Eight Drivers for Payer Interoperability Implementation, Now!

Eight Drivers for Payer Interoperability Implementation, Now!

This IDC Perspective discusses the drivers that will impact that deficient communications infrastructure on which the COVID-19 event rested upon. This pandemic event and concurrent regulation have finally driven payers to the realization, if they were not there already, that they may no longer sit alone. They must be part of the solution around unifying the fragmented health system or resign themselves to irrelevance. COVID-19 did not cause the interoperability need; it was always there. This pandemic emergency now explicitly gives motivation to those payers that have preferred to react instead of executing this digital transformation in a proactive way — by the way, they have to legally!"We should have had standard data models and interoperable standards a decade ago," says Jeff Rivkin, research director of Payer IT Strategies at IDC Health Insights. "The only way we can start approaching transparent cost and higher quality of healthcare is if we have a way to share knowledge through shareable data. That sharing can only happen if we have interoperability at a platform level. For payers, being part of that interoperable data ecosystem is now a binary survival variable. If they are in, they matter. If not, they do not matter, and they will perish."

Please Note: Extended description available upon request

Executive Snapshot
Situation Overview
Public Health Data Needs Move to Mainstream
Telehealth Moved from "Evolving" to "Mature" Overnight
Value-Based Contracts Continued to Erode Fee-for-Service Paradigms
The Supreme Court Issued a Risk Corridor Ruling Enabling $12 Billion in Funding for Major Payers
CMS Issued a Set of Mandated Interoperability Standards at a Legitimate Depth
The Importance of Social Determinants of Health Was Explicitly Exemplified by the COVID-19 Health Impact Disparities
COVID-19 Provided a New Focus on the Need for Flexible Security Models
Vendors Have Reacted to CMS and Matured
Apple and Google
Change Healthcare
Information Builders
SS&C Health
Advice for the Technology Buyer
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