How One Payer Increased the Use of Their Patient Access API

Patients deserve easy access to their full patient record and the ability to share their records using a third-party application of their choice. Beyond that right of access and exchange, patients that review their clinical and claims data on a regular basis see significant benefits, including greater engagement in their own health and better communication with their providers, leading to improved health outcomes overall.

Payers also see benefits when their members are more engaged with their own healthcare data, including more preventive care and earlier care interventions, which lead to better health outcomes at significant cost savings.

Historically, however, accessing existing health data has been difficult for patients and has created lots of manual work and administrative burden for payers.

The History of the CMS Patient Access API

To combat these challenges, in May 2020, The Centers for Medicare & Medicaid (CMS) released the Interoperability and Patient Access final rule which, among other things, required CMS-regulated health plans to provide their active members with access to clinical, claims, encounter, and formulary data via a Patient Access API. The CMS Interoperability and Prior Authorization final rule published in January 2024, took the Patient Access API requirement a step further, requiring access to prior authorization data, alongside the addition of yearly reporting requirements. 

Unfortunately, despite the investment impacted payers have made in their Patient Access APIs, many report low utilization of the benefit by their members. And, as a result, they aren’t seeing the expected benefits. Given the increased investment they’ll need to make to meet the requirements of the 2024 final rule, payers should look for ways to increase utilization of their Patient Access API. 

One notable success story comes from a payer who developed a communications strategy for their Patient Access API, leading to a marked increase in usage. The insights gained from this case study can serve as valuable guidance for other payers.

An Integrated Education and Engagement Campaign

The payer initiated an integrated, multi-channel education and engagement campaign to promote their Patient Access API’s usage, incorporating:

  • Website: On the “Member Information and Resources” section of their website, the payer provided directions on how members can access their health information, an FAQ to address additional questions, and a list of various third-party health apps that can be used by members.
  • Video Content: The payer created a video to educate members on how to access their healthcare data. The video walks members through how they can access their data, shares a phone number and website that can be used by members for support, and highlights the benefits of using apps to review health information.
  • Mailers: The payer also mailed their members physical letters, taking a phased approach to gauge the impact of the letters on member engagement and iteratively improve on the mailing campaign.

As a result of this effort, the payer saw a major increase in the utilization of their Patient Access API. During one communications push, utilization was up over 3000% for the month, as compared to the average across preceding months. The payer understood the key was not just to provide members with access to their health data, but also to educate them about how to access that data and use it effectively.

Now that we’ve looked at a success story, let’s do a deeper dive into the benefits members and payers see as a result of greater Patient Access API utilization.

5 Benefits of the Patient Access API to Members

  • Improved Health Outcomes: Regular review of health data can help members better manage their chronic conditions, adhere to medication regimes, and make lifestyle changes that can lead to improved health outcomes.
  • Increased Accountability: Regularly accessing and reviewing health data can increase a member’s accountability for their own health and encourage healthier lifestyle choices.
  • Greater Engagement: When members are engaged with their health data, they’re more likely to take an active role in their health and well-being. This can lead to greater self-efficacy, increased preventive care, and improved health behaviors.
  • Better Communication with Providers: Members who regularly review their health data have more informed conversations with their healthcare providers. They ask more specific questions, understand their health condition better, and take part more fully in decisions about their care.

6 Benefits of the Patient Access API to Payers

  • Improved Health Outcomes: Regular review of health data can help members better manage their chronic conditions, adhere to medication regimes, and make lifestyle changes that can lead to improved health outcomes.
  • Increased Member Engagement: When members have access to their healthcare data, they feel more engaged. Engaged members are more likely to complete preventive screenings and take part in wellness programs and other health plan offerings that can improve health and potentially reduce costs.
  • Preventive Care and Early Intervention: Regular review of health data can lead to early  detection and management of health issues, which can be more cost-effective than treating advanced diseases or complications.
  • Data Accuracy: Members who review their own health data may find and correct inaccuracies, leading to more reliable data for analysis and decision-making.
  • Greater Member Satisfaction: Providing members with access to their personal health data can increase their satisfaction with their health plan, potentially leading to greater member retention.
  • Cost Savings: By promoting an active role in personal health, payers can potentially reduce the long-term costs associated with chronic diseases, such as emergency room visits and hospitalizations, along with high-risk health behaviors. 

Empower Patients to Easily Access and Share Their Health Records 

The 1upHealth Patient Access API easily integrates with third-party applications, enabling patients to use the application of their choice to access and share their clinical, claims, encounter, and prior authorization data. This automated process accelerates data sharing, improves experience, and saves significant time and money. Check out the Patient Access API product page to learn more and contact us for more information.  

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