The best decision will always be an informed decision – especially in healthcare. The more data that your providers have about you and your health, the better they can care for you. The only problem in this case is that you don’t receive all of your healthcare at the same location from the same doctor. So the question then becomes – how do we get that data shared between those providers to receive that better level of care?
We reached out to our incredible Healthcare IT Today community to ask — how can healthcare IT facilities have better data sharing and interoperability between payers and providers to improve care coordination and patient outcomes? The following are their answers.
Bryan Laskin, DDS at Vyne/Toothapps
Healthcare IT plays a pivotal role in improving data-sharing and interoperability between payers and providers, which are essential components for enhancing care coordination and patient outcomes. In dentistry, the lack of open data access has long stifled innovation, transparency, and clinical efficiency. We advocate for a future built on open data standards, enabling seamless communication across systems. Open data not only supports regulatory compliance under mandates like the 21st Century Cures Act and HIPAA, but it also empowers providers to make informed clinical decisions and patients to gain greater control over their healthcare records. By embracing healthcare IT solutions that support interoperability, practices can access real-time insurance eligibility, reduce administrative burdens, and streamline revenue cycle processes. Ultimately, when data flows freely and securely, providers deliver better, faster care, patients make better decisions, and payers benefit from reduced errors and improved outcomes.
Matthew Brink, Client Relationship Executive, Health Plan at Xsolis
A new era of AI-driven transformation is unfolding across healthcare, with providers and health plans each racing to unlock greater efficiency and alignment. Forward-thinking leaders are recognizing that the true power of AI lies not just in automation, but in AI’s potential to leverage objective truth in data, create more transparency, and reimagine relationships. We still have a long way to go in fostering trust and collaboration between payers and providers through shared instances of AI, but I feel strongly that we can do this when we create shared value — whether that’s mutual time savings, or smarter ways to communicate and negotiate back and forth using a common language. This is where the healthcare industry must arrive to achieve a more connected and sustainable ecosystem for the future.
Daniel Vreeman, DPT, Chief Standards Development Officer at HL7 International
To improve care coordination and patient outcomes, payers and providers need more than shared data—they need shared context. That requires adopting data standards that allow information to flow with meaning across systems, organizations, and care settings. Interoperability is the foundation for mutual insight: enabling providers to understand payer policies in real time, and payers to appreciate the clinical reasoning behind care decisions. It’s time to move beyond one-off pilots and commit to shared standards that enable scalable collaboration through transparency, provenance, and clinical relevance.
Lance Reid, CEO at Telcion
The foundation for better payer-provider collaboration starts with secure, reliable data sharing. But interoperability isn’t just a software problem – it’s an infrastructure challenge. I’ve seen firsthand how outdated networks and fragmented systems can create bottlenecks in data exchange. If you want to improve patient outcomes, providers and payers need at least a shared baseline of connectivity that’s fast, stable, and secure. That means everything from modernized data centers and cloud infrastructure to solid cybersecurity protections that ensure trust in every transaction. Providers, payers, and their business associates shouldn’t treat interoperability as an afterthought or bolt-on feature – it needs to be a fundamental capability built into the foundation. Without that, even the most well-intentioned partnerships will struggle to share data at the speed that care demands.
Megan Zakrewsky, VP of Product of Clinical Data Exchange, Payer Solutions at Veradigm
Historically, payer-provider data exchange has relied on time-consuming and disparate processes to track down clinical data, lab results, and other patient records. Providers have faced fragmented health records across multiple EHR systems, while payers have relied on delayed or incomplete data to make critical decisions. Healthcare IT is working to reduce friction and improve workflows and collaboration between payers and providers. By leveraging automated payer solutions that integrate clinical data directly into provider workflows, payers can access timely, actionable insights. Automating the exchange of medical records and aggregate data from multiple sources using intelligent member-matching builds comprehensive, longitudinal patient records.
Near real-time data access can improve HEDIS and Stars scoring, enabling payers to close care gaps faster and at a lower cost to enhance quality performance. It also provides greater visibility into population health trends for strategic plan design, targeted interventions, and better risk management.
For providers, access to data at the point of care leads to more informed decisions, reduced documentation burden, and improved patient engagement. The automated exchange of patient data via trusted, integrated workflows facilitates payer-provider collaboration. With the right infrastructure, the industry can move beyond data silos toward a more collaborative, patient-centered future for improved patient health outcomes and lower costs for the healthcare industry.
Brad McIlwain, Senior Vice President, Product at mPulse
Health plans must adapt to a rapidly changing healthcare landscape – due to industry regulations and evolving member expectations – driving the need for secure data exchange among payers and providers for personalized consumer experiences.
As payers continue to have more responsibility for patient data, it’s critical to change the narrative from checking the box of engagement to truly delivering targeted, personalized experiences. To do this effectively, it is essential to have an integrated system that consolidates shared data, which allows all parties to work from a centralized patient profile; ultimately enabling a better understanding of the patient and more meaningful use of the data. Furthermore, health plans can move beyond compliance and data sharing with interoperability standards like FHIR, to real-time data transactions that provide the next-best steps on how a member can improve their health.
Health plans that build broader customer experience and engagement strategies using trusted, flexible technology can improve collaboration with providers, empowering members to engage in their care and improve overall health. The new member portal experience is shifting to be dynamic across the member experience and more personalized based on user behavior, communication preferences, and real-time data. By embracing these new strategies, plans can anticipate consumer and member needs and proactively deliver a unified experience across stakeholders with relevant, omnichannel content. Simply put, by leveraging advanced data management and interoperable technologies, health plans can enhance care coordination, break down silos across stakeholders, improve operational efficiencies, and positively impact health outcomes for patients.
Eric Makovsky, Senior Vice President, Customer Engagement at Tendo
Healthcare IT plays a vital role in bridging the data gap between payers and providers. The key is creating systems that prioritize not only secure data exchange but also usable, actionable insights at the point of care. Modern interoperability solutions go beyond traditional claims data and EMR integrations by combining clinical, financial, and social determinants data into a shared ecosystem. When both payers and providers can access a clearer, real-time picture of patient needs, it enables better care coordination, reduces duplication, and supports proactive, rather than reactive, care strategies. The future lies in interoperability platforms that surface relevant insights at critical decision points, whether that’s during care navigation, prior authorization, or care plan management.
Paul Wilder, Executive Director at Commonwell Health Alliance
Healthcare IT provides the crucial connections between providers, payers, and also patients. All three groups working in tandem from the same information is critical for improved care coordination and outcomes—but we can’t get there without trust. Not only do we need to trust that the data is accurate, complete, and safe, but also that the people accessing it are using it appropriately. Trust is the most crucial ingredient underpinning successful interoperability and is vital to the ability to share, collaborate, and work from the millions of data transactions happening daily.
Stacey Hawes, Chief Performance, Data and Growth Officer at MERGE
Bridging silos of care between payers and providers starts by aligning on unified care plans for patients and clearly defined roles among all stakeholders. Considering that payers, providers, and care teams serve as the foundation for streamlined data exchange, it’s crucial that these parties have defined roles for individualized patient care plans, allowing for better data sharing and usage. Additionally, advanced analytics help identify disease progression patterns, allowing for proactive, personalized action plans that enhance patient outcomes.
Libby Sagara, Managing Director at BluePath Health
Electronic consult (e-consult) platforms have proven effective in supporting care coordination between primary care providers and specialists who are on different EHRs, offering a first step to a routine, non-urgent referral. We are seeing managed care plans across the country cover the costs of these e-consult programs as they dramatically reduce the time Medicaid members wait to receive specialty advice — improving outcomes for our most vulnerable patients.
There are so many great responses to think about here! Huge thank you to everyone who took the time out of their day to submit a quote to us! And thank you to all of you for taking the time out of your day to read this article! We could not do this without all of your support.
How do you think healthcare facilities can better data sharing and interoperability between payers and providers to improve care coordination and patient outcomes? Let us know over on social media, we’d love you from all of you!
