Stream: implementers
Topic: Reference implementation for Payer2Payer Data exchange
Nirmal Fernando (Jul 20 2021 at 04:40):
Has anyone implemented Payer2Payer data exchange as per the CMS-9115F? Isn't there a lot of ambiguity? For an example; how a Payer supposed to know the P2P data exchange related API of the other Payer? Sorry, if I missed a previous discussion with regards to this - I searched and couldn't find any in this stream.
Josh Mandel (Jul 20 2021 at 13:46):
My take is that leveraging Patient access APIs (e.g., CARIN blue button) via SMART on FHIR is the cleanest, most transparent way to enable payer to payer exchange. New payer provides an app (which could just be a website, I don't mean to imply a native app); the patient (or authorized representative) approves it to access data from Old payer. Every payer needs to support the supply side of this API already, so it should be a universally available option. (Downside: Patient needs to be involved. Not everyone would call this a downside though :-))
That said, there's also a Da Vinci IG (PDEX?) describing a B2B flow with back-channel patient matching ($patient-match operation). I'm not sure there's any requirement in place to drive adoption, but someone else may have a better perspective.
Paul Church (Jul 20 2021 at 14:11):
I agree, patient access seems like the most practical way forward on payer2payer.
Eric Haas (Jul 20 2021 at 16:33):
The intent of the Da Vinci PDEX and PCDE Implementation Guides was to meet the requirements of these policies.
Nirmal Fernando (Jul 21 2021 at 10:26):
Thank you for your replies, I'll checkout these IGs.
Nirmal Fernando (Jul 21 2021 at 13:59):
@Josh Mandel the first approach (i.e. leveraging patient access api) requires the new Payer's app to be a registered/approved app on the old Payer's side - isn't it? How scalable this is then since a Payer have to build an app which supports all other Payers?
Josh Mandel (Jul 21 2021 at 14:02):
It scales like any other consumer app registration; you decide where to register; can be a broad campaign or targeted; and you can also lean on 3rd party apps already registered widely (e.g., a new payer could give users the option to share from sources like Apple Health rather than having to build/register its own app).
(Projects like FAST are looking at other approaches to scale up registration, by centralizing trust decisions; this could help too, but it's still early days!)
Nirmal Fernando (Jul 21 2021 at 19:52):
Make sense, Josh. Thanks.
Nirmal Fernando (Sep 02 2021 at 05:13):
When you really start to go into detail on implementing this - we feel there are a lot of challenges and ambiguity. Would love to talk with someone who has implemented this in real-world or is there any other channel that we can verify our concerns?
Lloyd McKenzie (Sep 02 2021 at 05:21):
#Da Vinci PDex would probably be the best place
Nirmal Fernando (Sep 02 2021 at 05:22):
Thanks @Lloyd McKenzie - will check there
Last updated: Apr 12 2022 at 19:14 UTC
