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Success in value-based care hinges on one critical factor: timely, high-quality data. Yet most healthcare organizations struggle with fragmented information trapped in non-standard formats from disparate sources and manual processes leaving staff mired in muck, delaying critical insights by weeks or months.
What many risk-bearing provider organizations don’t know is that an immense digital transformation is underway today for provider-payer data exchange workflows, not only at the federal level but also in various states across the country.
We’re speaking, of course, about federal-level requirements like the Interoperability & Prior Authorization final rule (CMS-0057) and state-level requirements like California Senate Bill 1419 (SB 1419) and Tennessee Senate Bill 2012. These regulations are mandating the use of FHIR-based APIs – including Patient Access APIs, Payer-to-Payer Data Exchange APIs, Provider Access APIs, and Prior Authorization Support APIs – to power standardized, near real-time health data exchange.
The 4 benefits of near real-time claims data exchange in value-based care
#1 Improved Patient Care
With up-to-date data at your fingertips, you can keep better track of patient population and close care gaps in near real time. If you are not seeing out of system encounters for individuals, this is a win. If you are already seeing such data, likely it’s one to three months stale. Imagine the power of data visibility for encounters you wouldn’t have otherwise known about mere days after the interactions.
#2 Reduced Risk
Powered with the data you need, you can see a significant reduction in risk. Comorbidities and complicating factors can more easily be identified. Duplicative procedures and conflicting medications can be made apparent. In instances where relevant parties are unaware of the need to coordinate, they are now made aware.
#3 Controlled Costs
With near real-time data in hand, you can achieve substantial savings by segmenting populations and better allocating care, particularly among those with complex care needs. You can thoughtfully enroll individuals into specialized programs that address specific demographic, disease, or risk profiles, and then monitor these programs’ effectiveness over time.
#4 Increased Efficiency
By eliminating highly manual and labor-intensive processes, you can improve operational efficiencies related to claims data engineering and processing. Surely there are more productive things to spend human capital on than hacking together SQL or making sense of changing, cryptic flat files.
How 1up Provider Access API powers data exchange in near real time
With 1up Provider Access API, risk-based providers and ACOs can connect to their affiliated payers – from CMS to Medicare Advantage plans to Medicaid MCOs and more – to pull claims data through a FHIR API into the 1up Platform and then to feed that data into existing systems to drive insights and take action in days not months.
With 1up Provider Access, providers and ACOs gain:
- A solution built to acquire and compute on data in days not months.
- True interoperability across contracted payers and top EHRs, allowing for consolidation of all claims and clinical data to eliminate gaps in care.Â
- Ingestion of data into existing population health applications, operational business systems, and analytics tools, driving powerful insights, improving care management and health outcomes, and reducing inefficiencies and costs.
- A straightforward implementation that easily scales for the future.Â
- Dedicated customer success support and a strong long-term partnership.
Ready to transform your data workflow? If you are a provider or ACO interested in obtaining data in near real time, contact us to learn how simple it is to take this next step as the digital revolution comes to healthcare.
