FHIR For Payers

1
FHIR FOR PAYERS CHALLENGES BENEFITS

• www.capminds.com

2
Introduction

• Payers will benefit from FHIRs utilization in
  the healthcare marketplace.
• It is the cutting edge standard for sharing
  healthcare information. Implementers can modify
  FHIRs core data elements, i.e., extensions.
• This extensibility is built-in it doesnt break
  the core standard or requires significant work.

3
Success Stories Of FHIR

• A large payer reduced development time by six
  months on a time-critical member-facing project
  and spared 500,000 by moving from custom API
  advancement to FHIR.
• A large provider implemented a chronic
  disease, SMART-on-FHIR application for patients
  in under 100 days.

4
FHIR For Payers

• For payers and other healthcare organizations,
  FHIR offers a few points of interest over other
  healthcare data standards.
• While other standards without a doubt include
  important health information, that information
  isnt really simple for applications to utilize. 

5
FHIR For Payers (Cont.)

• FHIR, interestingly, is a more specialized
  standard that empowers applications to plug
  directly into electronic health records systems
  or claims databases to obtain patient health
  data. 
• Also, when stood out from other standards, FHIR
  for payers, considers the sharing of little,
  discrete, explicit pieces of information, instead
  of reams of data in a Continuity of Care Document.

6
Benefits Of FHIR For Payers

• Effectively update providers about health plan
  conventions
• More liberated exchange of claims data and other
  patient health information using applications
  from third-party developers
• Automated evaluation/approval process, reducing
  time spent answering phone calls from practice
  staff about coverage

7
FHIR Challenges For payers
8
1.Quality of the clinical data

• One of the greatest challenges revolves around
  the quality of the clinical data that payers
  present to members. Health plans must use the
  FHIR standard to make these five types of data
  available
• 1) Adjudicated Claims
• 2) Encounters with Capitated Providers
• 3) Provider Remittances
• 4) Enrollee Cost-Sharing
• 5) Clinical Data, including Laboratory Results

9
Quality of the clinical data (Cont.)

• A few payers have recently implemented systems to
  deal with the initial four types of information,
  which can be planned to three parts of FHIR,
  specifically an explanation of benefits
  patient and coverage resources.
• The fifth kind, clinical information, is commonly
  the most important information for patients yet
  also speaks to the main possible roadblock for
  payers, especially those that are not yet
  utilizing clinical information.

10
Quality of the clinical data (Cont.)

• The reason is that the success of FHIR as an
  exchange format is dependent on data being
  well-structured.
• Because clinical data is often incomplete,
  redundant, or inconsistently coded, its value for
  patient access via FHIR can be limited.
• Data that is inadequately framed in the source
  electronic health record will deliver deficient
  as an FHIR resource.

11
CapMinds HL7 FHIR Integration Services

• The payers need to overcome the common challenges
  with FHIR to maintain interoperability between
  health systems and healthcare technology
  solutions. Make use of the best FHIR
  implementation and support services offered by
  CapMinds to improve your clinical workflow.

12

• Read More About HL7 FHIR
• _at_
• CapMinds FHIR Blog

13
CapMinds FHIR Services

• Contact us
• CapMinds Technologies
• 42240 Mason Ridge Ct, Brambleton, VA 20148
• 1 571.213.3245
• info_at_capminds.com
• https//www.capminds.com