In today’s healthcare payer landscape, interoperability isn’t just a buzzword—it’s a business-critical capability. At its core, interoperability is the ability to seamlessly and securely exchange, interpret, and use health data across disparate systems—from EHRs and payer platforms to third-party apps and provider portals.
And while regulations like CMS mandates have accelerated adoption, the most forward-thinking payers are realizing something bigger: interoperability isn’t just about compliance—it’s about connection.
It’s about giving members the frictionless, personalized experiences they expect. It’s about enabling providers to make faster, smarter decisions. And ultimately, it’s about turning messy, fragmented data into a strategic asset that drives engagement, lowers costs, and improves outcomes.
In the webinar “Unlocking Loyalty: How Healthcare Payers Leverage Interoperability to Transform Member Experience” , Joaquim Neto (Verato), Chris Walker (Humana), and Doba Parushev (CareFirst), explored how leading payers are making interoperability a core part of their data, operations, and member experience strategies. Here are the key takeaways.
1. The Interoperability Imperative: A Strategic and Regulatory Driver
Health plans today face a pivotal moment: compliance with CMS mandates and pressure to excel through differentiated member experience. As Joaquim kicked off the discussion, the call to arms was clear—health plans must rethink how they manage and activate data, shifting from fragmented information silos to a true 360° view of each member. That clear, unified member profile isn’t just regulatory compliance—it’s the cornerstone for personalized, effective care.
2. From Compliance to Connection: Data Exchange = Member Trust
Chris from Humana notes that data exchange literally leads to better outcomes. When interoperability isn’t just present, but integrated into strategy at every level, it transforms care delivery. For Humana:
- 90% of members are now impacted by at least one interoperable solution
- Over 200 million clinical records shared
- 750,000+ providers connected
These aren’t vanity metrics—they reflect real friction reduction, better-informed provider decisions, and higher member satisfaction.
3. Quality Is Just as Critical as Connectivity
“You can’t just build pipes—you have to ensure the water is pure.” That was Joaquim’s way of warning against superficial interoperability. A broken claim, missing lab result, or inconsistent data isn’t just an inconvenience—it’s a barrier to care and trust. For plans like CareFirst, rigorous identity resolution and data governance are just as important as infrastructure.
4. Real-World Solutions That Work
Three powerful use cases from the panel demonstrated how interoperability drives impact:
| Use Case | Benefit | Description |
| ADT Alerts (Admit/Discharge/Transfer) | Timely care coordination | Realtime data on hospital admissions enables immediate outreach and interventions. |
| Digital Member ID | Friction-free experiences | Replaces plastic cards with identity verification at check-in, streamlining access. |
| Real-Time Authorizations | Operational efficiency | Seamless electronic prior authorizations reduce provider burden and accelerate care. |
Each solution shows how interoperability moves beyond back-end systems into member-facing value.
5. Value-Based Care: A Catalyst for Collaboration
Value-based care models are accelerating interoperability. They force both payers and providers to share data transparently—covering clinical data, claims, and utilization patterns. For example, CareFirst’s work with VBC vendor partner MRO closes the data loop between what payers pay for and what providers deliver—enabling real-time insights and coordinated decision-making.
6. Why Payers Are Stepping Into Care
A webinar attendee asked: Why are payers in the care delivery business at all? Doba’s answer: because they have to be. When access gaps or fragmented data put outcomes at risk, payers step in—not to be providers, but to connect the dots. Humana’s CenterWell model is a great example—using data and interoperability to support high-touch, community-based care where it’s needed most.
Your Playbook: Tackling Interoperability Strategically
- Set Clear KPIs
Example: Humana’s “members impacted by interoperability” now hits 90%.
- Think Beyond Technology
Prioritize data quality, real-time workflows, and trustworthy identity resolution.
- Use Accountability Contracts
Bake data-sharing expectations into VBC and vendor agreements.
- Design for Frictionless Journeys
Target real-world pain points like scheduling, check-in, and prior auth.
- Align Internal Systems First
A fragmented internal ecosystem makes external exchange impossible.
Final Take
We’re at a “generational inflection point” for payer data strategy. The infrastructure exists, but now the focus must shift to trustworthy identity, real-time integration, member experience, and measurable outcomes.
Interoperability done right is not just technical connectivity—it’s business strategy, care strategy, and trust strategy. And for forward-thinking payers, it’s the path to better outcomes—and better margins.
