CMS Engaged in the Future

CMS is finalizing new rulemaking regarding payer-to-payer information exchange and making several additional efforts to continue to lay the groundwork for the future of interoperable data exchange.

CMS is now exploring how healthcare directories can help patients find information about their providers and further strengthen interoperability for healthcare and public health systems. Also, What role should CMS play in managing these directories?

CMS is also working closely with the Office of the National Coordinator (ONC) for HIT on the USCDI+ initiative  to advance CMS’s use of interoperable datasets for quality measurement and other areas. The U.S. Core Data for Interoperability (USCDI) standard sets the foundational set of data for HIEs, clinical care, and patient access.

In July 2021, ONC published USCDI version 2, which included some significant updates including the addition of social determinants of health, sexual orientation, and gender identity data elements to advance health equity and improve outcomes for minoritized, marginalized, and underrepresented individuals and communities.

The goal is to continue to improve data exchange across the healthcare ecosystem, including public health systems, for better coordination of care and enhanced clinical decision-making to provide a higher quality of care for patients.

CMS is also exploring with ONC how the Trusted Exchange Framework and Common Agreement (TEFCA), the nationwide network can be used to support a variety of CMS Use. Cases. CMS is also continuing to examine ways in which CMS can use technology tools to streamline prior authorizations to make them less burdensome on patients and providers.

CMS is also studying the use of a standards based APIs, using the HL7® Fast Healthcare Interoperability Resources ® (FHIR) standard to achieve price transparency efforts, including the Advanced Explanation of Benefits (AEOB).

FHIR is already being used to support electronic data exchanges among providers, payers, and patients, and may allow a consumer friendly AEOB to be produced that could encourage important discussions between patients and their care teams regarding cost and value.


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