Q&A With Cotiviti CEO About Interoperability

CMS and the Office of the National Coordinator for Health IT (ONC) announced final interoperability rules several weeks ago. The new rules are, among other things, supposed to create a standard application programming interface (API) for EHR data and prohibit information blocking. We sent Emad Rizk, MD, chairman, president and CEO of Cotiviti several questions about the interoperability rule change. Cotiviti is a healthcare data and analytics company headquartered in Atlanta.

How close are we to true interoperability and do the rules bring us closer or further away?

The new rules mandating interoperability are a big step in the right direction for healthcare, but there is still a lot of work to be done. True interoperability has been an industry-wide priority for years, and I have seen first-hand how incredibly complex this challenge is and how much we have needed a universal plan for achieving this goal across both payers and providers. The new rules will bring us closer to interoperability by providing specific guidelines and regulations that will serve as a map for navigating this new era of healthcare.

For payers and providers to achieve the full promise of interoperability, organizations must also make data meaningful and useful for patients. Real-time intelligence, advanced analytics, and pairing of both clinical and financial claims data for a complete picture of the patient’s health will be key in making good on the final patient-facing piece of the interoperability puzzle.

Some news reports say suggest the new rules threaten patient privacy. The American Hospital Association has been critical of the rules. Do you agree that it threatens patient privacy? If so, what would you change. If not, why not?

As data becomes more available and accessible, the chances of a breach or the misuse of information increases. Privacy concerns are very real and should be taken seriously, especially in this early stage where there are still many details to work out before these new interoperable standards become reality. For example, health plans may become more comfortable with these rules if legal penalties and damages from data breaches and HIPAA are mitigated and their exposure is lessened.  There are also big questions of how consumers will interact with third parties to move and manage their data. Who are these third-party organizations?  Do they understand healthcare and the sensitivity of this information? Can they be held accountable?

That said, concerns surrounding sensitive information should not be a roadblock for innovation in the healthcare industry. This initiative gives consumers greater control over their medical information than ever before and is a major milestone for patient rights. The benefits outweigh the costs and hurdles we must surmount.

One news report put it this way: “The ONC file rule is aimed at giving consumers free electronic access to their structured and unstructured medical data at no cost by trying to get all the healthcare organizations singing off the same sheet of music when it comes to interoperability.” Do you see it that way?

I agree that this rule has a goal of creating a single source of truth for all stakeholders in healthcare that will be beneficial for patients, payers, and providers in the long run. At the end of the day, true interoperability is meant to give everyone in the industry - patients, providers, payers, and other stakeholders - a longitudinal view of their health and health risks. This approach could strengthen care management capabilities and change the way in which healthcare providers and health plans pay for and provide care.

Do you agree that the electronic notifications to other caregivers when a patient is admitted will further aggravate the electronic health record burden on healthcare providers? That seems to be one of the chief complaints.

Given the lack of a single patient identifier, which remains one of the greatest shortfalls of the U.S. healthcare system, providers should embrace solutions that help improve the continuum of care for their patients. While implementing this provision may be challenging for care providers, it could have a very positive impact on improving care for their patients.

Name one positive thing about the new rules and one counterproductive thing.

If implemented effectively, these rules will reduce the cost of care and reduce over-utilization and coordination of care inefficiencies. I also believe that this initiative will help address our wasteful spending issue. Waste makes up 25% of U.S. healthcare spending (or roughly $900 billion) and administrative complexity (largely due to lack of interoperability) is the biggest driving factor. From our work with health plans, we understand that overcoming interoperability challenges could be a major boon to efficiency and help recoup some of these lost dollars.

However, I believe these new rules could have gone further by requiring the creation of a single patient identifier, which the U.S. unfortunately still lacks despite nearly all other developed countries having one in place. It is a critical factor in allowing patients to have their healthcare data follow them from health plan to health plan or provider to provider, which will dramatically improve outcomes. I am encouraged by recent efforts in Congress to spur the creation of a single patient identifier and hope this initiative draws bipartisan support.

Please explain briefly how these new rules will affect Cotiviti.

At Cotiviti, we saw the need for a longitudinal patient record and recently unveiled Caspian Insights, a unified data and analytics platform, which represents “a single source of truth of healthcare data,” giving health plans and providers access to actionable information that will be critical to advancing interoperability and quality care. This ruling means that Americans will soon have the ability to access their healthcare data more freely. That change will have a direct impact on our payer customers specifically. To ensure this information is not just accessible but useful and meaningful for patients, it will be necessary for payers to create a longitudinal data structure with member data (including claims but also clinical and social determinants data); share information with other health plans and providers; and protect data while complying with regulatory standards.