The CMS NPRM (Notice of Proposed Rule Making) is much more interesting than many of the past interop-related rules. That’s because it gets specific. It gets specific about technology by calling out FHIR APIs. It gets specific about use cases, such as patient access to data, payer to payer interoperability for administrative data, etc. And surprisingly, it even gets specific about collaboration by suggesting that all health plans look at the Da Vinci project and consider implementing its use cases.

On this episode, Don Lee and Shahid Shah examine the CMS NPRM from the payer perspective. Our goal is to help you understand what opportunities exist within the rule, and we explore topics such as:

  • How health plans can benefit by making administrative data (i.e. claims) available to their members via 3rd-party app vendors. It can lower their long-term technology costs and improve their members’ perception of their service.
  • Why good health plans should be thrilled with the requirement to share administrative data with their competitors when their members leave (I know… very counter-intuitive)
  • The impact of payer-to-payer interoperability on prior-authorization
  • Why CMS promoted health plan participation in HL7’s Da Vinci Project in the NPRM preamble
  • How ONC’s FHIR at Scale Taskforce (FAST) complements the Da Vinci project

There are a lot of opportunities here, and with little industry push back so far, we have a pretty good sense of where things are headed in the next 3-5 years. It’s the perfect opportunity for smart health plan executives to get a jump on their competition, and for entrepreneurs looking to support the new requirements with 3rd party apps and other services. Let’s dig in!


Be sure to check out our opening episode on the MS and ONC NPRMs: The Path to Healthcare Interoperability

And listen to CMS NPRM: Opportunities from the Payer Perspective right here:


Or, find it on your favorite podcast network such as:


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The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media.

Music by StudioEtar