How one U.S. health insurer met interoperability mandates while preparing for the future

Regulatory requirements are constantly front of mind for healthcare executives, and for good reason: the stakes are high, and failure to comply can lead to costly penalties. But beyond interoperability compliance, healthcare organizations are opening up to the possibilities of APIs, whether it’s enabling more efficient operations, driving innovative services, or offering more transparent pricing.

Here’s how one U.S. health insurer achieved compliance with the CMS Interoperability and Patient Access final rule on time and, with Axway, is laying a foundation for innovative healthcare services tomorrow.

Meeting the interoperability mandate on time

When the Center for Medicaid and Medicare Services (CMS) announced a new mandate for healthcare plans and providers to improve patient access to data, the company knew it needed to move quickly to enable digital healthcare services.

The CMS Interoperability and Patient Access final rule aims to promote greater interoperability within the healthcare system, with the goal of empowering patients to make better-informed care decisions. A foundational tool to these capabilities is the secure exchanges of patient data via APIs, using the Health Level 7® FHIR® standard.

Deadlines, although pushed back due to the healthcare crisis caused by the Covid-19 pandemic, were strict and meant healthcare organizations had to stand up API programs in short order – sometimes from scratch.

To meet deadlines and achieve its goals, the company needed an expert partner to help build secure, compliant API integrations with its cloud-based digital service providers. The insurer selected Axway to drive its API transformation initiative, deploying a hybrid integration platform based on the Amplify API Management Platform.

Axway provided support in all areas of the project: from sizing and provisioning new on-premises IT infrastructure for the Amplify platform, to designing, configuring, and testing the new FHIR® APIs.

“APIs were very new to us, and we greatly appreciated having a trusted partner like Axway to advise us,” says a company spokesperson. “Thanks to our work with Axway, we achieved compliance with the final rule mandate on time, avoiding the risk of regulatory penalties.”

Reducing the strain on IT teams with self-service and automation

Because the company engages with third parties to deliver digital services, member data is stored in multiple cloud-based environments. The Amplify platform gathers data from these third-party systems, consolidates it into a FHIR-compliant document, and then sends it securely to the authorized party that made the API call.

Today, the insurer publishes FHIR APIs via an open portal, where developers can help themselves and automatically register user accounts and healthcare apps. The API portal allows the company to provide secure access to member data, without increasing workload for its lean IT team.

As Axway VP of Healthcare Ruby Raley often says, improving the developer experience is crucial. And an API-first approach creates a more composable ecosystem of digital assets, which she says is the best solution for keeping up with upcoming regulations.

“Organizations that continue to think in terms of single projects will not be able to go as fast as U.S. regulatory timelines will require them to go,” explains Raley. “Instead, they should implement a strategy that gives them building blocks to reuse over and over – where developers will be empowered with the convenience of self-service and automation.”

Seizing the opportunity to transform

The interoperability rule is designed to protect patients because it puts the data in their hands and gives them control over who they want to share it with. And in a recent Axway survey, we found Americans want what healthcare APIs can offer: better access to and ownership of their health records.

Using APIs doesn’t just enable faster delivery of services; it also means better performance and a better patient experience. And this health insurer saw that their work with Axway was about more than achieving compliance – rather, by beginning to publish open APIs, they are laying the foundation for innovative healthcare services for their members in the future.

“We have such an opportunity to truly transform the patient experience and offer better value with these digital experiences,” says Raley. “Instead of half-heartedly adopting FHIR solely to check a regulatory compliance box, we can see this as a chance to lay a foundation and build all sorts of new things on top of it that we’ve never been able to do before.”

“We should use this foundation to innovate — delivering new services to improve health outcomes and to help patients take control of their healthcare experience,” Raley adds.

This health insurer had the vision to look beyond compliance, and as a result they’ve been able to:

• provide a secure port to discover and consume FHIR APIs
• enable compliance on time
• cut regulatory risk of noncompliance penalties

And, crucially, in seizing on this momentum they’ve simplified the development of new API-driven services by treating their APIs as a self-service platform for developers.

“Looking ahead, we see that the Amplify platform will allow us to rapidly comply with other requirements, such as the Transparency in Coverage final rule and No Surprises Act,” concludes the company spokesperson. “Most importantly, we now have a platform that will enable us to build innovative, data-driven services for our members — empowering us to deliver even better care experiences.”