Gartner Report Identifies Smile Digital Health's Payer Solutions

Smile Digital Health, the leading health data platform provider, is leveraging its core expertise in HL7 FHIR to accelerate compliance with CMS interoperability regulations that will also provide opportunities to power future innovation for US health plans. 

Smile Digital Health Inc, the leading FHIR data platform and global provider of enterprise-grade FHIR solutions, was named as a representative vendor in the recent Gartner report Prepare for CMS Interoperability and Patient Access API Compliance for U.S. Healthcare Payers, published June 15th 2020. The report reviews key challenges and provides recommendations for payers who want to ensure successful compliance with the CMS Interoperability and Patient Access final rule.

Outlining compliance challenges, the report, by Gartner VP Analyst for Healthcare Mandy Bishop, highlights that “Payers subject to the rule face tight implementation time frames and conflicting interpretations of requirements that complicate initiative planning and execution.” 

Noting that “vendors tend to fall into three camps: those that have a purpose-built solution, those that offer FHIR servers and those that offer professional services to help build a compliant solution,” the report recommends that affected payers “Accelerate compliance initiatives by employing vendor partners with purpose-built solutions,” like Smile. 

“There is an urgent need for payers to leverage FHIR quickly and at scale,” noted Duncan Weatherston, Co-Founder and CEO of Smile Digital Health. “The full FHIR specification has always been baked into our products and solutions, and our work with payers and provider organizations has attuned us to the challenges of bringing data together in a common standards-based environment. Our team brings unique insights, both from our deep knowledge of the FHIR specification and from previous implementation experience with large US health plans. These insights have informed the solution we’ve designed for payers.”

In terms of evaluating vendor solutions, the report further recommends payers consider whether their organization “Needs deep regulatory guidance from the vendor leadership, with expertise in developing standards and frameworks in accordance with previous CMS initiatives (not all have deep expertise).” 

“Our role as the maintainers of HAPI FHIR, globally the most widely deployed open source FHIR implementation and the reference implementation of the standard in Java, in addition to our work with industry initiatives such as the CARIN Blue Button project, the ONC Tiger Team on Certification, HL7 FHIR, NIH, the Regenstrief Institute, along with being a founding member of the FHIR Business Alliance (FHIRBall),  are all part of our contribution to improving global health via health standards governance,” commented James Agnew, Smile Digital Health co-founder/CTO, HAPI FHIR project lead and HL7 Co-Chair/FHIR Core Team member. 

The report further states that “While the new CMS rule presents significant implementation challenges, effective compliance will position payers to deliver health value to members by empowering them to orchestrate their data across the ecosystem and manage their own health more effectively.”  

It concludes by encouraging readers to “Think of interoperability as an opportunity to transform relationships with members rather than simply checking the box for compliance with the regulatory mandate.” 

To learn more about how payers can rapidly implement and scale required features like patient access APIs, provider directories and payer-to-payer data exchange, including what implementation challenges to expect and key characteristics to look for when designing a solution and selecting a vendor, claim your free copy of our whitepaper on the topic.

And to see how Smile's data platform and implementation team can help your organization comply with fast-approaching CMS regulations, check out our Payer’s Roadmap to Compliance.