The Nearly Half OF Americans Who Receive Health Insurance From Their Employers Will Soon Find Themselves On The Short End Of The Stick When It Comes To Benefiting From Innovations In Digital Health.
The nearly half of Americans who receive health insurance from their employers will soon find themselves on the short end of the stick when it comes to benefiting from innovations in digital health. That’s because new federal rules that make it easier for many consumers to use smartphone apps to manage their health don’t apply to commercial insurers that offer employer-sponsored health insurance.
Announced early this year by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), the rules are designed to help patients easily access and share their medical records and insurance claims data, as well as any of their clinical data owned by an insurer. But as with other CMS rules, the changes apply only to government-sponsored health plans such as Medicare Advantage, state Medicaid and Children’s Health Insurance Programs (CHIP), as well as commercial insurers offering plans through the federal marketplace.
If only CMS’s new rules applied to employer-sponsored plans, then by July 2021 when the rules take effect, employees would be able to harness control of all of their health care information using the digital apps of their choice. Dozens of apps on the market today enable consumers to access health information stored in their providers’ electronic health record (EHR) or held by their insurance company, without having to log into a web portal every time. Many of the apps offer additional capabilities, such as alerting users to overdue medical tests or teeing up educational content specific to their condition.
If the new data-sharing rules applied to employer-sponsored plans, not only would employees be able to benefit from the same capabilities, but their health information would also be portable. They could take their medical records and insurance claims data with them on their phone whenever they moved to another provider or health plan. That would greatly simplify the transfer of personal health information from one provider or plan to another, sparing employees the task of obtaining a physical print-out that can be hundreds of pages long.
The gap in applicability of the information-sharing rules is especially galling at a time when employers are developing Covid-19 return-to-work strategies, and when hospitals and emergency rooms are constantly under stress with limited time to gather patient health information. Now more than ever, we need advanced digital solutions that efficiently connect people to available health information and public health resources.
The Solution: New Interoperability Protocols
The foundation of the information-sharing rules developed by CMS and ONC is a technology called application programming interfaces (APIs). APIs are bits of software that enable disparate computer systems to connect to third- party software applications. App developers use APIs to pull in data from third-party databases, such as bank records or insurance claims. The CMS rules use an API created especially for health care called Fast Healthcare Interoperability Resource (FHIR). FHIR was designed to enable EHR records to be easily exchanged between different computer systems. Thanks to the use of FHIR APIs allowed under the CMS/ONC rules, many consumers will be able to securely and easily obtain their digital health information from their providers and insurance companies using the app of their choice.
But again, the rules don’t apply to employer-sponsored health plans. Nor do other federal laws require administrators of these plans to share claims data with the employers and employees who – don’t forget – collectively bear the cost of the plans. As a general matter, many plans either refuse to share this data, or they charge for access, treating it as proprietary information.
I think that’s wrong. To ensure that all Americans benefit from data liquidity, not just those covered by CMS programs, I believe the Biden administrationshould immediately push for reforms to the Cures Act 2.0 that guarantee data access for self-insured plan sponsors and participants in their group health benefit plans. During the Covid-19 emergency, the Secretary of Health and Human Services, who oversees CMS and ONC, should take intermediate steps by requiring payers subject to the final CMS rule and that deliver Administrative Services Organization (ASO) or third-party administrative (TPA) services to self-insured plan sponsors to support the required patient-facing APIs and provider directory APIs for their commercial members.
As the nation phases in economic recovery efforts, self-insured employers have an urgent need for health data liquidity to support their workforce, to keep their worksites safe and to hold plan administrators accountable for their claims adjudication practices. Just as important, employees of these companies should be able to enjoy the same benefits of digital health innovation that regulators have now enabled for other consumers.
Philips Johnson is Chief Innovation and Strategy Officer of b.well Connected Health, and a member of The CARIN Alliance, a non-partisan organization enabling consumers and their authorized caregivers to access more of their digital health information with less friction.
This article originally appeared on BenefitsPRO: