Successful Go Live! Meeting the CMS FHIR Mandates

1upHealth team, in collaboration with our health plan partners, is going live today, July 1st

1upHealth knew this would be an enormous undertaking. Simplifying medical data is hard work. The healthcare industry has taken its first, yet monumental, step towards its conversion to FHIR, a language that moves healthcare towards internet-like ease and functionality.

The Centers for Medicare and Medicaid Services (CMS) mandated that health plans offering government-sponsored plans begin using FHIR by July 1, 2021, with two application programming interfaces (API). 

One is known as the Patient Access Rule, which allows an active government-plan member to request and receive claims, encounters, clinical and formulary data with an app developer. The other is the Provider Directory Rule, which requires that directories of network providers be made available to third-party developers using FHIR. 

To find out more about the lessons learned with the implementation of the CMS rules, please check our Virtual Health Conference. #VHC21 #TheFutureofHealthcare #BuiltOnFHIR #BeyondJuly1st

While it’s been a mad scramble for payers to meet this deadline, we are proud to say that the 1upHealth team, in collaboration with our health plan partners, got this done!

It remains to be seen (and validated) whether it is true that only 15% of all health plans who offer Medicare, Medicaid, and Children’s Health Insurance Plan (CHIP) are actually up and running and live by today, as required by CMS. 

With that in mind, it is enormously satisfying for our entire company to announce that EVERY ONE of our health plan customers successfully went live, representing a majority of all active Patient Access and Provider Directory APIs. 

Our efforts are already making a big impact:

  • 21 Million Patient records available
  • Each API supports 300+ FHIR resources

What does this mean?

It means that starting July 1, 21 million patients can query the FHIR resources in a way they were never able to do so before. Patients can look for elements such as: 

  • Explanation Of Benefit
  • Coverage
  • Organization
  • Practitioner
  • Organization Affiliation
  • Provider Directory Information
  • Formulary / Preferred Drug List Information
  • A subset of Clinical resources (e.g., Observations, Conditions, and more)

With FHIR, health plans and app developers can leverage a data language that allows them to do all sorts of things they were never able to do before when the most interoperable standards were a fax machine or a PDF file. 

Health plans and app developers can now better enable telehealth, remote patient monitoring, population health analytics, smart apps, and genomic research so that consumers can live longer, healthier lives. 

There is still much hard work to be done. The next big compliance due date is January 1, 2022 with the Payer to Payer API requirement. But I do want to take a moment to relish today, July 1st. It’s why I started 1upHealth. It’s why our dedicated employees came to work for 1upHealth: to help our customers, and push the industry to transform the use of health data.

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