Payers

Streamline interoperability, meet regulatory requirements, and unlock new value streams

For Medicare, Medicaid, and Commercial Payers
For Payers

Featured Webinar Series

Navigating The CMS Final Rule: Building Your Compliance Roadmap

Payers operate in a complex ecosystem.

As the backbone of the healthcare economy, payers interact with a range of partners, from Accountable Care Organizations (ACOs), third-party administrators (TPAs), and Pharmacy Benefit Managers (PBMs) to a wide variety of digital health companies. Each of these partnerships relies on data. But a lack of standards and connectivity makes accessing, processing, and exchanging data with these organizations hard.  
1upHealth is the market leader helping Medicare, Medicaid, and commercial payers acquire, manage, share, and analyze health data, supporting not only their regulatory requirements but also helping them drive ROI from their interoperability investments. Stop chart chasing and start driving clinical and financial improvements with combined EHR and claims data standardized on FHIR. Make the move to 1upHealth.

Drive results with 1upHealth

Deliver timely post-adjudicated claims data to value-based partners and receive timely USCDI clinical data from provider EHRs on shared patient populations via FHIR® APIs.

Meet all current FHIR API mandates and future-proof your compliance strategy ahead of upcoming regulations. Join the 75+ regulated health plans that are achieving CMS compliance with 1upHealth.

Convert CCDA, HL7v2, and other flat files from Health Information Exchanges (HIEs) and other sources to FHIR to support analysis across your organization.

Unlock population health insights and data exchange use cases that improve your top line.

The power of 1upHealth FHIR® data solutions​

1upHealth takes a standards-based, modern cloud, and API approach to data portability and governance. In partnership with 1upHealth, health plans can easily access, process, and exchange data to improve member experience and outcomes, comply with CMS FHIR regulations, operate efficiently, share risk, carve out services, and improve profitability.

platform

We’re built on FHIR – the open and truly portable data standard – from the ground up.

ingestion

Our market-leading compliance solution enables you to meet CMS regulations without the hassle of building in-house or working with inexperienced vendors.

medical-files

Our end-to-end platform supports all of your data needs – from ingestion to analytics and everything in between.

ingestion

Ingestion of clinical and claims data from multiple sources results in a complete, standardized source of member health information.

payer

Our implementation process is battle-tested, having brought 80+ health organizations live on our platform.

helping-patient

Dedicated customer success support ensures a strong long-term partnership.

1upHealth’s network effect

1upHealth allows you to combine clinical and claims data for a more robust dataset. The growth of our network speaks for itself.

7,000+

provider endpoints for clinical data

150+

payer endpoints for claims data

1upHealth for payers

FHIR

1up FHIR Platform

Acquire, manage, share & analyze health data with an industry-leading, end-to-end managed platform.

Patient Connect

1up Patient Connect

Empower patients to access & share their health records with providers, payers, and digital health applications.

Population Content

1up Population Connect

Drive better health outcomes & make better business decisions with patient population data imported from top EHRs.

1Up Comply

1up Comply

Meet current & future health data exchange regulations.

1Up Exchange

1up Exchange

Streamline patient- and population-level data exchange with your key clinical & business partners.

Analyze

1up Analyze

Unlock new insights & better outcomes by accessing healthcare data stored in FHIR® and integrating it into existing analytics systems.

Leading payers using 1upHealth

Regional Health Plan

Accessing EHR data to properly assess quality goals

 

 

A regional health plan with three risk-based provider contracts uses 1upHealth to access EHR data in order to properly assess quality goals. This is the first time in its history that this payer has access to clinical data at scale.

Large Health Insurer

Improving processes using EHR data merged with other data
 
 

One of the country’s largest health insurers together with a national health services organization uses 1upHealth to merge EHR data with other external and internal data, creating the backbone for prior authorization, analytics, and all care management and network interactions.

We saw huge strategic advantages of getting everyone on the 1upHealth platform. Now we can standardize our measurements, improve our plan and care interactions, and measure performance, among many other critical initiatives.
Chief Information Officer
National Payer

Ready to Learn More About Healthcare’s Modern Data Platform?