Leap Orbit, the innovation partner to market-leading health data networks, announced today the launch of Convergent, a provider directory that enables stakeholders to meet the requirements of the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule by its current implementation deadline of July 1, 2021. The launch of Convergent aligns with a major trend in healthcare that is reorienting the overall sector: the shift to open data to foster greater patient control and technology innovation.
In Maryland, where the state’s Medicaid program is utilizing Convergent to comply with the CMS Interoperability Rule, the provider directory is being deployed in partnership with Leap Orbit’s longtime client CRISP, a regional health information organization that is Maryland’s state designated health information exchange (HIE). Convergent is also being used to deliver more actionable provider information to the point of care, to support COVID-related clinician workflow, and to enhance reporting by the state’s prescription drug monitoring program. CRISP has contracted with MedChi, the Maryland State Medical Society, to provide data stewardship services for the provider directory.
“Having accurate primary care provider and care team information at the point of care is vital to the role that CRISP plays in care coordination,” said David Horrocks, president of CRISP. “Given the fragmented and often incomplete provider information that accompanies data like encounters and lab results, HIEs have historically struggled in this area. Now we are finally making meaningful progress.”
“Keeping physician information up-to-date and consistent across organizations is a monumental challenge,” said Gene M. Ransom III, CEO of MedChi. “There is a lot of duplicative effort, and no one seems to ever get it right. The State of Maryland has chosen an innovative, unified approach with Leap Orbit’s Convergent provider directory front and center.”
The new CMS Interoperability Rule requires state Medicaid agencies, Medicaid and CHIP managed care organizations, Qualified Health Plans in ACA exchanges, and Medicare Advantage plans to provide a public provider directory application programming interface (API) as a new condition of participation. However, many health plans do not yet have a plan or platform to meet the provider directory API and FHIR® compliance requirements by the current July 1, 2021, deadline. Convergent offers a low-risk, cost-effective, turnkey solution that can bring the agency or plan powerful long-term benefits. For Medicaid and CHIP managed care plans, Convergent can also supply the mobile-enabled provider directory interface recently mandated by the 2020 Medicaid Managed Care final rule.
Acting as a cloud-based “thin layer” on top of existing sources of provider data, Convergent handles FHIR 4.0 mapping, data ingestion, and data stewardship to quickly deliver health plans a clean and compliant provider directory. Upon access to the plan’s provider file, Convergent can typically be configured to be compliant with the Interoperability Rule in a matter of weeks.
Many organizations impacted by the CMS Interoperability Rule may be focused primarily on its patient-access requirements, given their complexity. However, choosing Convergent to satisfy the rule’s provider directory API requirement positions an organization to turn provider data into a competitive strength instead of perpetual challenge. Convergent’s sophisticated matching and data cleansing algorithms, along with proprietary reference data sets, provide organizations with curated, highly accurate network data.
“It’s a small step for patients and providers to have access to trusted data on who is in-network when making care decisions, but a big leap forward for interoperability,” said David Finney, co-founder and partner of Leap Orbit. “We are excited to draw on our leadership implementing the FHIR standard for HIEs and PDMPs to empower new partners in Medicaid and Medicare Advantage.”
Getting Started with Convergent
Health plans and other organizations ready to lead on provider directory compliance can learn more about Convergent by clicking here: leaporbit.com/convergent.
They can also schedule a free 30-minute demo of Convergent here: leaporbit.com/convergent-demo.
About Leap Orbit
Founded in 2015, Leap Orbit is the trusted innovation partner to many of the market-leading health data networks, including CRISP, Manifest MedEx, and NEHII. Leap Orbit’s philosophy is to run toward healthcare’s biggest challenges, providing technology and solutions to assist with the opioid crisis and patient data privacy. Through its health organization partners, Leap Orbit’s work reaches at least 45 million patients from Alaska to Maryland. For more information, visit LeapOrbit.com and follow on LinkedIn.
CRISP is a regional health information exchange (HIE) serving Maryland, the District of Columbia, West Virginia, and the surrounding regions. A nonprofit organization advised by a wide range of stakeholders that are responsible for healthcare throughout the region, CRISP has been formally designated as Maryland’s statewide health HIE exchange by the Maryland Health Care Commission. Health information exchange allows clinical information to move electronically among disparate health information systems. For more information about CRISP, visit http://www.crisphealth.org.