How Third-Party Apps Complement Payer Member Portals

Empower Members, Simplify Reporting, and Achieve Compliance with API Integrations

Today, payers are managing a whole host of priorities – including ensuring quality care, managing costs, maintaining member satisfaction, increasing Star Ratings, and complying with government regulations. They’ve invested in member portals as the primary platform for members to access information and take action, including managing benefits, viewing claim status and history, paying premiums, searching for providers, researching covered medication, and checking prior authorization status. 

Given their investment, payers often have a strict policy of directing and keeping members in their portals. And yet there’s a wide variety of digital apps on that market today which allow members to engage with their health data in ways that appeal to their interests. Payers often view these third-party apps as competing with their member portals. On the contrary, we at 1upHealth see third-party apps as complementing – not competing – with payer member portals. Here’s why. 

Today’s consumers expect healthcare to integrate seamlessly into their lives. 60% of consumers expect their digital healthcare experience to mirror that of retail. They value convenience and technology-based care, including apps that deliver everything in one place. Forward-thinking payers like Highmark are enabling members to sync claims data with third-party health apps integrating wearable devices and are reaping the benefits of member engagement. 

Third-party apps offer broader functionality than payer member portals

Third-party apps offer functionalities beyond the standard information found on payer member portals. These include:

• Health Monitoring: Tracking vital signs and chronic condition symptoms. This category includes apps like Garmin Connect, Noom, Oura, MySugr, and Apple Health. 
• Clinical Trial Recruitment and Management: Apps that help Clinical Research Organizations (CROs) and life sciences companies recruit, onboard, and manage participants in clinical trials. These include TrialX, Evidation, Medable, Reify Health, ObvioHealth, and curebase.
• Medication Management: Apps that provide reminders and tracking for medication adherence, including Medisafe and MangoHealth.
• Wellness Programs: Apps that provide fitness, nutrition, and mental health resources. These include FitBit, Headspace, Strava, WHOOP, and MyFitnessPal.

There are over 350,000 health apps on the market today. Digital health tools will continue to broaden their capabilities and functions to support diagnosis, treatment, and monitoring. 

Integration with third-party app offers payers deep value

Forward-thinking payers that offer their members integration with third-party applications see multiple improvements, including: 

• Improved member satisfaction: A recent study found that members who engaged with health-related applications felt more positively about their health plans, viewing them as trusted health partners. 
• Increased Member Engagement: Digital tools keep members actively involved in their health.
• Better Patient Care and Outcomes: Digital tools improve member and provider interactions. 
• A Competitive Advantage: Offering data integration with third-party apps positions organizations as innovative leaders in healthcare.

FHIR APIs are the enabling technology driving this value

FHIR-based APIs enable the secure transmission of health data from payers (and providers) to third-party apps. In fact, APIs are a key component of the tech stack powering full interoperability across the healthcare ecosystem. 

FHIR APIs offer a whole host of benefits to payers, including:

• Ensuring Regulatory Compliance: CMS-9115 Patient Access and CMS-0057 Interoperability and Prior Authorization final rules require impacted payers to implement a variety of APIs, including Patient Access API, Provider Access API, Payer-to-Payer Data Exchange API, and Prior Authorization API, with the end goals of enhancing data exchange and patient access. 
• Improving Operational Efficiency: APIs streamline data exchange, reducing administrative burdens.
• Decreasing Costs: APIs eliminate the need for manual, labor intensive workflows, resulting in decreased administrative costs. 
• Streamlining Reporting & Bolstering Star Ratings: To comply with government regulations, beginning in 2026, impacted payers are going to need to report on Patient Access API utilization. Utilization data generated through APIs demonstrates compliance and highlights member engagement for CMS submissions, bolstering Star Ratings.
• Maintaining Secure Data Transfer: Robust API protocols ensure secure data exchange, maintaining member confidentiality.
• Improving Plan Performance: Members equipped with more tools to manage their health report higher satisfaction, positively influencing a plan’s performance metrics.

Complement Payer Member Portals with APIs

We know some health plans worry about third-party apps competing with their member portals. We at 1upHealth believe third-apps complement payer member portals – they don’t compete. And FHIR APIs act as a bridge, securely linking third-party apps to payer member platforms. 

Adopting API integration aligns with modern member expectations, offering strategic benefits like improved member satisfaction and optimized business processes. Supporting third-party app usage through secure API connections fosters deeper member trust and engagement. Finally, integrating with third-party apps can enhance the value of payer services, offering a strategic advantage over other payers.

With 80+ enterprise customers, 1upHealth has the most CMS APIs in the market. We’re here to not only help payers meet CMS requirements, but also succeed in promoting API utilization across their member base – ensuring they accrue the maximum benefits. We offer our clients best practices guidance, tools, and templates to achieve the highest levels of utilization. 

If you’re a 1upHealth customer, reach out to your Customer Success Manager to learn more. And if you’re a payer looking to learn more about how 1upHealth FHIR APIs, contact us.