1upHealth vs Smile Digital Health
Updated October 20, 2026
Federal interoperability rules require health plans to let patients, doctors, and other plans pull member data through standard connections called FHIR APIs, and most plans buy software to run them instead of building their own. 1upHealth and Smile Digital Health both sell that software, but the question most plans underestimate is how much engineering they want to own: 1upHealth packages each required connection as a product, while Smile offers a deeper data platform that rewards plans with their own FHIR engineers. That trade-off drives cost and timeline, so we compared the two.
Our analysts compared 1upHealth and Smile Digital Health on main job, products, quality measure tools, platform depth, and pricing clarity, using the HIR review of each company and each vendor's own announcements this year. In the following sections, we compare them in one table, describe the health plan each one suits, and list what each has released recently.
1upHealth vs Smile Digital Health at a glance, October 2026
| What buyers weigh | 1upHealth | Smile Digital Health |
|---|---|---|
| Pricing model | A yearly subscription for health plans, usually priced by the number of members covered and the connections and modules needed. | Smile Digital Health sells software licenses and services by contract. |
| What drives cost | How many members you cover, how many of the CMS-required connections you need, how much prior authorization work is included, and any clinical data feeds you add. | For Smile Digital Health, cost depends on the modules you license, data volume, hosting, and how much implementation and managed service you buy. |
| Main job | Ready-made FHIR connections that federal rules require health plans to offer, plus a feed of clinical data for quality work. | A FHIR data platform, Smile Omni, that converts health data, runs the APIs that CMS rules require, and calculates digital quality measures. |
| Who it fits | Plans whose main job is meeting the CMS interoperability and prior authorization rule on time. | Plans and large IT teams that want to build on open-source HAPI FHIR. |
| Products | Patient Access, Provider Access, Payer-to-Payer Data Exchange, Provider Directory, Formulary, and Electronic Prior Authorization. | OmniVera for data conversion, OmniCompli for the CMS APIs, OmniQ for digital quality measures, and OmniConcierge for services. |
| Quality measures | Clinical Connect pulls EHR data into one member record for HEDIS and Star ratings work. | OmniQ runs digital HEDIS measures and reports less than 1% average variance from NCQA results in parallel testing. |
| Platform depth | Scores 7.0 for its payer FHIR platform. | Scores 8.2 for its FHIR data platform. Higher score |
| Compliance results | Scores 6.6 on compliance and data results. | Scores 7.1 on compliance and data results. Higher score |
| Getting live | Scores 6.5 on getting APIs certified and live. | Scores 6.6 on getting the platform live. |
| Time to full value | About 4 to 6 months | Not published |
| What you need first | A plan for the CMS deadlines. | Not published |
| Deal-breaker | You are a provider, not a health plan. | Not published |
| Pricing clarity score | 6.5 Clearer pricing | 5.6 |
| HIR overall score | 6.7, Conditional. | 7.1, Recommend. Higher score |
| Best for | Health plans and Medicaid agencies working toward the CMS interoperability and prior authorization rule (CMS-0057-F). | Health plans that need CMS interoperability APIs on a FHIR data platform. |
| Not a fit for | Provider groups that want a records network for their own clinicians. | Small practices that want a ready-made app. |
Which fits which buyer
Count the FHIR engineers on your team before you choose.
Choose 1upHealth if
- You need every CMS-required connection running with the least build work.
- You want a product for each required API instead of a toolkit.
- You run FHIR systems of your own and only need a compliance layer on top.
Choose Smile Digital Health if
- You have FHIR engineers or a budget for services hours.
- You want to build on open-source HAPI FHIR.
- You are moving HEDIS reporting to digital quality measures.
Verdict
Smile Digital Health scores higher and fits plans with engineering depth that want one FHIR platform for compliance and quality measures. 1upHealth fits plans that want each required connection delivered as a product with less build work.
Neither posts a price list, so ask each for the yearly cost at your member count with hosting and services included.
Where the two tools are headed in 2027 and beyond
1upHealth: 1upHealth launched 1up Gateway on July 8, 2026, for plans that want CMS compliance on top of FHIR systems they run today. It launched 1up Clinical Connect on September 1, 2026, with Capital Health Plan as its first user.
Smile Digital Health: Smile Digital Health shipped Smile CDR 2026.08.R01 and HAPI FHIR 8.12.0 in its August 2026 quarterly release, presented in a webinar on August 27, 2026.
Both point their work at the January 1, 2027 deadline in the federal rule, so ask each which connections will be live for your plan before then.
Methodology
Each row comes from the HIR reviews of 1upHealth and Smile Digital Health, scored under the HIR method, and from each vendor's public pricing where it exists. Any published price for 1upHealth or Smile Digital Health was checked on that vendor's own site on October 20, 2026.
A green check marks a clear edge for 1upHealth or Smile Digital Health only where their review scores differ by at least 0.3 points or the two reviews show a plain difference. Rows with nothing published for either 1upHealth or Smile Digital Health are left out, and time to full value for each adds up the rollout stages in its review.
Sources
- HIR review of 1upHealth and HIR review of Smile Digital Health
- 1upHealth announces 1up Gateway, July 8, 2026
- 1upHealth launches 1up Clinical Connect, September 1, 2026
- Smile CDR 2026.08.R01 and HAPI FHIR 8.12.0 release webinar, August 27, 2026