Benefits of New Cloud-Based Program for Health Plans

Eric Sullivan, senior vice president of innovation and data strategies, Inovalon, discusses the Consumer Health Gateway, a new portal that allows health plans to build their own Patient Access API to comply with the new requirement of the 21st Century Cures Act, and he highlights why health plans should consider integrating similar technologies into their work flow. 

Please introduce yourself and tell us a little about your background as well as Inovalon

I’ve been with Inovalon for about eight and a half years as their senior vice president for innovation and data strategies. I had business ownership for all of our data assets, our deidentified data assets, our emerging and new products, interoperability, and AI solutions.

I’ve been in health care for about 30 years now, amazingly so. 31, now. Primarily on the either health care delivery side, health plan, or analytic side of the health care ecosystem.

Inovalon is a fantastic organization, really providing a full suite or platform of cloud-based analytic services, predictive services, and other analytic pick services and management services for health plans, provider groups, health systems, pharmacy, as well as life sciences.

Can you give us a brief description of the Consumer Health Gateway?

We announced the Consumer Health Gateway Solution back in May, really as our response to the March 9 release by CMS [Centers for Medicare & Medicaid Services] and the Office of National Coordinator (ONC), on the final interoperability rule. That rule, as you know, calls out for health plans and others in the industry, but squarely on health plans to make their health care information available to consumers.

This is building off of the 21st Century Cares Act, trying to empower consumers to have access to their data, bring it into their life, into their workflow—whether it is their FitBit app, or their Apple Health, or whatever they’re using. The goal is to have consumers get access to that same information in the pharmacy and laboratory, providing an improved health care experience because most consumers actually don’t have readily available access to, we want to give it to them through a standardized way.

That was a CMS mandate that by July of next year, 2021, about 300 health plans or payers will need to be compliant with the latest in technology, so leveraging what’s called FHIR [Fast Healthcare Interoperability Resources]. It is a health care data standard, both in terms of what kind of data is shared and how it’s shared through and open API [application programming interface] or an interface, with third-party applications.

It could be a health care electronic health record. It could be a FitBit app. It could be another PHR [personal health record]. That mandate is on payers. They have to respond. They have to have a solution, which is good. This advances the consumers’ ability to improve their own health and wellness.

Our response, the Consumer Health Gateway Solution, is a fantastic extension of what we provide our current customers today. We have health plan or most of the requisite data required to be shared under this CMS mandate. We already had most of that data for our plans. Frankly, well more than a third of the entire health plan sector in the United States is already available.

We are extending our platform and current model. We already have in production a FHIR based bidirectional clinical data exchange model supporting a large part of the pharmacy industry. We are augmenting that to support some additional nuances. This Consumer Health Gateway Solution is the response to plans that work with us, as well as plans that do not.

We are absorbing their health care data, packaging up and transforming it to the requirements of CMS. On July 1 of next year, if an application comes and is seeking for Eric Sullivan’s health care data from Cigna or Blue Cross Blue Shield, we will provide a solution that in real time can respond with that data. It is a seamless, secure, and cutting-edge technology solution to help plans be compliant.

Why should health plans consider integrating similar technologies into their workflow? How do technologies like the Consumer Health Gateway help improve processes within health plans?

It’s an interesting question. What this does is produce a mechanism for health plans to bring their data forward, which is typically siloed within the health plan’s data warehouse ecosystem. This helps them to bring it forward and expose it in a secure and normalized way to their members, patients,
and consumers. 

It actually is bringing the data more into the consumer’s—I wouldn’t say workflow—but the consumer’s real-world life. It’s more of the opposite, in some ways, in terms of the predominant goal here is to bring that data forward and make it part of the consumer’s life, whether it’s their Alexa app or otherwise. All of a sudden, it now becomes integrated into their—if they’re weighing themselves in the morning or counting their calories, whatever—it now becomes part of that full story.

We’ve got about two dozen health plans we are talking to right now. The focus here is not just exposing this basic claims data, as we would call it—the pharmacy, prescription fill, or lab result. Health plans have a tremendous amount of other information, like if the patient’s noncompliant for diabetes screening or they haven’t seen their oncologist in the last 12 months and they need to do that because of the evidence-based medicine. Now, payers have a mechanism to deliver that information into that consumer’s experience.

What are the biggest challenges you have experienced when implementing new technologies into everyday workflow? Do you have tips on how to avoid these challenges?

There’s always challenges. The focus of Inovalon is to start with the standards. Ideally, everyone would be using the same national standards—that is what we start with, but that’s not where most providers and payers and others are, right?—Everyone’s in their own life cycle of development and advancement.

The challenge of how we implement new technologies is to start with the standard but make the platform adaptable and flexible enough to meet people where they are. If a health plan is not quite ready for producing data that’s going to fit into the FIHR standard, that is okay. We have adapters. We have the ability to adjust for that and close their gap with our scalable platform. It starts with standards—understand how that data’s going to be consumed. Whether you’re introducing a quality alert to a provider or the payer’s trying to introduce an alert for disease or their emergency room (ER) visit alert to a patient, how do you get it into their workflow?

It is understanding the workflow, documenting it, understanding the requirements. As I said, it does not mean that how you identify a patient’s workflow, their technology, their meaning as the recipient of that data, is going to be ready. Just have a good platform that can adapt and be scalable. Also, be flexible enough to meet these other platforms where they are with a goal of trying to bring them forward and also meeting the same standards.

Is there anything you would like to add?

I’m excited and Inovalon is excited about this CMS interoperability rule because, as I mentioned, it is not just about health plans checking the box that come July 1, they can do the bare minimum and provide the bare minimum health care data to a consumer.

It creates and opens a floodgate of opportunity for payers, providers, pharmacy, and others, to know we are all rallying around a national standard for what it means to share a pharmacy piece of data, or a lab result, or a ER visit.

It opens up so many opportunities to bring the consumer closer to the payer world and closer to the provider world, because that has always been the gap. In the 30+ years I’ve been in health care, I remember very much in the late 1980s, frankly, very early 1990s, challenged with that same issue.

I worked at a health system at the time. How do we reach out to our members who just got discharged from the hospital and make sure they take their medications? Now, there’s a mechanism. It took 30 years, but we’re here. Now, there will be a standard that’s top down.

We are excited for the opportunity to see health care finally get closer to where it needs to be so we get the best outcomes and results, as well as the right wellness for the US population as a whole.