Q&A: Colt Courtright, Premera, on HHS’s rule on interoperability

Colt Courtright is the Director of Corporate Data & Analytics and is a key leader in Premera Blue Cross’s interoperability initiatives. We recently caught up with Courtright to discuss a proposed rule from the U.S. Department of Health and Human Services (HHS) that aims to advance interoperability and allow patients to better access their medical data. The rule was announced in February 2019, and was issued by the Centers for Medicare & Medicaid Services (CMS). 

Emily Boerger: What’s the purpose of HHS’s recently proposed rule on interoperability? What are the key requirements?

Colt Courtright: “At the end of the day, HHS’s goal is to enable a patient to access their own data. Today, a patient has to drive around town to capture their medical records on paper in order to share them with the various providers overseeing their care. Some providers charge for records, some providers make it difficult — nearly impossible — to access records because of concerns around liability or privacy. So, people who are dealing with a health event end up taking binders of paper from provider visit to provider visit to get informed care. This bill aims to stop that process by ending the data blocking practices.

This bill mandates that a patient’s information cannot be blocked by any party including a hospital system, provider practice or payer (insurance company), or any vendor that represents them such as EMR (electronic medical record), software development firm, etc.  — no one is to be allowed to block data. Beyond data blocking, the regulations prescribe which data will need to be made available, how it should be organized, and how it needs to be delivered to enable payers and providers to communicate together on the patient’s behalf.

Also, the bill changes payer to payer interactions. Payers are traditionally competitive entities and we don’t have robust lines of communication. However, patients do change insurance and can have multiple insurance carriers, and the bill addresses that. In addition, payer to patient (or customer in our case) is absolutely part of the bill. And then there are payer to third-party apps. And that part of the rules opens up the door for new ways to interpret data on behalf of the patient.

This particular rule is focused on the federally-insured, not commercial populations.”

EB: Is there a timeline outlined in the rule?

CC: “There is. It was one of the challenges a lot of parties have seen. The rule is very detailed; it’s prescriptive around the specific data elements that must be shared. And, they need to be shared with a very short turnaround time – under a day. Most organizations don’t have the infrastructure set up to be able to do that today.

The rule as currently written — it’s proposed still — has January 1, 2020, as the deadline. And the rules were launched in February 2019. So, one of the challenges is, within the same calendar year (which, for most organizations, is the same fiscal year) large organizations typically had already organized their budget, they had their plan for the year and they had their strategic priorities set. You can imagine the reaction to an announcement in February that said this is all to be done by January 1 of next year. Timeline’s a huge complicating factor.

There is a strong belief in the community that the deadline will be pushed out. But because of the intent, and I think most agree the importance of empowering the patient with their own medical record, it’s not going to be pushed out long. Basically, we don’t know what the final deadline will be. We are expecting an update sometime in December, but as proposed it’s three months from now.”

EB: So, you mentioned infrastructure and the short timeline as challenges, are there any other challenges specific to Washington that would make implementing this rule difficult?

CC: “Depending on the state, there’s going to be different challenges in meeting this rule. Washington is challenged in that we don’t have a statewide HIE (Health Information Exchange) with some components. There will be a larger onus on insurers and provider groups to pull this off. But in Alaska, we have an HIE that is several years old, and actively exchanging data. For Alaska, it’s a change in the format… So that’s more of a technical challenge, whereas in Washington, the challenge is broader because we don’t have our provider groups knitted together and exchanging data to a central hub.

Regardless, the individual health plans are going to be challenged. The technical exchange of information between provider groups has been something that has evolved over the last ten years.  There is more advancement in this space amongst the provider community than the payer community. And one of the intents of this rule, I think, is to really make health plans interoperable and able to contribute the data we have.

Bringing data together to create a more holistic picture is really advantageous for the patient. Whether they’re accessing data on their own or their provider is accessing it, there’s kind of a multiplicity of benefits.”

EB: Are there concerns about privacy?

CC: “Yes. There’s opt-out capability so people can choose to not have their data shared. But for those who do want to access their data there is a concern related to the stringency of the entity that the data is being shared with. Today, within the rule, there’s no certification method defined for the 3rd party applications that we must share data with… So, if a member directs us to share data with a third-party application, it may or may not be HIPAA compliant. This will hopefully be resolved in the final rule but today it remains a concern.”

EB: What steps is Premera taking to move in the direction of interoperability?

CC: “We began early with some critical building blocks. We invested in a clinical data strategy and tools that allow us to exchange clinical data with HIEs and providers in real time. And the tools we have support bi-directional exchange. So, when you think about the payer to provider, the provider to payer, and payer to third party app requirements, we have the technology in place to be able to do that. And it is compliant with the direction of the new standards that are in the new rule — the prescribed message-types and data formats.

We also have converted our data for more real time accessibility within Premera. Traditionally, payers organized data for underwriting or contracting with provider groups. It was refreshed on a monthly basis for that type of work. And over the last couple of years, we have implemented new capabilities such that data refreshes every 15 minutes. And what that means is that we’re better able to respond to that one-day turnaround time required in the rule. Those are two pieces that we’ve actually accomplished ahead of the rule being announced, that are working across our commercial population as well. Of course, meeting the rule requirements will remain challenging for everyone, including Premera, given its breadth and expectation of participation across the health care community.”

EB: So, you’ve accomplished those aspects. Are there other changes in the works to meet the specifications in the rule?

CC: “So, we are waiting for the final rule, to see if anything changes. The idea of sharing health care data with a third party makes many of us concerned… Who certifies? How do we remain a responsible steward of our members’ data and assure our compliance with the rule?

But the core technology investments, the core ability, and experience to do the things within the rule, those I think we’ve done well, and we’re in pretty good shape. We have live clinical data exchange today, we have it running across 13 states, but no one has implemented the latest formats that meet the entirety of this new rule. We will need a live system: payer to payer, payer to provider, payer to member, payer to third-party app. But no one has actually done it, so we all have more to learn and there’s still a lot of work to be done.”

EB: Is there anything else we haven’t touched on that you want to make sure I know?

CC: “Today there’s a lot of activity centered around delivering health care information differently. But there’s also the question of what do you do with the data once it’s flowing between the stakeholders?   In this space, not only do logical clinical intervention opportunities exist like reducing medical errors and informing health care consumers, but also great opportunities to advance health care with AI and machine learning capabilities. We need to improve how the health care system works today. Combining artificial intelligence with free-flowing data, and interoperability between payers, providers, and patients/members, provides for a potentially powerful mix to improve how the health care system operates over the next few years.”

This interview has been edited for clarity and length.