As API integration becomes the norm, health plans are learning not all health information technology is created equal.

With the release of the 2015 Edition Final Rule, API integration for electronic health records became required. Its direct effect on patients and providers was clear: better access to data for the patient and the provider with the long-term goal of improving interoperability and data transparency. But health plans have just as much to gain from the advances that APIs offer, as long as they’re able to visualize the free flow of data that ensues. 

“The 2015 Edition Health IT Certification Criteria (2015 Edition) builds on past rulemakings to facilitate greater interoperability for several clinical health information purposes and enables health information exchange through new and enhanced certification criteria, standards, and implementation specifications.”

HealthIT.gov

3 Goals of APIs

In the 2015 Edition Final Rule, Don Rucker M.D., National Coordinator for Health Information Technology, set forth three goals for the use of APIs:
  1. “The API criterion requires health IT to provide application access to the Common Clinical Data Set via an application programming interface (API).”
  2. “API functionality will help to address challenges such as the ‘multiple patient portal’ problem by potentially allowing individuals to aggregate data from multiple sources in a single web or mobile application of their choice.”
  3. “APIs need to be standardized, transparent, and pro-competitive. Open and accessible APIs have transformed many industries. We think they can transform health care as well.” 

How API Integration Benefits Health Plans

The government has declared that APIs are a better solution for data interoperability and health information technology than old exchange protocols offer. We often see the benefits of API touted to patients (access to health data is a priority) and providers (tasked with ensuring said access). But health plans are another important stakeholder in this conversation, especially as they move towards transparency and interoperability (read more about regulatory technology requirements in our article “Prepare to Meet the Future with Data”). 

Health plans require discrete data exchanges, “calls” that respond back with the minimum data needed for the task at hand. API integration makes streamlined data access possible, a more elegant solution than outdated, clunky HL7 2.0 interfaces. When a user requests data, API allows that data to be delivered in real-time (as opposed to batch FTP). With quick, secure access to information, health plans are able to break down silos and seamlessly interface between departments, suppliers and providers.

It is understood that API integration promotes innovation; other industries have realized huge gains by using this technology. Similarly, health plans may work with 20 technology vendors (or more) in API-powered relationships that allow organizations to cherry pick applications that are exactly right for them. Rather than tasking your IT department with maintaining multiple, manual data feeds (incidentally creating more data silos), API integration serves as your jumping off point for leveraging advanced technology solutions like NLP. 

Pareo® Acts as the “Central Hub” for your Plan’s API Integrations

Most health plans we speak with already understand, and in fact currently use, API integrations. But many find it difficult or overwhelming to manage the numerous API connections they may use in the payment integrity department alone. Our technology solution, Pareo, works as the central hub for your plan’s API integrations, connecting data points across your health information technology ecosystem in a way that allows you to maximize revenues, create efficiencies, and effectively manage your payment integrity operations

Access to a single, intuitive interface that provides users with the information they need to efficiently perform PI functions offers many value adds for health plans that deploy Pareo. Depending on your health plan’s goals, Pareo can be used to:

  • Improve vendor lift through quicker supplier integrations
  • Manage vendor concepts quickly and easily
  • Automate elements of the claim process allowing specialized workforce to focus on higher-value tasks
  • Improve communication between all stakeholders through bi-directional intelligence
  • Apply innovative technologies to data reporting efforts for immediate access to real-time information — across your entire payment integrity system

On their own, APIs hold promise but lack comprehensive connectivity. With a system like Pareo — the only one of its kind in the market — health plans can leverage their integrations to create a more robust, more efficient digital strategy

Talk to ClarisHealth about how Pareo®advanced payment integrity technology is helping health plans deliver on their most advanced digital strategies..