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FHIR For Payers

FHIR is the forefront standard for sharing healthcare information in a safe and secure way. Here are the advantages and Challenges of FHIR for payers.

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FHIR For Payers

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  1. FHIR FOR PAYERS: CHALLENGES & BENEFITS www.capminds.com

  2. Introduction Payers will benefit from FHIR’s utilization in the healthcare marketplace. It is the cutting edge standard for sharing healthcare information. Implementers can modify FHIR’s core data elements, i.e., extensions. This extensibility is built-in; it doesn’t 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 isn’t 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 @ CapMinds FHIR Blog

  13. CapMinds FHIR Services Contact us CapMinds Technologies 42240 Mason Ridge Ct, Brambleton, VA 20148 +1 571.213.3245 info@capminds.com https://www.capminds.com

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