In an increasingly competitive U.S. healthcare industry, HM Health Solutions’ clients face a fast-moving regulatory landscape, as well as customers who expect better, more responsive, and personalized services.
With Axway’s Amplify API Management Platform, the payer solutions provider can offer health insurers across the U.S. better agility and cost-efficiency, all while helping to deliver innovative digital services to their customers — thanks to an API-first approach.
Shifting healthcare needs and expectations
HM Health Solutions is a leading payer platform that provides end-to-end and documents solutions to 13 health insurance companies in the U.S. Its platform-as-a-service solution manages some 11 million health plan members, processing 205 million claims a year.
The company’s cloud platform enables small- and medium-sized plans to deliver leading-edge services without the enterprise price tag. Because agility and cost-efficiency have never been more important for health plan payers, HMHS saw an opportunity to reimagine its services from a customer-centric business perspective.
Marc Patterson, Lead Enterprise Architect., HM Health Solutions, explains that in the past, their digital services and associated documentation were complex and oriented toward internal development teams. “We were confident that an API-driven architecture would help us to transform our existing cloud services into new digital experiences,” said Patterson.
Several of HM Health Solutions’ healthcare partners wanted to expand their digital services. For example, by creating mobile apps to deepen engagement with their members.
To drive this transformation, HMHS selected Amplify API Management Platform, a solution that enables organizations to create, test, publish and manage APIs to a secure, central catalog, and monitor their consumption with fine-grained analytics.
Unlocking value with an API-driven architecture
As Axway Catalyst, Brian Otten puts it, API design is not an optional part of the life cycle.
“API First is simple — rather than just diving in and building applications, teams can collaborate on the design and development of an interface before any implementations are started,” Otten explained. “This approach encourages teams to nail down the design of APIs first, so quite often API First and Design First can be a dynamic duo to accelerate planning, testing, and mocking of APIs with a maximum of feedback.”
Otten worked with HM Health Solutions as they implemented the Amplify platform. At one point, he advised the team to consider API Value Proposition co-collaboration sessions as a standard practice, setting up some sessions to systematically understand customer needs and to design APIs as products that customers want.
Otten explains that a big breakthrough was made in these sessions when different consumer groups such as Member Management and Clinical Utilization got involved to describe the gains they wanted to see and the pains they wanted to solve.
Since deploying the Amplify platform, HMHS has turned the digital services that underpin its cloud platform into a rich catalog of APIs that will ultimately enable its clients to build next-generation services for their members.
“In the past, our approach to IT was heavily focused on individual projects, which led over the years to significant amounts of redundancy and complexity in our digital services,” said Patterson. “By switching to API-driven development, we are shifting from a project focus to a product mindset. Publishing all our digital services on a central catalog will offer our developers an instant overview of what APIs are already available — reducing duplication of effort and cutting time-to-market for new products.”
Greater agility in responding to healthcare regulations
The shift to an API-first design also means thinking about how their APIs will be used by others. For example, with healthcare-specific FHIR APIs, the patient member data API has the same kind of data that the provider and payers need, allowing rapid reuse and less pressure on IT teams to create a new solution for each requirement.
Composable ecosystems allow for less duplication of efforts, giving companies a set of components, they can put together to deliver services faster to their partners – whether they are internal business leaders or patients, or members.
For example, the Center for Medicaid and Medicare Services (CMS) recently created a mandate for healthcare plans and providers to improve patient access to data, promote greater interoperability within the healthcare system and empower patients to make better-informed care decisions.
To meet the new requirements, HMHS uses the Amplify platform to enable the secure exchange of patient data using the Fast Healthcare Interoperability Resources (FHIR) standard.
Working with Axway, HMHS has created a dedicated portal to publish its CMS-related FHIR APIs, enabling healthcare application developers to discover, register, and consume this data rapidly and efficiently — ultimately contributing to better patient access to important healthcare information.
Working closely with an experienced partner like Axway is helping HMHS move faster to align with healthcare regulations. “When we needed to stand up OAuth identity management capabilities for our API platform, Axway was able to share best practices and recommendations based on their extensive experience with clients across a wide range of industries,” said Chris Hengst, Lead API Architect/API Evangelist at HM Health Solutions. Read more about why OAuth is critical to make interoperability work here.
Hengst concludes, “To help our health plan payer clients to compete effectively, we aim to empower them to create responsive and personalized member experiences online and on mobile. By partnering with Axway, we are well on the way to delivering the client-facing APIs that will power a new generation of digital healthcare services.”
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