1up FHIR Platform
1up Patient Connect
1up Population Connect
1up Comply
1up Exchange
1up Analyze
The 1upHealth team recently hosted a webinar entitled, “CMS in Action: Strategies for Effective Interoperability & Maximum Impact.” The session covered how to develop a strong plan for implementation and the importance of taking a broader approach to health data exchange. In addition, our Chief Product Officer Andrea Kowalski introduced upcoming improvements to our health data management platform and our 1up Comply solution. In this blog, we cover 4 key takeaways from the webinar.
The time to act is now
It’s been seven months since the Interoperability & Prior Authorization final rule (CMS-0057-F) came out. Given its deadline of January 1, 2027, the healthcare industry seemingly has plenty of time to get the job done. However, CMS is asking a lot of payers as part of the regulations.
Not only do we see important updates to the Patient Access API requirements – primarily around usage reporting and the addition of prior authorization data – but payers also need to be able to stand up net new FHIR API functionality to support payer-to-provider data exchange, payer-to-payer data exchange, and electronic prior authorization.
New technology will be needed to enable all of these changes – at scale. And, beyond the technology changes, the requirements will impact long-established business processes that must be rethought and propagated throughout the organization.
In short, the time to act is now, so you have the runway to update your business processes and build, test, and roll out all the enabling technology.
A health data management platform is needed to enable true healthcare interoperability
1upHealth is rising to the occasion. We’re investing in our platform to enable true interoperability – at scale. The result is a healthcare data management platform that is purpose-built for data acquisition, data management and standardization, data governance, and data interoperability.
To power the 1up platform, we’re investing in a next-generation data lakehouse architecture. We’re using battle-tested technologies endorsed by tech giants like Google, Netflix, and X. This new architecture is unrivaled in the market and will deliver:
- Unprecedented efficiency and scalability
- Flexibility to support many future use cases and applications
- Superior data quality
Building off this next generation of our platform, we’re also investing in a differentiated solution to support CMS-0057.
Key improvements are coming to 1up Comply, our CMS-0057 solution
Our approach to CMS-0057 consists of multiple APIs for compliance, delivered as a single integrated solution for interoperability known as 1up Comply. This solution uses the same foundational components across the board, including:
- A flexible data ingestion and conversion pipeline
- An extensive network of payer, provider, and third-party app endpoints – fully owned and managed by 1upHealth
- Robust access controls and data filtering capabilities
- Usage reporting specific to each API
1upHealth’s APIs include:
- 1up Patient Access, which empowers members to easily share their health data with a third-party app of their choice
- 1up Provider Access, which allows payers to easily and cost-efficiently share member data with trusted provider partners
- 1up Payer-to-Payer Data Exchange, which enables payers to easily and securely exchange member data with other payers in a standardized format
- 1up Prior Authorization, which permits payers to streamline prior authorization with a centralized hub for prior authorization requests
Our integrated solution is giving you more than APIs. It’s giving you end-to-end workflows so you can put your data to work. Watch our 1up Comply video to learn more about these solutions.
Interoperability moves from compliance to business strategy
At face value, CMS-0057 may appear to be loosely related compliance requirements coming from the federal government. The reality is that the new rule represents a tipping point for the industry. CMS knows what they’re doing. They didn’t ask every CMS-regulated payer to stand up Patient Access FHIR API in 2021 in a vacuum. The intent, we believe, was to prime the pump for a broader industry shift toward standards-based data exchange, with payers sitting at the center of that transformation.
The challenge for all of us is to successfully implement these new capabilities in a way that both gets us to compliance AND benefits core business. We absolutely need to think differently about the approach and the underlying technology that’s going to get us there.
The core opportunity is about data access and data exchange. It’s about how the Access APIs fit into a broader picture around how payers can acquire, aggregate, standardize, and exchange data more effectively – this is about the “Advancing Interoperability” part of the CMS-0057 rule title. So we challenge you to ask yourself, if you already have to do this FHIR thing for compliance, then why not apply it to all your key business areas (risk management, care management, etc.) to get so much more out of your investment and your data?
Time to dig in more?
This is just the tip of the iceberg of what was covered in the full webinar. To learn more, you can watch the full webinar. Or, if you’re interested in getting started today, contact us now. We’d love the opportunity to talk with you about your plan, act as a resource, help you strategize, and position you to succeed with CMS-0057 compliance and create business value beyond the regulations.
