Tomato System-Backed U.S. Insurer Secures CMS Final Approval; Official Launch Set for January Next Year
IT DAILY ·
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Tomato System said MCP Texas has received Full Plan Approval for its 2027 insurance business from CMS.
MCP Texas plans to begin recruiting insurance enrollees in October and officially launch insurance services on Jan. 1, 2027.
Tomato System plans to work with MCP to refine a business model that connects insurance operations software and digital healthcare services.
Tomato System said on the 21st that Medcare Partners Health Plan Texas (MCP Texas), an insurer under Medcare Partners (MCP), the U.S. company in which it has made a strategic equity investment, has secured Full Plan Approval for its 2027 insurance business from the Centers for Medicare & Medicaid Services (CMS). The approval came after MCP Texas met all of the essential requirements needed to operate a U.S. government insurance plan, and the final approval date was Sept. 11.
Accordingly, MCP Texas plans to begin recruiting insurance enrollees in October and to officially launch insurance services on Jan. 1, 2027.
Tomato System completed a 5% equity investment in MCP last October together with its U.S. subsidiary CyberMDCare (CMD), establishing a strategic partnership through the investment. With this final approval, Tomato System said it believes the U.S. insurance business has entered the service launch stage, and it expects to secure new business opportunities in the insurance operating platform and digital healthcare businesses.
Tomato System is building a supply structure for insurance operations software and a supply structure for digital healthcare services while carrying out the equity investment in parallel. The strategy is based on securing both platform operation demand stemming from the expansion of the insurer's business and opportunities to connect with medical services.
Against this backdrop, CMD signed a comprehensive service operations agreement with MCP Texas in June. Under the contract, CMD will handle integrated operations for the 'broker management portal,' which supports insurance sales and enrollment management; the 'insurance application portal,' which supports insurance product sales, enrollment support, and customer management; and the digital healthcare platform 'NOVA.' The two portals support the overall insurance operation.
NOVA integrates and manages enrollees' health information and supports medical professionals' health management and clinical decision-making. Through this, CMD plans to provide connected services from insurance enrollment to health management, while improving the efficiency of U.S. insurer operations and enhancing the level of enrollee management.
As MCP Texas' insurance business officially launches, insurance operating systems such as the broker management portal will be applied to the actual business environment. This CMS final approval means that the insurance platform business CMD has been pursuing has entered the actual operation stage.
Accordingly, demand for operating digital healthcare platforms is expected to rise as the number of enrollees and the scope of service deployment expand. CMD is preparing to expand NOVA services linked with medical networks in the U.S. and is currently preparing pilot services for NOVA for three IPAs (Independent Physician Associations). It also plans to expand the scope of service deployment after confirming the platform's usability in actual medical settings.
At the same time, CMD is pursuing the establishment of a K-Medical Organization (KMO) to build a medical network in the U.S. The KMO will pursue business based on cooperation with local medical institutions and medical professionals, and Korean-style health screening centers are being considered as potential partners connected to the KMO. In addition, the KMO is seeking to expand health management and digital healthcare services using NOVA.
Tomato System plans to work with MCP to refine a business model that combines insurance operations software supply and digital healthcare services. It plans to link insurance operating systems such as the broker management portal and the enrollment application portal, and to connect digital healthcare services centered on NOVA. Based on this, it plans to expand its business scope to other insurers and medical institutions in the U.S. going forward.
A Tomato System official said the CMS final approval means MCP Texas has cleared an important hurdle for the official launch of its insurance business. The official added that the U.S. insurance business, for which investment and technological cooperation have been pursued, has entered a full-scale service stage. Starting with the launch of MCP Texas' insurance business, the company plans to gradually pursue NOVA pilot services in step with the official launch of the insurance business in 2027, while also gradually pursuing the establishment of a KMO and the building of a medical network.
Tomato System said it plans to support the efficiency enhancement of U.S. insurers and the advancement of medical services as part of its strategy to continuously expand its local business base in the U.S. It also plans to continue expanding its business foundation in the U.S. insurtech and digital healthcare markets.
Source: IT DAILY · Yang Seung-gab
Original: https://www.itdaily.kr/news/articleView.html?idxno=241750
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Source: IT DAILY
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