For decades, interoperability has been a persistent challenge in U.S. healthcare. Countless discussions, policy changes, and technological advancements have attempted to solve it, yet for many payers, it remains an uphill battle. While much of the conversation has focused on payer-provider data exchange, there's another side of interoperability that often goes overlooked — the complex administrative data exchanges that keep the healthcare system running.
This was the focus of our recent webinar, Proven Tactics and Practical Solutions for Seamless Interoperability, where Richard Fu, Chief Commercial Officer, and Casey Hancock, Chief Technology Officer of Flume Health, shared insights on how payers can assess their interoperability readiness, overcome common hurdles, and build a scalable, future-ready data strategy.
The Hidden Interoperability Crisis in Payer Data
When most people discuss interoperability, the focus tends to land on EHRs, clinical data sharing, and patient access. While these efforts are critical, payers are left dealing with a different kind of data complexity — one that’s less visible but just as urgent.
As Richard Fu highlighted during the webinar, payers are overwhelmed by rising data demands as they navigate:
- Personalization Expectations: Employers and members demand more tailored, condition-specific health plans.
- Carve-Out Growth: Increasing reliance on niche vendors requires seamless data exchange.
- Regulatory Pressures New policies like Transparency in Coverage and No Surprises Act demand real-time, accurate data.
- Value-Based Care & AI: More data-driven models require payers to manage and integrate ever-expanding datasets.
The real issue isn't getting more data — payers already have an abundance of it. The problem is making sense of it, ensuring accuracy, and enabling real-time, frictionless exchange.
The Cost of Doing Nothing: Why Payers Must Act Now
The demand for interoperability isn’t going away. It’s accelerating. Without action, payers risk:
- Siloed, fragmented data that slows operations and frustrates stakeholders.
- More manual workarounds that increase administrative burden and cost.
- Limited agility to respond to new products, carve-outs, or compliance changes.
- Lost market relevance, as newer, data-driven entrants outmaneuver traditional plans.
The path forward requires a shift from rigid, point-to-point data exchanges to a flexible, automated data orchestration approach.
A Three-Step Approach to Seamless Interoperability
During the webinar, Casey Hancock outlined a practical framework for payers to evaluate, implement, and scale their interoperability strategies.
Step 1: Evaluate & Align
- Assess your current data infrastructure and identify bottlenecks.
- Align stakeholders across IT, operations, and business units.
- Establish clear goals and KPIs for interoperability readiness.
Step 2: Implement & Automate
- Transition from point-to-point integrations to scalable, many-to-many data orchestration.
- Automate repetitive data transformation tasks to reduce errors and delays.
- Ensure real-time observability so issues can be detected and resolved instantly.
Step 3: Scale & Optimize
- Expand integrations to support additional vendors, plans, and regulatory needs.
- Future-proof infrastructure for AI-driven insights and automation.
- Adopt a configurable, flexible approach to data management to stay ahead of industry shifts.
Lessons from the Field: Two Approaches to Interoperability
During the discussion, Richard and Casey shared real-world examples of two different organizations tackling interoperability:
- A Tech-Forward Startup – Built its infrastructure from scratch, leveraging AI-powered automation and asset-light technology to scale efficiently.
- A Legacy Payer with Technical Debt – Took a business-first approach, aligning interoperability efforts with member experience goals, adopting a common data model, and strategically modernizing systems in phases.
Both approaches highlight an essential truth: Interoperability is not a one-size-fits-all journey. Whether starting fresh or modernizing legacy systems, payers must take an iterative approach, focusing on high-impact areas first while keeping scalability in mind.
Final Takeaway: Small Steps, Big Impact
One of the most important insights from the webinar? Interoperability doesn’t have to be an all-or-nothing investment.
Payers can start by:
- Focusing on a high-impact, low-risk proof of concept (e.g., a PBM carve-out or real-time claims exchange).
- Testing new approaches with a key client or internal pilot program.
- Gradually migrating data and integrations in phases — not ripping and replacing everything at once.
As healthcare data complexity grows, interoperability isn’t just a technology challenge — it’s a business imperative. The payers who invest in scalable, future-ready data strategies will be the ones who thrive in the next era of healthcare.
Continue the Conversation
If you missed the live webinar, you can view the full recording here, or reach out to Flume Health for a deeper discussion on how to accelerate your data strategy.
Contact us to learn more.
