAB has provided invaluable insights into how organizations can prepare for CMS compliance, balance innovation with regulatory requirements, and streamline interoperability processes. We look forward to continuing to meet with our CAB leaders throughout the year to identify health plans’ shifting priorities and the best ways to address their top challenges, as well as evolve the 1upHealth strategic roadmap to best serve the industry’s interoperability needs and deliver value for years to come.