Healthcare Operations Policies

A thriving data exchange requires clear rules of engagement on various activities in the data exchange to ensure trust from all actors. The key list of policy candidates to be addressed is:

  1. Onboarding

  2. Defaulting/Deboarding policies

  3. Dispute resolution policies

  4. Access control (Data sharing) policies - which actor plays what role and gets to see which parts of data. These policies will then affect the visibility and access to domain specific attributes that will typically travel in the body of the data structures defined by the data exchange.

  5. Business SLAs

  6. Charges and fees - These would be policies around charges various data exchange entities will be allowed to levy on others depending on the role they play

  7. Service rating policies - What would be the parameters and mechanisms to rate each type of actor on the data exchange.

The success of the data exchange will depend on trust and willing participation from its ecosystem players. Therefore, to ensure the success of the claims data exchange, its governing policies need to focus on enabling the ecosystem and gaining its trust. To ensure this, the following key policy design guidelines are recommended:

Key Design Considerations

  1. Policies should focus on enabling the ecosystem rather than monitoring or controlling it

  2. Policy formulation should be done as an open consultative process to foster trust in policies

  3. Rules of participation and disqualification should be transparently laid out

  4. They should follow the principle of minimalism and be evolved over a period of time

Keeping these guidelines in mind, the following key policies guidelines are provided for the purpose of wider consultation as part of version 1:

  1. Access control (Roles)

  2. Participant onboarding/deboarding

  3. Grievance redressal

  4. Event Audit

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