1up Clinical Connect
Automate clinical data acquisition to improve quality, risk, and care management
Software · Cloud SaaSCompany source
Company profile
About 1upHealth
1upHealth offers the most advanced, FHIR-first health data management platform designed specifically for health plans. The company simplifies health data exchange so payers can move faster, operate with confidence, and gain a competitive advantage. Powered by a lakehouse architecture, 1upHealth connects and activates health data across the healthcare ecosystem – securely, reliably, and at scale – so interoperability works for health plans, not against them. The 1up Platform brings together core capabilities payers need to support interoperability from ingestion to activation, including flexible data ingestion and storage, unified data modeling, built-in data quality controls, comprehensive data governance, and enterprise-grade security. The platform ingests raw clinical, claims, and financial data into a unified, reusable data foundation, organizing and linking data across domains while resolving identities before mapping to FHIR or other external formats. 1upHealth serves Medicare, Medicaid, and commercial health plans of all sizes, from small regional plans to national payers. The company's modular solutions include Electronic Prior Authorization, Payer-to-Payer Data Exchange, Provider Access, Patient Access, Provider Directory, Formulary, and Clinical Connect. Whether health plans are looking to simply meet government regulations or reimagine their interoperability strategy from end to end, 1upHealth provides the technology, regulatory expertise, and dedicated support to help them succeed.
Company description 1upHealth official website
Mission. We simplify health data exchange so you can move faster, operate with confidence, and gain a competitive advantage.
Primary marketGenerative AI & Healthcare Infrastructure
Commercial modelCommercial information available on request
Company presenceOfficial website
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01 · Operating footprint
Where the Company operates
Company-profile context for clinical focus, customers, deployment, integration, milestones, and partnerships.
Clinical focus
No clinical focus areas are currently listed.
Who it serves
- Commercial Health Plans
- Fee-for-Service Plans
- Managed Medicaid Plans
- Medicaid Plans
- Medicare Advantage Plans
- State Agencies
Deployment & integration
Api Only · Cloud Saas deployment with recorded integration context.
Recorded integration context: Care Management systems, EHR systems, Medicare Plan Finder, Provider portals, Utilization Management systems.
Geographic context
MarketsUnited States
Company sourceOfficial website
Company milestones
Platform expansion
1upHealth Leads Industry in CMS-0057 Readiness with All Health Plan Customers Reporting Ahead of Deadline (2025)
Partnerships
Recorded partners
- Aetna/CVS Health
- Fallon Health
02 · Flagship portfolio
Products, workflows, and platform capabilities
Selected source-backed Company products and the available commercial context.
1up Console
Command center for payer teams to manage data flows and ecosystem connections
Software · Cloud SaaSCompany source
1up DevPortal
Developer portal for external payers, providers, and apps to access payer data
Platform · Cloud SaaSCompany source
1up Electronic Prior Authorization
FHIR-powered automation for faster prior authorization decisions
Software · Cloud SaaSCompany source
1up Formulary
Deliver transparent drug coverage details to members and providers
Api · Api OnlyCompany source
1up Patient Access
Give members easy, secure access to their health information
Api · Api OnlyCompany source
1up Payer-to-Payer Data Exchange
Unlock historical member data to improve onboarding and close care gaps
Software · Cloud SaaSCompany source
1up Platform
FHIR-first data platform for payer interoperability at scale
Platform · Cloud SaaSCompany source
1up Provider Access
Enable providers with timely patient data for better care decisions
Api · Api OnlyCompany source
03 · Research intelligence
Research Intelligence evidence
Publications, preprints, clinical validation, and regulatory records in Evidence Position order.
Evidence position
Publications, clinical validation, and regulatory records connected to this Company appear here.
Research
Publications & preprints
Strengths, weaknesses, opportunities, and threats for the nation's public health information systems infrastructure: synthesis of discussions from the 2022 ACMI Symposium.Journal of the American Medical Informatics Association : JAMIA · May 5, 2023
Enhancing the nation's public health information infrastructure: a report from the ACMI symposium.Journal of the American Medical Informatics Association : JAMIA · Apr 19, 2023
The Promise of Digital Health: Then, Now, and the Future.NAM perspectives · Jan 1, 2022
High Performance Computing on Flat FHIR Files Created with the New SMART/HL7 Bulk Data Access Standard.AMIA ... Annual Symposium proceedings. AMIA Symposium · Jan 1, 2019
Clinical validation
Clinical-trial records
No linked records are currently available.
Regulatory
Regulatory records
No linked records are currently available.
04 · Company-reported outcomes
Outcomes and case studies
Company-reported outcomes and customer stories are distinct from linked Research Intelligence evidence.
100+ million member records managed
Platform scale
50+ million MCO members supported
Managed care organization coverage
1+ billion EOB records processed
Explanation of benefits processing volume
Unnamed Health Plan
Platform implementation and vendor replacement
Smooth implementation with high uptime and system availability; replaced previous vendor due to superior performance
Aetna/CVS Health
FHIR data and interoperability strategy implementation
Key to delivering on member-first promise
All 1upHealth Health Plan Customers
CMS-0057 compliance and reporting
100% of customers reported ahead of CMS-0057 deadline, leading industry in readiness
Fallon Health
Navigating interoperability regulations including prior authorization and patient data access
Successfully addressed CMS requirements with FHIR API expertise
Regional Blues Plan
Modernizes interoperability solution
05 · Leadership
Leadership team
Leadership profiles and professional links from the current Company record.
Ron Wampler
Executive Director of Interoperability, Aetna/CVS Health
John Budaj
Vice President of Information Technology, Fallon Health
06 · Company updates
Updates from 1upHealth
Recent articles published on 1upHealth's official website.
No Company updates are currently listed.
07 · HAIC coverage
Coverage and analysis
Health AI Central reporting that mentions this Company.
No HAIC coverage is currently linked to this Company.
08 · Official presence
Company sources and channels
Curated official destinations from the active Company record.
09 · Market pathway
Additional Companies in this Market
Other active Companies in the same market, selected alphabetically from the HAIC directory.
Market context
Generative AI & Healthcare Infrastructure
Companies providing generative AI platforms, large language models (LLMs), foundation models, or broad AI infrastructure specifically designed for healthcare applications. These companies serve multiple clinical use cases across the health system rather than focusing on a single clinical application or disease area.
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Linked research, clinical, and regulatory source pathways.
Expanded product, deployment, integration, and partnership research.
Record-level provenance and review context.