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Interoperability Meets the Safety Net: What to Expect

Like all health plans, Safety Net Health Plans are gearing up for the explosion of data that will come with interoperability. Altruista Health Chief Technology Officer Craig Wigginton recently moderated an online panel of IT colleagues from health plans that serve the most socially and economically challenged members of society. These plan leaders have learned many lessons during the pandemic that are relevant to the coming wave of change interoperability will create in the industry.

Some members faced distinct barriers in accessing telehealth during the pandemic, as just one example. Some had problems with bandwidth in the home, a lack of technical skill, or even a preference to not have their home environment as a backdrop while they were speaking over video.

“The technology needs to be an enabler, not a barrier,” Wigginton said. He predicted similar concerns will arise when interoperability hits.

“Members are going to get data they’ve never seen before,” said Dan Dunkers, Vice President of IT at Johns Hopkins Healthcare. Members will head straight to the internet to understand what they are reading. Then they will call their health plan with questions.

This sparked a lively discussion about the impact to member services representatives who will answer these calls. How can they be trained to deal with the range of questions that might come in? Reps may be asked about technical issues that arise from the data download, along with related benefit questions and clinical inquiries. Will these reps be able to deal with all of this or will the call get dragged out trying to chase down answers? Plans need to handle this correctly, the panelist said, because members’ satisfaction with the process is going to affect Medicare Advantage scores.

Small Time Window to Impact Member Behavior

Wigginton said with the wave of data coming, there will be a wave of consumerism. “People are going to wonder, “if my Amazon purchase can follow me to Facebook, why can’t my health data follow me to the pharmacy or to my caregiver’s phone?”

The real-time nature of that data is important to capturing a member’s attention at exactly the right time to impact member behavior, the panel agreed.

Panelists weighed in about where plans should focus investments to get ready for interoperability. They agreed that data governance and security should top the list. The organizational siloes need to come down.

“The chief medical officer and IT have to work hand in glove,” Wigginton said.

The panel strongly agreed that technology should not create inequities among members.

“There should be no member left behind,” Wigginton said.

Other panelists were Stuart Myer, Chief Information Officer, VillageCare, and Kalyan Narayana, Chief Information Officer, Commonwealth Care Alliance.