I sometimes have trouble explaining the risks of DIY to people who haven’t worked on cars. I became an inadvertent shadetree mechanic when I got my first car. I wanted to keep my maintenance costs as low as possible, and figured the best way to do that was to do repairs myself and learn as I went along.
What I found was that, while this was effective for tasks like replacing the brakes or suspension, I quickly got out of my comfort zone with more advanced work. This culminated in more than one Saturday morning project that spiraled out of control and left me in danger of not having a car for my Monday morning commute. Only when I found a trustworthy local mechanic was I successful in striking the right balance between my budget and maintaining my car at a high level of quality.
For health insurance plans across the U.S., this same risky path is before them as CMS ratchets up the complexity and stakes of FHIR interoperability requirements with rule CMS-0057-F. While many plans were successful with their DIY implementations for CMS-9115-F, the lift of supporting the latest requirements has the potential to leave them out of their depth with the January 1, 2027 deadline looming like my Monday commute.
For payer organizations, the question is no longer if they must comply, but how. The traditional inclination of large enterprises is often to “build it themselves.” However, a rigorous financial and operational analysis reveals that, in the complex landscape of healthcare data, self-build is a false economy.
The True Cost of Building FHIR Interoperability Solutions In-house: A Financial Wake-Up Call
When health plans estimate the cost of an internal FHIR solution, they often stop at salaries. This severely underestimates the Total Cost of Ownership (TCO). Based on internal audits from a midsized U.S. health plan, the burdened labor costs alone are astronomical, and that’s before factoring in infrastructure, maintenance, and the ever-present threat of scope creep.
The Labor Trap of Building Interoperability Solutions
An initial FHIR solution (like CMS-9115) might be managed by 3-4 FTEs, representing an annual burdened labor cost of approximately $719,550 (including Data Engineer, Senior Architect, and IT Director allocation).
However, the requirements of CMS-0057, especially moving beyond a single line of business (LOB) to an enterprise-wide solution, dramatically increase the complexity and human capital demand:
- Single LOB: Requires an estimated 8 FTEs, or $1,439,100 annually in labor costs.
- All LOBs (Enterprise-Wide): In environments with fragmented data, the effort can quadruple to 16 FTEs, or an astonishing $2,878,200 annually.
Overlooked Operational Expenses of an Internal FHIR Data Exchange Build
The labor figures are just the tip of the iceberg. An internal build requires continuous investment in areas where 1upHealth offers comprehensive coverage:
- Compute & Storage: An internal build incurs recurring cloud hosting fees that can spiral out of control. With 1upHealth, this is Included in the subscription.
- Data Processing: An internal build includes costs associated with processing and indexing millions of FHIR resources. With 1upHealth, this is Included in the subscription.
- SLA/Maintenance: An internal build requires Internal Help Desk and DevOps resources to maintain the mandated 99.9% API uptime availability. 1upHealth provides a Dedicated support team and 24/7 monitoring.
- Regulatory R&D: An internal build requires continuous internal engineering for new Implementation Guides (IGs) and regulatory changes. 1upHealth provides Industry leadership, ensuring you are always ahead of the regulatory curve.
- Hiring: An internal build requires 4-7-month timelines and costs to hire health-data-specific engineering talent. 1upHealth requires Zero hiring costs for the core platform.
Quantifiable Savings When You Buy 1upHealth’s Interoperability Platform
When comparing the TCO, the financial argument for “buying” is overwhelming. 1upHealth provides a predictable, budget-friendly model that eliminates the hidden and spiraling costs of an internal build.
Scenario A: Single Line of Business (CMS Only)
Building an in-house solution for a single Line of Business requires an estimated 8 FTEs and an Annual Cost of $1,439,100.
- 1up Platform: Requires 0 FTEs and an Annual Cost of $112,500, resulting in $1,326,600 Savings and a 92% Cost Reduction. The internal team can be reallocated for higher value efforts.
Scenario B: All Lines of Business (Enterprise Wide)
Building an in-house, enterprise-wide solution requires an estimated 16 FTEs and an Annual Cost of $2,878,200.
- 1up Platform: Requires 0 FTEs and an Annual Cost of $937,996, resulting in $1,940,204 Savings and a 67% Cost Reduction. The internal team can be reallocated for higher value efforts.
In the most comprehensive scenario, health plans are projected to save nearly $2 million annually compared to the burdened labor costs alone of an internal build. When factoring in cloud infrastructure and 24/7 support, the TCO for an internal build is conservatively estimated to be 2-4 times higher than the cost of the 1up Platform.
The case for buying is not just about cost reduction; it’s about strategic value and re-usability. Building a solution offers only compliance; buying a platform offers a competitive advantage.
Reallocate High-Value Talent When Buying an Interoperability Platform
Internal engineering teams are currently tied up in the low-value, high-effort task of data cleaning, transformation, and source-to-FHIR mapping. By leveraging the hundreds of thousands of engineering hours already baked into the 1up Platform, health plans can pivot their high-value engineering talent away from basic data plumbing and toward high-impact priorities like complex analytics leveraging the 1up unified dataset and direct member/provider experience tools.
Achieve the Unified Longitudinal Dataset with 1upHealth
The 1up Platform delivers a unified longitudinal dataset out of the box. This is the holy grail of healthcare data: a single source of truth that powers everything from regulatory reporting to advanced analytics. This dataset is reusable for clinical connectivity and downstream applications, both internal and external (with partner vendors and organizations).
Immediate Operational Impact with the 1up Platform
The 1up Platform provides power-on, out-of-the-box analytics that drive measurable financial and operational improvements:
- Cost Centers: Identify and reduce high-cost populations.
- Fraud, Waste, and Abuse (FWA): Root out unusual patterns.
- Prior Authorization: Streamline processes, reduce manual work, and enhance provider experience, capturing meaningful operational savings that only occur at scale.
Unparalleled Service and Reliability of the 1up Platform
A build solution is limited by institutional knowledge and the availability of 4-8 FTEs. A vendor solution provides guaranteed reliability:
- 24/7 Monitoring and Support: Guaranteed availability rating, exceeding CMS mandates.
- Proactive Issue Identification: The service identifies issues with your data and raises potential problems before you even know they’re there.
- Dedicated Partnership: A dedicated point of contact and executive sponsorship ensure rapid escalation and continuous value derivation as 1upHealth finds new ways to help you leverage our platform.
Build vs. Buy is the Way to Go for Health Data Interoperability
The era of building bespoke, bolt-on FHIR data pipelines as a sidecar to payers’ existing infrastructure is over. Pursuing an internal build is a path toward unpredictable costs, regulatory risk, and the stagnation of high-value engineering talent. Partnering with 1upHealth provides immediate, recurring financial savings, while simultaneously activating powerful new networking and analytics capabilities.
By buying into a system like the 1up Platform, health plans can stop managing cloudops, network validation, and IG updates, and start focusing on what truly drives member value: innovation and superior member experience.
Contact us today to learn more about the value of the 1up Platform.