Clover Health becomes first healthcare payer to meet CMS interoperability standard
Clover Health, a publicly traded medical insurance and healthcare technology company focused mainly on providing Medicare Advantage plans to seniors, is now the first payer to operate live on a CMS Aligned Network.
Any healthcare entity that exchanges patient data—hospital, health system, payer network, or medical record exchange—can earn the status, but they need to meet certain benchmarks for speed, quality, and safety established by the Centers for Medicare & Medicaid Services (CMS) and the Trusted Exchange Framework and Common Agreement (TEFCA).
To be a CMS Aligned Network means the organization participates in TEFCA-compatible networks and follows interoperability policies set by both agencies. This includes using standardized secure data exchange formats, such as FHIR, which was adopted by Clover.
As part of aligning with the interoperability initiative, the company said it will provide real-time data access upon receiving a request, “enabling patients to securely authenticate and request their health information from any participating payer through a connected network.”
This is made possible via a collaboration with Kno2, a company that specializes in healthcare interoperability. Its network and technology allow medical records to be exchanged between stakeholders—including hospitals, payers, and other vendors—even when they operate disparate, incompatible EHR systems.
In an announcement, Clover outlined a scenario where a “Medicare patient with multiple chronic conditions” may need to jump between different healthcare settings, from primary care to hospitals and home-based services. It’s then that seamless data exchange becomes critical.
Not only for providers and payers, but for the patients. The best care delivery is made possible when everyone engaged in an encounter is operating with a complete medical history. While data may sometimes be in different hands, this collaboration means those covered by Clover health plans will be able to have it all come together and follow them as they seek services.
"When our members have secure, real-time access to their clinical and claims information, it enables both transparency and control, including easier sharing with caregivers and providers, and ultimately a deeper understanding of their own health journey,” Jamie Reynoso, CEO of Medicare Advantage at Clover Health, said in a statement.
Data needs of AI assistant fast-tracked interoperability
Clover’s technology and service arm, Counterpart Health, is part of what makes this possible. Within the CMS Aligned Networks framework, Kno2 securely routes patient-initiated requests throughout the network, Counterpart ensures standardized data exchange.
Data access has always been important to the core Counterpart product—an AI assistant used by physicians to aid with rapid diagnoses, so chronic conditions can be spotted and managed sooner.
“Counterpart Assistant was built from the ground up as a bi-directional interoperable platform, already connecting hundreds of data sources,” Kevin Holub, Chief Product Officer at Counterpart Health said. “These are not bolt-on capabilities or compliance projects. They are foundational components of how the system operates in production.”
Holub said this foundation is what allowed Clover to align with the CMS and TEFCA interoperability standards before any of its healthcare payer competitors.
“When that infrastructure already exists, participating in CMS aligned networks becomes a fast add-on benefit, not a build,” he added.
Patients can begin requesting their medical information immediately.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.