CMS Payer Interoperability 2024 How Are Payers Optimizing the Use of Their Solutions beyond Compliance?

With the initial goal of meeting CMS requirements (e.g., CMS-9115-F), payer organizations have invested heavily in interoperability solutions to transform data into the FHIR format and provide APIs for member portals and other data exchanges. Still, industry-wide usage among patients for these types of offerings is low, with very few enrolled members asking payers for their medical information. As a result, payers need to determine how to utilize the solutions in a way that maximizes their value, especially as some payers report higher price tags from vendors for the technology to support more use cases. To help payer organizations navigate this field, this report examines the performance of CMS interoperability vendors as well as what current and future use cases are a priority for payers.