Navigating Complex Data Exchange Regulations in Value-Based Healthcare

Value-based care relies heavily on the efficient, secure exchange of accurate data among key healthcare stakeholders like CMS, accountable care organizations, payors, and providers. However, the regulatory environment governing this data flow is fragmented, involving federal privacy laws, CMS policies, HIPAA, and various state-specific regulations that often conflict or overlap. The complexity increases because CMS-sourced data and Medicare Advantage data operate under different regulatory frameworks, posing unique challenges for organizations trying to leverage this information for value-based care initiatives. Legal experts Kevin Malone and Karen Mandelbaum analyze these intersecting compliance requirements, highlighting operational hurdles in data access, quality assurance, and governance within large healthcare networks. Understanding how these rules affect data exchange is critical for organizations aiming to optimize value-based care models while maintaining regulatory compliance and ensuring patient privacy.