The API Revolution That's Securing the Future of Virtual Healthcare

This article previously appeared in VentureBeat, June 2021

When the pandemic hit, the use of telehealth, which until then had been only lightly used across the health care ecosystem, soared. The CDC found that the number of telehealth visits increased by 50% during the first quarter of 2020, compared with the same period in 2019. In March 2020 alone, telehealth saw a 154% increase in visits compared to the previous year.

This boom has revealed the overwhelming need for industry-standard APIs, software solutions, and hardware bundles to help telehealth platform vendors and health care providers rapidly deploy virtual care services.

“The pandemic created the opportunity for this mode of care to gain traction and use,” says Gautam M. Shah, vice president of Platform and Marketplace at Change Healthcare. “And the expansion in the ability of providers to offer telehealth appointments was a systemic change, forcing providers to rethink how they operate.”

That includes the underlying availability of the technology that enables telehealth; regulatory restrictions being lifted in emergency measures with the passage of the CARES Act; recognition from provider organizations that this was a better way to serve the health care consumer; and, not surprisingly, increased demand by patients.

“The pandemic forced us to take a hard look at all the places where, in our health care journey — as patients, as providers, as insurers — the gaps existed,” Shah says. “Telehealth is a shining example of how we rapidly embraced a virtual-care model through legislation, through technology, and through connectivity. With recent moves by Amazon, Walmart, and United Healthcare Group in this space, it looks like telehealth will continue to grow.”

And this expansion will require breaking down long-standing information silos — silos that have locked up patient data in scores of places from the hospital, to primary care offices to specialist practices, diagnostic facilities, and more.

APIs: The foundation of health care virtualization

Creating rock-solid virtual care includes the critical need for data interconnectivity to provide an easy-to-navigate virtual-care experience that results in a positive outcome for the patient, the doctor, and the insurer.

“Data sharing and information exchange isn’t just critical to virtual health care, it is the bedrock,” Shah says. “You can’t have modern, consumer-friendly health care experiences without data interoperability and data flow.”

Application programming interfaces, or APIs, are the intelligent integrations that enable all of this functionality at scale. APIs connect disparate systems to enable seamless data sharing and communication. That’s key to keeping pace in the digital era: 90% of health care organizations see APIs as mission critical or very important, a Change Healthcare API study revealed, demonstrating that APIs are emerging as the backbone of the digital health economy and will tip the balance when used at scale by 2023.

“If data is the bedrock that we build this house on, the APIs are the foundation,” Shah says. “The APIs are how we make these experiences work, how we share data, how we provide connectivity to all the different systems in place.”

“If data is the bedrock that we build this house on, the APIs are the foundation.”

That requires thinking of APIs as products that solve problems versus merely serving niche data-transfer functions, so developers can leverage their capabilities and patterns to more quickly create purpose-built, scalable, multifunctional solutions to manage specific parts of the workflows. Productizing APIs ensures that the data is secure and private, as well as performant, which are among the chief concerns of the health care industry.

“Using APIs enables health care startups, hospitals, health plans, and other health care-focused businesses to more rapidly develop innovative products and services while meeting regulatory requirements and advancing the health care industry’s adoption of modern, open interoperability standards,” Shah says.

The use of open standards means that APIs and services can be readily deployed across the entire health care ecosystem, internally and externally, to help reduce the time and cost associated with many health-information technology deployments.

Over time, Change Healthcare expects to have hundreds of open, standards-based APIs available that represent the company’s comprehensive portfolio of health care IT solutions, as well as API-based solutions from its partners. This will help solve not only long-standing challenges but ready the industry for the future of health care.

The benefits of APIs to patients and providers

APIs are behind the scenes and invisible to the patient — but the enormous benefits to patients are front and center. What matters is the way APIs enable providers to have the most up-to-date clinical and insurance information on a patient, allowing them to offer the most appropriate care and ensure the claim and reimbursements are timely and accurate.

“One of the biggest dissatisfiers in a health care experience is how confusing and redundant it is for patients.”

But it also means patients have access to their own data, such as immunization records, as well as the ability to schedule appointments or pay bills in seamless, mobile-friendly ways.

“One of the biggest dissatisfiers in a health care experience is how confusing and redundant it is for patients: refilling out forms, having to redo tests, coordinating between the care provider and the insurance company,” Shah points out. “It’s especially painful when you have a chronic condition, like more than half of Americans do.”

Having all that information available means patients have experiences that are driven by their health history, allowing them to transit the system most effectively, especially as they age.

Another big benefit is efficiency. The United States health care system has an access problem, among others. On average, it takes 45 days to get an appointment with a specialist, and then that appointment is filled with forms and reviewing patient history, Shah says. APIs remove the administrative burden and reduce the friction of the care process, which leads to better access and ultimately, better care.

How payers benefit from APIs

When payers become more efficient and when they have better data and use it for better analytics, the payment process works faster, more accurately, and more efficiently. It’s ensuring that money can flow in the system in an efficient manner so all members of the health care ecosystem spend less time dealing with operational activities and more time dealing with care.

“It’s critical, and that’s where the APIs help. They create that data flow, which impacts the ability to deliver great care for the providers and the patients, and they make it more efficient for the payers,” he says.

Back-office processes, like checking eligibility, processing claims, and providing payments are relatively automated processes behind the scenes, but they’re disconnected. Tying them together with health care data and APIs creates a flow of financial transactions that allows the back office to operate more efficiently and process claims in the right way. It simplifies and automates processes and improves transparency. The payer can determine more quickly what a patient owes, and the patient has that information up front.

“From the payer perspective, that access to data, the ability to do analytics on the data, on the population, and understand how best to tune their models, is critical.”

The inherent complexity of that process grows as the number of doctors, health care groups, hospitals, and health systems grow, from primary doctors to specialists,” Shah says. “If you can create efficiency at every one of those steps, that process grows with scale.”

On the regulatory side, the CMS Interoperability and Patient Access Rule requires payers to give members control over their information, which is an unprecedented opportunity for innovation, Shah says, especially for third-party digital health care developers. They can make their payment operations or reimbursement operations more efficient and offer better experiences for health care consumers, with more transparency and better ways to manage health care, optimize spend, and more.

“From the payer perspective, that access to data, the ability to do analytics on the data, on the population, and understand how best to tune their models, is critical,” he says. “And as more people go to high-deductible health plans, it’s a management benefit for members, who can understand their payment benefits more easily and figure out how best to use health care benefits.”

Implementing and scaling APIs securely

APIs are becoming more established in health care, and any developer should be able to easily and quickly use them, Shah says. However, solving challenges related to data transfer and solution development is unquestionably not an efficient way to use your time when these have already been solved, particularly if you think of APIs as products that provide solutions. Rather than merely serving niche data-transfer functions, developers can leverage productized API capabilities and patterns to more quickly create scalable, multifunctional solutions.

“A developer wants to pick up and use something that already exists; that offers the functionality, connectivity, and operability they need, so they can spend their time building a great experience, the next product, and so on,” Shah says. “That’s the approach Change Healthcare has taken, building secure, private, and performant APIs as products that a developer can plug into their product and start using right away.”

That’s why the company offers a destination for developers, the API & Services Connection^TM for Healthcare. Digital health companies can visit the portal to select APIs, use the sandbox to test out their APIs and their functionality, and click the “Buy” button to efficiently check out. It also offers comprehensive resources for developers, including documentation, implementation guides, a community, the sandbox, and more.

APIs are a great democratization of the capability to build out virtual health care solutions for companies of every size.

The API & Services Connection currently has more than 70 API products that cover the care journey from pre-care, during care, post-care, and continuity of care. It allows developers to engage in those transactions in a simple, standards-based way, from a company with more than 2,400 payer connections, and which performs 15 billion health care transactions a year. The API products are built to common standards to promote security, interoperability, and scalability.

Change Healthcare uses this API & Services Connection internally, which is critical, Shah says.

“When developers come to Change Healthcare, they’re using the same APIs that we’re using to develop our products,” he says. “We’re a $3.5 billion health care technology company. You’re taking advantage of the products that we’re developing; that we’re using to deliver that much value to the health care ecosystem in that API that you can just pick up and use.”

The APIs are a great democratization of the capability to build out virtual health care solutions for companies of every size. Change Healthcare has customers ranging from the biggest payers and health systems in the United States to entrepreneurs, all of whom are using this API technology to innovate ways to provide care and solve problems at the point of care.

The future of health care

Data interoperability is the cornerstone of future innovation, Shah says, and regulations have created the baseline. As we proceed, because hospitals, health systems, and payers are putting the APIs into their environment, he expects to see greater liquidity of data.

From a patient/member perspective, that means greater access to our health care data. With increased access, consumers will be able to carry that data to share with providers wherever and whenever necessary. Greater liquidity of data also means that the general efficiency of care will start to increase because it will be easier to use the interoperable data underneath, and the APIs, to create seamless care experiences.

An example of that will be in the transitions of care, like admissions, discharges, and transfers. Those are the seams in the experience. They’re where data, people, and information traditionally get lost. A pool of accessible data connected together with APIs and workflows covers those seams.

“That’s an amazing opportunity to innovate, because now that we have access to the data, whether it’s a provider organization or a digital health company, you can start to create the experiences that smooth the discharge-and-transfer part of that transition,” he explains.

Some of that will be driven by new regulations, but data and APIs are what raise the health care experience to new levels, because it will become smoother.

This will also help address areas of health care previously less served by the digital health ecosystem, including things such as maternal health and behavioral health, which has become an even greater crisis over the course of the pandemic. Providing innovative ways to engage with and support the behavioral health of the population is critical, says Shah. It also includes health equity, or broadening of access to care for people across the country, no matter where they live or what kind of access they have (or don’t have) to technology.

“A big part of the work I do every day, bringing the APIs and data out into the world, is simplifying how we operate in the system to bring more people into the fold,” Shah says. “That’s why comprehensiveness, security, scale, performance, and privacy are so critical, because when you get into the mass of the population, if you don’t have solutions that operate in that way, with that comprehensiveness and trust we’ve built into our products, it’s going to be hard to get to that scale.”