Stream: startup
Topic: Insurers
Noam Kurtis (Feb 18 2021 at 17:11):
When insurers are required to provide a list of their provider resources through an API, how challenging will this be for third-party developers to access this?
Josh Mandel (Feb 18 2021 at 21:09):
When you say "provider resources," I'm not 100% sure what you have in mind.
But generally for US federal data interop mandates, there's a FHIR implementation guide describing data profiles. For example:
- US Core for clinical data, or
- CARIN Blue Button for financials, or
- PDEX Plan Net for provider directory,
... and then there's an IG describing authorization
- SMART App Launch is typical for user-facing access when there's patient data being shared; or
- no access control at all, when it's public data (as in Plan Net)
Josh Mandel (Feb 18 2021 at 21:12):
So for Plan Net, the developer "lift" is basically: decide which (publicly listed) endpoints you want to connect to; issue some FHIR API calls as often as you need to; store and work with the data (see examples).
Noam Kurtis (Feb 19 2021 at 13:11):
Hi Josh, thanks for your reply. I should’ve known better than to loosely use the word “resources” on a FHIR chat! ( I was referring to a provider directory that payers will be required to make available via an API)
Thanks for clarifying the Interop federal data mandates - that is very helpful
Will the PDEX Plan Net be the sole IG for accessing provider directories from Payers? If I understand this correctly, the PDEX Plan is a function of the da Vinci project. Will there be a parallel provider directory offered via the payers through a separate pathway?
Noam Kurtis (Feb 19 2021 at 13:13):
Or in other words, will there be another way to access the provider directories of the payers other than through the PDEX plan net ?
Josh Mandel (Feb 19 2021 at 19:39):
There may certainly be additional ways (some standardized, some not). I think the key question for you though is whether regulations will guarantee that this one particular way works everywhere. I'm not sure if there's a definitive answer to this; it depends on a set of rules that have not yet landed in the Federal register as far as I am aware. as far as I know right now the only guarantee is that there will be some kind of publicly accessible fhir based API
Noam Kurtis (Feb 19 2021 at 19:49):
@Josh Mandel thank you
Brendan Keeler (Feb 20 2021 at 17:58):
I imagine one or more companies will aggregate this data and sell that value add as a service, similar to Plaid, HumanAPI, or Turquoise have done for different public endpoints.
Noam Kurtis (Feb 24 2021 at 16:08):
Thanks Brendan
Last updated: Apr 12 2022 at 19:14 UTC
