Innovating on Healthcare Payor Interoperability Using AWS HealthLake with MHK

MHK serves seven out of the top 10 health plans in the US and 40 percent of all Medicare contracts rated four stars and above. MHK CareProminence, a platform for integrated medical and pharmacy management, was purpose-built to reduce information siloing and bring together vital information—improving member care while facilitating compliance in a dynamic regulatory environment. So MHK was acutely aware of CMS-0057-F, a significant healthcare regulation released by CMS on January 17, 2024, that aims to streamline prior authorization processes and improve interoperability through FHIR standards. The rule covers multiple areas, including the Patient Access API, the Payer-to-Payer API, and the Prior Authorization API. Healthcare payors participating in CMS programs are under pressure to comply with the new interoperability requirements while also shifting to FHIR standards.

MHK understood that it was vital to its business that its payor clients should have the capabilities to meet their interoperability needs—and well ahead of the deadlines. So the team at MHK set out to design a solution that was flexible enough to accommodate evolving regulations, aligned with payors’ complex ecosystems, and simple and elegant in its design. MHK looked to build an end-to-end solution on a single platform, and owing to past experience, AWS was a natural option. “We previously used an AWS enterprise solution and had been impressed by the level of direction provided to our developers, so this time we leaned into the collaboration with AWS,” says Geoff Felder, chief technology officer at MHK. “The expertise shared by AWS empowered us to keep innovating while bringing the interoperability capability to market.” AWS HealthLake met MHK’s technical and design criteria: It could be seamlessly integrated with existing core offerings and API systems of MHK CareProminence while providing compliance with FHIR standards.

By making AWS HealthLake central to data storage for the interoperability component of MHK CareProminence, the team at MHK reduced complexity, made use of existing integration architecture, and implemented FHIR standards without building from the ground up. “Adopting AWS HealthLake was a simple choice. AWS has built a solution aligned with the top standards for FHIR, including Da Vinci implementation guides and SMART on FHIR,” says Felder. AWS HealthLake also complemented MHK’s streamlined data management approach, which emphasizes simplicity and elegance in design.

AWS HealthLake provided the heavy lifting of a compliance-ready data infrastructure, meaning that MHK could focus on optimizing its clients’ performance and costs in anticipation of coming compliance deadlines. AWS HealthLake streamlines compliance with CMS-0057-F by maintaining implementation guides for FHIR and automatically setting up required APIs. The service manages the release and maintenance of specific API endpoints, removing the need for customers to develop and manage their own API middleware. “Because of the efficiency gained by collaborating with AWS, we achieved interoperability capabilities for our customers within 90 days of first adopting AWS HealthLake,” says Felder. “Overall, it was a very positive experience for our developers.”

Along with implementing AWS HealthLake, MHK worked with AWS Professional Services—a global team of experts that can help companies realize their desired business outcomes when using the AWS Cloud—to accelerate the development of a FHIR converter, the automation of delivery, compliance with HIPAA, and robust security. Taken together, the guidance from AWS Professional Services combined with the capabilities of AWS HealthLake saved MHK approximately 9 months of engineering time. Through continuous integration and continuous delivery and Terraform scripting, which automate production releases, in less than 1 week MHK can deliver its interoperability solution to clients—a process that normally can take months. Moreover, AWS HealthLake helped MHK achieve end-to-end response times of less than 1.5 seconds per transaction, meaning that clients have near real-time responsiveness.

From a technical perspective, AWS HealthLake not only empowered MHK to launch its interoperability solution in less than 90 days but also made it possible to complete new customer implementations in days rather than months. For MHK’s payor customers like Blue Cross Blue Shield of Massachusetts, which are aiming to achieve compliance with CMS-0057-F with minimal impact to their existing systems, a fast implementation time, along with the option to remain with one vendor, has alleviated the pressure of regulatory compliance. “The technology and collaboration we’ve had with AWS have empowered us to deliver so quickly that our customers can choose when they want to turn on the interoperability capability rather than planning around when the technology will be ready,” says Felder.

MHK’s innovativeness and its ability to bring out a feature ahead of market demand have won it new levels of confidence from its customers. MHK is now going further with AWS services, in particular using Amazon QuickSight—which powers data-driven organizations with unified business intelligence at scale—for analytics on operational data, including authorization trends and health plan efficiencies. Looking ahead, MHK’s use of AWS HealthLake has laid a foundation for future innovation. For instance, Amazon QuickSight can analyze operational data together with clinical data stored in AWS HealthLake, facilitating enhanced reporting. And FHIR APIs empower payor clients to use artificial intelligence and machine learning capabilities more simply where appropriate. Taken together, the new data foundation will support payor clients’ needs as they begin to look beyond compliance and see FHIR adoption as a strategic opportunity to transform their business operations.