The client is a recently established medical savings account (MSA) health plan that contracts with Medicare. At the time of this engagement, the company was less than three years old.
Because the company is a Medicare Advantage (MA) plan, the company was subject to the Interoperability and Patient Access final rule (CMS-9115-F). First and foremost, the company needed assistance with understanding and complying with the final rule, which required the client to adhere to specific technology standards, including:
The health plan also did not have any existing digital touchpoints with their members compared to larger, more established health plans and needed assistance choosing a cloud-computing platform. While the client utilized a third-party administrator vendor for all claims processing, the new interoperability ruling required the client to (1) establish a patient access application programming interface (API) allowing members access to their health information via third-party applications (effective July 2021) and (2) support a payer-to-payer data exchange to achieve compliance (effective January 2022).
Baker Tilly helped the health plan interpret the operational implications of the final rule as well as what processes and technology were required in order to become compliant. With the company having a minimal amount of digital assets, Baker Tilly assisted in developing the technology infrastructure needed to comply with the final rule and in deploying a custom software solution to implement all the requirements.
Baker Tilly led the selection of the cloud-computing platform, an out-of-the-box managed service from which Baker Tilly used several components of the technology stack to build a custom solution for the client’s particular needs, including:
Baker Tilly also helped with the development of the operational infrastructure of the new business processes so the company could become self-sufficient and sustainable after the end of the engagement, including the creation of:
The client achieved compliance with part one (i.e., patient access API) of the Interoperability and Patient Access final rule by the law’s implementation date. In addition, the company now has built a solid foundation for its technology infrastructure to build off for further operational enhancements.