Skip links

On-Demand Webinar: To Learn How Payers Can Automate Prior Auth at Scale with AI. View Now.

Industry blog

Three Ways Interoperability Improves the Payer and Provider Outcomes

Data acquisition methods have remained mostly unchanged over the past few decades – there are an estimated 4.1 million clinicians documenting patient care and data held in more than 100 different electronic health record (EHR) systems. Within these systems, over 1.2 billion clinical documents are generated annually but about 60% of clinical data is unstructured and thus underutilized by payers and providers when managing and delivering care. This lack of coordination has led to a variety of problems and much discord within the healthcare system. However, with the utilization of new technology standards like FHIR® APIs, health information exchanges, and healthcare regulation with CMS Interoperability and Patient Access Rule, interoperability is trying to close the loop on these data silos and provide payers, providers, and patients with an improved data exchange process. Here are three ways in which true interoperability can impact payers and providers to improve clinical, operational, and financial outcomes.

#1: Improved Care

While historically it requires many hands, heads, and systems to develop a clear patient health history, interoperability allows for a simple and secure way to retrieve this data.  Rather than spending administrative time searching for files in different systems, using AI-powered interoperability, offices could now receive a complete and updated patient profile at the right time, every time. Administrative teams could have access to an integrated workflow system that enables better decision-making at the point of care and removes a time-consuming pain point that plays a role in clinical burnout. Patients can spend less time repeating their healthcare history, which can sometimes be unclear and incomplete, allowing providers more time to develop and deliver personalized care plans. Meanwhile, payers are able to better evaluate the management and coordination of care.

#2: Streamlined Processes

Interoperability alleviates the operational and administrative burdens associated with managing structured and unstructured data in multiple systems and has the potential to reduce the time for patient chart retrieval from months to just hours. Since the majority of EHR systems notoriously do not communicate, plans and providers generally find themselves repeating administrative tasks – this means today’s point of care experience can be redundant and time-consuming with the use of outdated processes and lack of cross-system communication. By using interoperability to help facilitate a stronger and more secure record-keeping process, providers and payers could stream and analyze data in near real-time.

#3: Reduced Costs

By streamlining the data process, payers and providers are able to reduce administrative bottlenecks and potential coding inaccuracies. The time used to track down, download, and triple-check patient data is decreased and faster access to recent lab results, which reduces unnecessary repeat testing, saves time, and improves labor productivity. By utilizing interoperability to communicate patient healthy history, providers would have timely access to medication and allergy information which can reduce adverse drug events and comprehensive treatment plans to reduce readmissions.

Apixio has the interoperability solution for your team

With Apixio’s InfoStream solution, our partners gain direct access to clinical and administrative data from leading EHR platforms such as Epic, Cerner, athenahealth, and other EHR systems. This data can then be processed to fulfill your chart retrieval needs and can be directly analyzed to power your retrospective chart reviews, prospective risk capture activities, and quality abstraction projects with Apixio.

Learn more about Apixio’s interoperability solution, InfoStream™.

🍪 This website uses cookies to improve your web experience.