Unlocking the Future of Healthcare Data Exchange

New York State's Vision for Social Care Network (SCNs)

The New York Health Equity Reform (NYHER) 1115 Waiver represents a major effort to integrate healthcare and social care by creating Social Care Networks (SCNs). Approved by the Centers for Medicare and Medicaid Services (CMS), this waiver grants New York State up to $500 million to support the development of these networks.

The SCNs have been awarded this funding to address health-related social needs (HRSN) by screening and referring eligible Medicaid beneficiaries to appropriate services. This initiative is part of a larger $7.5 billion, three-year waiver program, with nearly $6 billion sourced from federal funding.

Important Dates and Stipulations

Time is up. Healthcare organizations need to be ready now to successfully tackle New York State’s ambitious 1115 Waiver data exchange goals. Acting now and keeping pace with the changes is key. Important dates to be aware of include:

• September 2024: Award of the waiver and initiation of preparatory activities.
• January 1, 2025: Start of the first phase of data exchange implementation.
• July 1, 2025: Mid-year review to assess progress and make necessary adjustments.
• January 1, 2026: Full implementation of the data exchange system.
• December 31, 2027: Conclusion of the waiver program, followed by a comprehensive evaluation of outcomes and impact.

The Social Care Network Lead Entity (SCN Lead Entity) Request for Applications stipulates that IT platforms must be FHIR®-enabled within 90 days of contracting by October 31, 2024. To meet this requirement, IT platforms should comply with the relevant Implementation Guide (IG) to be considered FHIR-enabled.

To address the health disparities properly, NYS plans to initiate:

• Seamless Bi-Directional Data Sharing: Enable secure, effective access to Health-Related Social Needs (HRSN) data through SHIN-NY. Share screening results, closed-loop referrals, and more with entities within and outside your SCN.
• Direct Access and Integration: Facilitate smooth data exchange by connecting directly to your SCN data and IT platform or utilizing a public subscription to SHIN-NY’s data repository.
• Adherence to HL7 FHIR Standards: Align with national Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standards within 90 days of award date.

Challenges With Navigating the NYHER 1115 Waiver

Healthcare organizations face several challenges with navigating the NYHER 1115 Waiver, including:

1. Integration of Services: The waiver aims to integrate healthcare and social care, which requires healthcare organizations to establish or enhance partnerships with social service providers. This integration often involves complex coordination and alignment of services that can be difficult to manage.
2. System and Technology Upgrades: Healthcare organizations must update their IT systems to be FHIR-enabled, as required by the waiver. This involves not only investing in new technology but also ensuring that existing systems are compatible and can effectively exchange data.
3. Data Exchange and Interoperability: Ensuring that data exchange meets the waiver’s standards for interoperability can be challenging. Organizations must work to achieve seamless data integration across various platforms and ensure that all systems comply with FHIR standards.
4. Compliance and Reporting: Meeting the regulatory requirements of the NYHER 1115 Waiver involves detailed documentation and reporting. Healthcare organizations need to develop systems for tracking performance metrics, maintaining compliance, and preparing reports, which can be resource-intensive.
5. Financial Management: Managing the financial aspects of the waiver, including the allocation of funding and ensuring that expenditures align with the waiver’s goals, poses a challenge. Organizations must navigate complex funding structures and ensure efficient use of resources.
6. Training and Capacity Building: Training staff on new processes, technologies, and compliance requirements is imperative. Building the necessary capacity to manage the changes brought by the waiver requires significant time and investment.
7. Data Privacy and Security: With increased data exchange comes the need for enhanced data privacy and security measures. Organizations must ensure all data sharing complies with privacy regulations and that sensitive information is protected from breaches.
8. Stakeholder Coordination: Engaging and coordinating with a broad range of stakeholders, including patients, providers, and community organizations, can be challenging. Effective communication and collaboration are essential for successful implementation.
9. Change Management: Adapting to the new requirements of the waiver requires significant organizational change. Health care organizations must manage these changes carefully to avoid disruptions in care and ensure smooth transitions.
10. Evaluation and Adaptation: Developing effective mechanisms for evaluating the impact of the waiver’s initiatives and adapting strategies based on these evaluations is crucial. Organizations must be prepared to adjust their approaches based on performance data and feedback.

Help Is Nearby

If your organization is seeking help with meeting the NYHER 1115 Waiver, ZeOmega empowers health plans and other risk-bearing organizations with the industry’s leading technology for simplifying care management. Jiva, ZeOmega’s powerful platform, contains innovative solutions specifically designed to seamlessly integrate with FHIR standards, helping SCNs effectively meet the Waiver’s requirements. Named Best in KLAS for Payer Care Management Solutions in 2024, 2023, and 2022, ZeOmega has a proven record of strong dedication to clients and reliability.

ZeOmega can help healthcare entities meet the needs of the NYHER 1115 Waiver by bringing:‍

• Cutting-Edge Integration: Jiva supports seamless bidirectional data exchange with SHIN-NY and integrates directly with Managed Care Organizations (MCOs) via APIs or shared interfaces.
• Enhanced Data Sharing: Jiva facilitates the exchange of Enhanced Service Eligibility data and fiscal administration, optimizing collaboration with MCO partners.
• Future-Proof Solutions: Jiva’s adaptable solutions evolve with industry standards and NYS requirements to help healthcare organizations flex to meet requirements exactly when and where needed.

Connect with ZeOmega to learn more.

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