Strategies To Successfully Manage Accident Claims


See how APIs in healthcare are promoting innovation and helping payers, providers, and digital health companies deliver a more efficient, consistent experience.

Let’s say you’re one of the millions of Americans with a chronic disease, or have a child that’s getting sick, or are just feeling unwell yourself. You might go online to research possible illnesses or conditions. You might tap into an on-line medical advice service. And you might book an appointment with your healthcare provider through a patient portal.

You may decide to triple-check to check your coverage on your employer’s benefits site. You jump to your insurance company’s website to verify coverage or to check on copays and your deductible balance. (You may be one of the millions of Americans on high-deductible health plans who want to manage their out-of-pocket costs.) After your visit, you check drug costs before deciding to go to your local pharmacy or order prescriptions on-line.

Now count the number of sites you’ve visited – from research to your pharmacy. That’s a total of six separate healthcare systems for one episode. And we haven’t even added the billing and payments systems you’ll interact with!

Oh, and here’s the rub: Not all these systems are connected; not all of these systems share data. You have a fragmented experience, while all you really want to do is to focus on getting better.

The inability to obtain and use comprehensive data, driven by the lack of interoperability between systems, hampers our ability to create great patient experiences and make workflows more efficient.

Healthcare consumers, patients, our loved ones—all of us—deserve better. As an industry, we need to provide the same types of seamless, integrated interactions we find in other sectors, such as financial services, retail e-commerce, and travel.

How APIs Enable Data Interoperability Between Healthcare Systems to Deliver a Better Patient Experience

There is, however, a solution. It’s in the form of application programming interfaces (APIs), which provide the means to create a connected system with data interoperability and standard interactions. APIs break down system silos and enable the creation of more holistic experiences for finding, booking, and managing payment and billing for healthcare services. Of course, APIs must be designed to meet robust security and privacy requirements, be built to accepted industry standards, and delivered in a manner that promotes both adoption and use.

At Change Healthcare, we provide APIs, sourced from an ever-growing portfolio of “elegant integrations,” workflow enablers, and intelligent advisors. These APIs allow payers, providers, and digital health companies to create better patient experiences and optimize workflows that create new and innovative ways to engage, care for, and manage patients.

Interoperability best practices: How APIs make the patient experience more seamless

The use of APIs is not new. Take the example of an app-based ride-hailing service such as Lyft. These services use APIs to combine texting, phone calls, phone application protocols, communication stacks, maps, geographic positioning systems (GPS), and payment systems into one seamless experience for the consumer across any type of mobile devices.

The same kind of connectivity can and should be available in healthcare, whether that’s giving patients access to their data (which we all have a right to under HIPAA), or creating better overall processes as patients interact with payers and providers or as providers interact with payers.

Our industry needs to make data usable by providing access, an easy way to input information, the means to make financial transactions, and a way to enhance the user experience. APIs are key to providing overall transparency.

Just as the modern digital economy cannot exist without APIs, healthcare cannot modernize without APIs. These are becoming the connective tissue that sits between systems, as well as drives connectivity and access.

The Four Forces That Drive the Use of APIs in Healthcare

Indeed, APIs are more than bits of code: They promote innovation in healthcare by addressing four core challenges:

  1. Transition to value-based care
  2. Consumerization of healthcare
  3. Growth of scalable, accessible technologies, and
  4. A means to address healthcare regulations and laws

Value-based care relies on data about each patient and that patient’s interactions with providers and payers over time. We must bust through the silos of clinical and financial information. We must connect applications and experiences by leveraging data that resides in every system.

Consumerization in healthcare is woefully behind. You can pick up a mobile device and order and pay for a meal. You can check the ratings of a movie and reserve a seat at the closest multiplex. For the most part, you can’t do something similar in healthcare.

As consumers, we should be able to engage the healthcare ecosystem in the same way we order a meal or go to a movie. That requires a single linked view of healthcare data that’s available in a secure, scalable manner.

Technologies continue to advance. Consider our growing reliance on mobile devices and how a consumer-friendly interface is now table stakes. Consider how many of these systems operate on scalable, secure cloud platforms that host modern digital systems. Imagine the promise of AI providing similar insights and an optimized experience in healthcare.

Emerging regulatory trends also impact our need to interlink systems. There are four key pieces of legislation here:

  1. The American Recovery and Reinvestment Act of 2009, which includes HITECH, the push towards EHRs, and overall patient protection
  2. The Affordable Care Act, which began to move us toward value-based care
  3. The 21st Century Cures Act, passed in 2016, which started to create a basis for the kind of interoperability which APIs address
  4. The just-released information blocking rule, which furthers the provisions of the Cures Act and mandates the use of APIs

APIs should be comprehensive, easy to use, and promote trust throughout the healthcare ecosystem

APIs should be more than a means to integrate systems. To be effective, they should be built to a set of standards. They should be comprehensive and easy to use. And they should enable our industry to build platforms that integrate payer-provider-patient systems.

That’s the mission of Change Healthcare’s newly announced marketplace, API & Services Connection™ for Healthcare. More than a portal to buy code, API & Services Connection is a destination for healthcare players to manage their own products and services. This should help create lasting, trusted customer relationships with API-enabled products and services.

The API & Services Connection marketplace provides access to APIs, along with comprehensive documentation, a sandbox, industry-standard implementation guides, and—coming soon—a community that links users with support, product managers, and other users.

Think of the API marketplace as providing tools to build a single, longitudinal, consistent, safe patient journey from the moment a patient decides to get care, through the process of delivering that care, any follow-up and prescriptions, and the entire process of billing and payment.

As each patient goes through their own unique patient journey, data linked via APIs travels with them. Patients receive better care because APIs link healthcare information. A broader, linked healthcare ecosystem helps patients become better stewards of their own care.

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