The 2024-2030 Federal Health IT Strategic Plan (Plan) provides a blueprint of the work that federal agencies have underway to improve the access, exchange, and use of electronic health information (EHI) and achieve better health outcomes for all Americans.

This new blog series, “Federal Agencies Leading the Charge,” will explore the ways federal agencies are using health IT strategies, initiatives, and programs to fulfill the Plan’s goals. To begin the series, we’re exploring how the Centers for Medicare & Medicaid Services (CMS), the largest payer in health care, is at the forefront of how health IT directly impacts health care providers and the care they deliver.

Helping Providers Spend More Time with Patients

The Plan recognizes the opportunity to use health IT so that “providers experience reduced regulatory and administrative burden.”

A key contributor to provider burden is prior authorization, the process under which patients need to get approval from their health plan before receiving a service or getting a prescription filled. Today, prior authorization processes can vary widely from plan to plan, requiring substantial investments of time and resources from provider offices, as well leading to delays in care received.

The CMS Office of Healthcare Experience and Interoperability (OHEI) is working to simplify health care processes so that health care providers can spend more time with their patients. In the CMS Interoperability and Prior Authorization Final Rule, CMS required certain payers to streamline their prior authorization processes and to implement a Health Level Seven International ® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) Prior Authorization application programming interface (API) to standardize information exchange around prior authorization.

In addition, the CMS final rule requires impacted payers to provide a specific reason for denying a prior authorization request. These changes intend to speed up the prior authorization process by allowing providers to deliver care sooner and accelerate any resubmissions or appeals should prior authorizations be denied.

Health Care Access and Quality

The Plan outlines strategies for using health IT so that “patients experience expanded access to quality care and reduced or eliminated health disparities.”

CMS implements quality measurement programs across a broad range of inpatient and outpatient care settings that contribute to improvements in health care, enhance patient outcomes, inform consumer choice, and promote the transformation to a digital health ecosystem. CMS has set a goal of advancing quality measurement by transitioning all quality measures used in its reporting programs to digital quality measures (dQMs). The increased availability of structured, FHIR-formatted electronic health record (EHR) data exchanged through FHIR APIs creates an opportunity to dramatically improve CMS’s quality measurement systems, address long-standing challenges, and realize the creation of a learning health system.

The CMS Office of Minority Health works with local and federal partners to eliminate health disparities. The CMS Framework for Health Equity 2022-2032 prioritizes expanding the collection, reporting, and analysis of standardized data, with particular emphasis on standardizing social determinants of health (SDOH) data. Integration of SDOH data into health care acknowledges that an individual’s health outcomes are not solely defined by their body, but also by conditions in their environment such as access to food or stable housing, exposure to environmental toxins in their communities, and limited choice and access to health care services.

By standardizing this data, it becomes more accessible to those who need it and supports better connections between local community partners and health care organizations to address unmet social needs and support emergency and disaster readiness that can target resources and tailor policies.

CMS’s report, The Path Forward: Improving Data to Advance Health Equity Solutions, presents actions that CMS plans to take to address challenges to health equity using data. These include filling gaps in existing data, collecting new data elements (such as SDOH), aligning data to standards such as the United States Core Data for Interoperability (USCDI) standard, and disaggregating data, while protecting privacy.

Price Transparency

The Plan also provides a strategy to expand methods to measure and make care quality and price information available electronically so that “health care is improved through greater competition and transparency.”

CMS leads this objective through policies, guidance, and tools for hospital and health plan price transparency. Since 2021, CMS has required that hospitals post their price information online; in 2024, CMS updated these requirements so that the data would be more accessible and comparable.

To do this, CMS requires that the data be in a machine-readable format and has laid out a standardized template and data specifications. Updated requirements will go into effect in January 2025 and CMS will continue to adjust as needed to ensure that the price information is useful for consumers.

This blog post only scratches the surface of what CMS is doing to advance health IT used to improve health care. We invite you to follow the links provided to each CMS project, program, and policy to learn more, and to look forward to the rest of this series as we continue to explore how federal agencies are leading the charge to improve the access, exchange, and use of EHI through health IT.