Solutions

CMS Interoperability and Patient Access

Achieve coordinated care, improved health outcomes, and reduced costs

The healthcare ecosystem is under tremendous pressure to comply with the Centers for Medicare and Medicaid Services (CMS) interoperability final rules of data sharing, aimed at advancing care continuity and patient access to information. Organizations need to take some strategic steps to stay compliant and tackle challenges in the road ahead. For instance, healthcare data silos continue to be a major bottleneck in the delivery of coordinated care. Disparate sources, inconsistent formats, and fragmented systems prevent the free flow of data between providers, payers, and patients, thereby impacting operational efficiency and quality of care. Moreover, lack of data sharing not only limits innovation but also results in declining member satisfaction and retention rates.

Virtusa’s CMS Interoperability and Patient Access Solution ensures seamless, fast-tracked implementation of interoperability rules in accordance with the client technology landscape and preference. Virtusa’s deep domain knowledge in HL7 formats and Fast Healthcare Interoperability Resources (FHIR) compliant data model, along with access to API marketplace, simplifies the CMS interoperability journey for payers, providers, and patients alike.

Features

  • Conversion of existing health plans, clinical data, and API to FHIR standard
  • Building of consumer applications with SMART on FHIR framework
  • Building of MVPs/CVPs and reference implementations
  • Library of API endpoints for payers
  • Proven consent management and security framework for interoperability compliance
  • Accelerate build of FHIR complaint provider directory and patient access API

The solution also leverages key components of the vLife™ platform, which include:

  • FIHR complaint healthcare API
  • API Exchange
  • Consent management and data security framework
  • FHIR resource mapping and conversion accelerators

Benefits

  • Improved Care Quality – Enables value-based care, care gap closure, and improves STAR & HEDIS ratings
  • Increased Member Satisfaction – Empowers patients with real-time access to clinical and claims information through member consent and identity management and enables data sharing across the care continuum
  • Improved Data Quality – With strict security controls, simplified data sharing, and enhanced transparency, the solution boosts data accuracy and provides cleaner provider directories
  • Continuous Innovation – Facilitates AI/ML transformations, and increased participation by external stakeholders and partners via API Exchange, enabling access to open innovation platforms
  • Operational Efficiencies – Potential to increase throughput by 60~80%; streamlines clinical workflow and value-based contracting, improves analytics, and increases medical loss ratio
  • Trusted Partner – Lower cost, improved care, portable health record, and accurate/holistic member/provider info, thus eliminating fraud, waste, and abuse

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