Recently Healthcare Innovation interviewed Jay Nakashima about how his organization, eHealth Exchange, is playing a key role in Utah’s pioneering efforts around compliance with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). Other states, including Massachusetts, are also making progress on this front. 

In June, the Massachusetts Health Data Consortium (MHDC), in partnership with vendor ZeOmega Inc., launched a network solution to automate prior authorization and streamline clinical data exchange for quality measurement among Massachusetts health plans and providers.

MHDC explains that this initiative expands upon its New England Healthcare Exchange Network (NEHEN) service. 

The NEHEN service currently supports X12 Electronic Data Interchange (EDI) claims, eligibility, and referral transactions. The next generation of the NEHEN service, NEHEN FHIR, will incorporate FHIR APIs to enable real-time, automated prior authorization and clinical data exchange for quality measurement and reporting through a single connection.

The initiative supports compliance with the CMS Final Rule and leverages HL7 Da Vinci Implementation Guides for prior authorization. It will also support a FHIR version of MHDC's Quality Measurement Specification to improve clinical data sharing for quality measurement and reporting.

In August MHDC announced that it has chosen to work with a company called Datycs on the FHIR version of its Quality Measurement Specification. NEHEN's FHIR-based quality measures service is expected to support bulk data exchange and measure-by-measure exchange approaches.

Early adopters include Blue Cross Blue Shield of Massachusetts, Point32Health, (the parent organization of Harvard Pilgrim Health Care and Tufts Health Plan), and WellSense Health Plan. These organizations are among the first to begin integrating with the enhanced NEHEN platform, helping to lay the foundation for broader statewide adoption.

"Establishing a shared standard for quality measure data exchange is essential to reducing complexity and administrative burden across the healthcare ecosystem," said Denny Brennan, executive director of MHDC, in a statement. "By aligning on a common FHIR-based approach for meeting state and federal reporting requirements, we can streamline data collection between payers and providers, improve consistency, and ultimately assist organizations in their effort to focus more time and resources on improving patient outcomes.”