How API Marketplaces and Strategic Partnerships Drive Payer Innovation

October 02, 2023 - Improving the healthcare system is a joint effort. Healthcare consumers and providers increasingly seek clear communication and guidance through data-driven solutions. Payers and technology developers have an opportunity to enhance the healthcare experience while also identifying cost-saving opportunities. This process begins with utilizing the data at hand to develop solutions that simplify the healthcare experience.

APIs are pivotal in the healthcare industry, empowering payers to elevate member experiences, optimize operations, and strengthen provider relationships through real-time data access, personalized services, and operational efficiencies.

To achieve these goals and stay competitive, payers are increasingly partnering with technology providers boasting established and extensive API marketplaces. Such partnerships accelerate the development, deployment, and scalability of healthcare solutions, fostering innovation and enhancing the experiences of members, providers, and internal staff.

The success of API marketplaces in finance and banking has piqued the interest of payers and technology developers, according to Zelis Vice President of Enterprise Enablement Matt Zelehowsky.

“Professionals working in healthcare technology roles within these organizations face formidable challenges when it comes to integrating experiences and meeting the increasingly high expectations placed upon them,” he says.

As health plans actively explore strategies to refine and streamline their purchasing processes, developers seek API ecosystems that grant them convenient access to pre-built tools, resources, and services, strengthening their capabilities in software development projects.

The success of an API marketplace hinges on its ability to cater to the distinct needs of two critical stakeholder groups: health plans and developers.

For health plans, transparency and a well-communicated roadmap are paramount.

“Payers have emphasized the importance of knowing that the APIs exist and understanding key features under development, allowing them to align with their own roadmaps and capitalize on opportunities to avoid redundant development efforts. This is important for health plan organizations as they are typically planning experience and investment strategies two to three years in advance – it is key to have a transparent and aligned vision to fully realize partnership value,” Zelehowsky explains.

Meanwhile, developers also require an ecosystem that fosters speed, innovation, and collaboration.

“The perfect API marketplace scenario offers a dedicated environment catering to developers, a sandbox where developers can experiment with sample data and access code examples for API integration,” Zelehowsky maintains. “The space must enable professionals to share experiences, seek assistance, and collaborate effectively. So often, the technology team for a payer is oversubscribed with maintenance, support, and compliance initiatives. Tools that enable simplification and streamlined adoption put power back into the hands of developer teams. A collaborative support network offers them an operational scale that might otherwise be out of reach.”

Meeting these needs ensures that the API marketplace thrives, benefiting health plans and developers in the healthcare technology landscape.

Choosing the right partner and marketplace

When evaluating a strategic technology partner, health plans need to consider how the former approaches expanding and enhancing its API marketplace.

“The right strategic partner must be willing to venture into uncharted territory by supporting developers in their API marketplace,” says Zelehowsky. “They should embrace a strategy blending cooperation and competition to offer resources in an innovative manner. Imagine a landscape where service partners, banking partners, security partners, care delivery partners, and operational support partners coexist in a seamless collaboration space that unlocks speed and innovation.”

According to Zelehowsky, health plans should focus on two essential initiatives.

The first step involves evaluating the organization’s API strategy and partner data integration. A good partner prioritizes solution transparency, collaborative roadmap development, and an innovative approach. Potential partners should provide insights on improving solutions, reducing costs, and delivering comprehensive solutions for all stakeholders (e.g., providers, members, internal staff). Most importantly, balancing modernization with securing sensitive data protection is essential as healthcare becomes more of a target for bad actors.

The second is fostering collaboration. The right partner establishes a platform for technologists from health plans to discuss technology trends openly. Seeking feedback on programming languages and data streaming preferences is essential, especially in areas like FHIR (Fast Healthcare Interoperability Resources) and interoperability. The goal is to ensure that the assets developed align with developers’ needs and support their technology roadmaps effectively.

On a more technical level, health plans must closely consider how well a technology partner handles API orchestration, security, compliance, connectivity, and utilization insights.

API orchestration is the process of efficiently managing and coordinating multiple APIs to work together seamlessly to achieve specific tasks or functionalities. It involves using a component library, API library, SDK library, performance optimization, and reference documents to organize the interactions between different APIs, ensuring they function cohesively within a software application or system.

API management involves controlling and optimizing APIs to ensure their secure and efficient use by developers and applications. It includes providing a sandbox environment and comprehensive documentation for testing, automation, version control, security, logging, and sample code to facilitate the seamless integration and management of APIs within a development ecosystem.

API connectivity refers to the capability of a system or platform to interact with other systems or services through APIs (Application Programming Interfaces). It encompasses both inbound API connectivity, which involves receiving data and requests from external sources, and outbound API connectivity, which entails sending data and requests to external sources. Additionally, omnichannel integration ensures these interactions can occur seamlessly across various communication channels and platforms.

Standardized development and analytics involve using methodologies and best practices to structure and manage APIs per industry standards and compliance requirements. These include ensuring standard business logic, adhering to routing standards, and capturing API utilization metrics. It also involves metering usage, a dashboard for monitoring, and providing reporting functionalities to analyze and optimize API performance and usage.

“The API economy offers a solution to the challenges faced by businesses dealing with external and internal demands,” Zelehowsky notes. “A good API marketplace provides APIs and tools to streamline development, speed up time to market, and simplify stakeholder experiences.”

Strategic partnerships and transparent roadmaps are essential for health plans, developers, and technology providers to drive innovation and modernize the payer market through robust API marketplaces. The right technology partner can help modernize the payer market and drive future innovation via APIs and marketplaces.

________________________________

To learn more about the role of APIs in healthcare and how you can take advantage of them to extend your capabilities, click here to download “The Role of APIs in Transforming Healthcare” whitepaper.

To learn more about the Data Revolution, click here.