Health Insurance Providers Need Interoperability to Meet Transparency and Burden Rules

  • February 17, 2021
  • 1:00 PM – 2:00 PM ET
  • Online

Fast-forward to year 2023, when the overall flow of data to advance health care, driven in part by HHS requirements for transparency of patient coverage and costs, access to patient data through APIs, and reduced burden of administration processes like prior authorization are evident in the industry.

With a focus on enabling patients, health care providers and health insurance providers to easily and seamlessly access their health information, health insurance providers will need to adjust their technology strategy to adopt new interoperability standards, including HL7 FHIR, and ensure their back-office platforms can adapt to the new digital world. Across the market landscape, insurance providers need to understand not just the final rules, but where the industry is heading overall and how to get involved before it’s too late.

Hear from health care interoperability industry experts who will provide an overview of the market challenges in light of the recent CMS final rules for Interoperability and Patient Access (CMS-9115-F), Interoperability and Prior Authorization (CMS-9123-F), and Transparency in Coverage (CMS-9915-F) and the market landscape including HL7® FHIR® Accelerators like Da Vinci and ONC FHIR at Scale Taskforce (FAST.)

During the second half of the webinar, we’ll explore how health insurance providers can prepare a scalable platform solution to meet the requirements and breakout the barriers to success that health insurance providers data is plagued with today.

Attendees will:

  • Understand the current market landscape including overviews of CMS final rules:
    • Interoperability and Patient Access (CMS-9115-F)
    • Interoperability and Prior Authorization (CMS-9123-F)
    • Transparency in Coverage (CMS-9915-F)
  • Gain understanding of the role HL7® FHIR® and Accelerators like Da Vinci, CARIN, ONC FHIR at Scale Taskforce (FAST) and how health insurance providers can get involved to attain compliance
  • Learn how to break out of data silos and gain insights to develop a scalable platform approach with tools and components needed to enable data liquidity across claims, clinical, encounters, and price transparency in the new and coming member-engaged world


Lynda Rowe
Sr. Advisor, Value-based Markets

Ms. Lynda Rowe is Senior Advisor for Value-Based Markets at InterSystems acting as a subject matter expert around the shift to value-based payment models. She shares her expertise with customers and the industry through her speaking engagements and published pieces.

For the past two decades, Ms. Rowe has held senior-level positions in health information technology. Her experience spans work for payers, health systems, start-ups, vendors and the federal government. Prior to her role at InterSystems she was an executive in the health market at Booz Allen Hamilton, where she led a number of consulting projects for the Centers for Medicare and Medicaid and the Office of the National Coordinator within HHS. She provided leadership for quality measurement, health information technology use and adoption, health information exchange, interoperability and standards. She continues to be active in a number of national efforts including the HL7 Da Vinci project.

Paul Oates
Managing Director & Lead for the M&A Technology Practice

Paul Oates currently leads the technology practice for Mergers, Acquisitions, Joint Ventures and Alliances for Cigna, focusing on technology aspects of target screening, due diligence assessments, and integration planning.

Unable to shed his architect DNA, he also continues to provide leadership for integration, interoperability, HIT standards, and disruptive technologies that enable speed and collaboration. He currently is co-lead for the ONC Fhir at Scale Task Force. Many moons ago, he chaired the HIMSS Payer SIG, was an original incorporator for the Connecticut Regional Health Exchange, lead for technology and community health information network at Middlesex Hospital, and who knows what other efforts that have all built towards where we are today, brick by brick.

Gary Austin
Interoperability Lead
Point of Care Partners

Mr. Austin leads the Interoperability Practice for Point of Care Partners (POCP). In addition to his 40+ years in health care, his roots in Interoperability go back to the 1990’s days of WEDI, CHINs, and RHIOs.

He has worked with or for more than 60 health care entities, including Payers, Providers, Pharma, Health IT Vendors, and numerous Consultancies. Additionally, he has been involved in 4 start-ups, with one IPO, co-chaired the HIMSS Payer-Provider Roundtable, and been on numerous industry advancement groups including the HIMSS and BCBSA Interoperability Workgroups amongst others.

Vanessa Candelora
Senior Consultant
Point of Care Partners 

Vanessa Candelora is a senior health information technology consultant with Point-of-Care Partners (POCP) with over 15 years’ experience implementing and managing complex health care and technology related initiatives, programs and/or products. She is currently the Project Manager for Da Vinci, a Payer/Provider led initiative to leverage HL7 FHIR © to exchange critical data required for Value Based Care contracts.

Prior to POCP, Vanessa worked for MedeAnalytics with healthcare data analytics products supporting Health Payers, IDNs, and Providers including Employer Reporting, Provider Analytics and Value-Based Performance Management (VBPM) solutions where she led the Payer Account Management team through transition from a custom development organization to a SaaS product company. Vanessa also worked at NaviNet, now NantHealth, project managing technical improvement projects including Master Data Management, provider registration and supported teams implementing standard data exchange projects for Payer/Provider interoperability across several workflows.