Mphasis addresses the lack of interoperability that is dangerous to our health

The lack of interoperability across the healthcare ecosystem impacts human health by delaying, denying, or reducing access to healthcare, as Exhibit 1 shows. The Centers for Medicare and Medicaid Services (CMS) released multiple rules between 2020 and 2022, including Interoperability and Patient Access, Interoperability and Prior Authorization, and Price Transparency, that will force health plans and health systems to do more than pay lip service to connecting data meaningfully across the healthcare ecosystem and address the triple aim of care (reducing costs, improving health outcomes and enhancing the experience of care).

Mphasis is developing an interesting set of services underlining its FHIR-as-a-Service (Fast Healthcare Interoperability Resources) offering to address interoperability opportunities and expand its value proposition to its health plan and health system clients.

The interoperability buzz needs executable solutions faster than we have seen

While regulations are a powerful tool in changing business behaviors, the penalties for not being compliant remain light. That will change over the next two years as the gentle nudge turns to a heavy stick with fines of up to $1 million per violation.

As with new rules modifying entrenched industries, there is a settling-in period. That period includes health plans pushing back on regulators to dilute regulations, seek additional time to implement, reduce penalties, etc. An example is CMS agreeing not to enforce the payer-to-payer data exchange in 2022.

Exhibit 1: Interoperability is not a data problem—it’s a human health challenge when systems hoard data and don’t share it

Sample: 2,375 adult consumers
Source: Kaiser Family Foundation, HFS Research, 2022

Still, understand that the rules are here, and they will be enforced. Noncompliance will lead to financial penalties, reputational risk, and lower reimbursement for Medicare Advantage plans, whose star ratings will be impacted. It is critical for health plans to find reliable and qualified partners to take a programmatic approach to address this very significant business headwind immediately.

Mphasis FHIR platform is making some progress with a viable solution

About a year ago, Mphasis began experimenting with hyperscalers to leverage its FHIR servers and create applications for consumers and healthcare providers (HCP). To validate the approach, Mphasis developed a chatbot on top of an FHIR server in the Google cloud hackathon in 2022 and scored the runner-up trophy.

Since then, it has crafted an evolving architecture to leverage hyperscalers’ FHIR servers to develop data exchange systems, FHIR facades, and applications (see Exhibit 2). One such asset is its Telehealth platform, which demonstrates data from health plans and HCPs can be converted into FHIR resources and moved into any FHIR server adhering to the published specifications.

The Telehealth platform based on The Front2Back™ Framework is front-ended by a portal for both patients and HCPs; it has a set of features and functions to improve ease of use, completeness of information, and support for making a quality diagnosis.

Mphasis is maturing a solid slate of interoperability services, including setting up FHIR infrastructure; developing smart apps; tools for exchanging data between HL7, HIPAA, and FHIR; FHIR enabling its products (Javelina); verifying and validating for FHIR specifications; and helping reimagine experiences for interoperable healthcare.

Exhibit 2: Mphasis’ emerging architecture for healthcare applications leverages the HL7 (standards used to transfer and share data between HCPs) framework and FHIR

Source: Mphasis, 2023

The Bottom Line: Executing for interoperability has financial implications beyond checking off regulatory and compliance needs; service providers must get aggressive with their health plan clients.

We recognize pushing clients may be anathema to suppliers, but we are at that point where health plan failures will stick to service providers. They will be left holding the bag for lack of delivery and performance. Interoperability is a competitive problem with various solutions from service providers. The competition will continue to heat up as the pressure on health plans and health systems builds due to regulations and consumer expectations. This is a must-watch space.