Project Overview
CMS has added new mandates to improve the accessibility and sharing of health-related data (claims, clinical, coverage, etc.). Two key goals of Interoperability are improving the quality, and lowering the cost, of care by making relevant data accessible to individuals and to their respective care teams, and; improving, and adding transparency to, processes that are hindering the ability to provide more timely and cost-effective care, most notably prior authorization. PM, BA, and EA resources are needed for leveraging existing Gainwell investments (1Up and Gainwell's PMM) to meet the CMS requirements. Utilizing existing solutions provides a combination of benefits including the alignment of existing processes and lessening impacts on both members and providers. This approach also decreases the complexity of solutioning.
The project’s estimated completion is June/July 2027. This accounts for the final deadlines for CMS mandates (January 1, 2027) and CMS certification (estimated 6 month process).
Key Contacts
- Joseph Liscinsky – Project Sponsor
- Robert Larkin – Business Lead
- TBD – Project Manager
- TBD – OCM Lead