Health plans are no longer treating interoperability as a check-the-box requirement; they are embracing it as a driver of strategic transformation. That was the core message from a featured session at Becker’s Fall 2025 Payer Issues Roundtable, where a panel of industry leaders shared how interoperability is enabling healthcare organizations to address business challenges, improve outcomes and foster cross-sector collaboration.
The session, “Turning mandates into momentum: Realizing value through interoperability,” included insights from Hayes Abrams, former health data exchange leader at Health Care Service Corporation; Suzanne Wogelius, vice president of product at Hyphen; James Lin, senior adviser at ZS; and Manavjeet Singh, principal at ZS.
Here are four key takeaways from the discussion:
1. Interoperability has evolved from mandate to mission.
Mr. Singh from ZS opened the session by emphasizing a major shift in how healthcare leaders approach interoperability. What began as a regulatory obligation is now viewed as a catalyst for transformation — one that enables organizations to rethink how they use data to support care delivery, collaboration and innovation.
“The real opportunity lies in moving from mandate to value and from data sharing to data utilization, ensuring that clinical information flows meaningfully across all channels and systems to drive outcomes, improve member experience and reduce friction throughout the healthcare continuum,” Mr. Singh said.
2. Health plans are realizing value with targeted use cases.
Both Hyphen and Health Care Service Corporation have seen measurable value from interoperability, particularly in risk adjustment, medication adherence and quality performance.
Ms. Wogelius described how Hyphen partnered with Healthfirst, New York’s largest nonprofit health plan, to go beyond compliance and build a connected care ecosystem.
“We connected Healthfirst with 600 independent community pharmacies by integrating into pharmacy management systems and serving up value-based care insights for pharmacists — such as refill outreach, 30- to 90-day conversions or education on the value of generics,” she said. The initiative also led to a 2,000% increase in health equity data capture by embedding screening tools directly into clinical workflows.
Mr. Abrams shared that his former organization pursued many of the same high-impact use cases, including risk adjustment, quality improvement and concurrent review, with results to match. “We saw 49% year over year HEDIS care gap closure gains,” he said.
He also emphasized the importance of flexibility when working across provider environments, noting that even systems using the same EHR vary widely. “We have some flexibility in our model because if you’ve seen one provider’s office, you’ve seen one provider’s office,” Mr. Abrams said.
3. Multi-payer collaboration is essential — but difficult.
Achieving provider engagement requires critical mass. Mr. Abrams emphasized the importance of multi-payer partnerships to drive adoption and reduce friction for providers.
Mr. Abrams stressed that real progress requires a collective approach. “To get to a tipping point in a provider’s office, you need 65% of their patient population — and ideally 65% of their revenue — to get utilization,” he said. “That means BCBS, plus government, plus one or two commercial plans working together.”
While he acknowledged that multi-payer collaboration can be politically sensitive within health plans, especially with network and marketing teams, he noted it’s essential for meaningful provider engagement. “Multi-payer is tough, but it’s also very fruitful,” he said.
Mr. Lin also highlighted the complexity from the provider’s point of view, where they struggle to navigate websites, processes, and technology for individual health plans. “Many health plans have seen success by implementing a multi-payer solution to standardize access and drive adoption with providers,” he said.
4. Success in interoperability ultimately depends on people.
While much attention is paid to APIs, data standards and health information exchanges, the panel stressed that people are at the heart of successful interoperability initiatives.
“You don’t achieve value through interoperability with a capital ‘I,'” Mr. Abrams said. “You achieve it through people.” He shared that his organization’s interoperability efforts began well before federal requirements, driven by internal business needs and a shared commitment to progress. “It’s about taking that big rock, breaking it into little pieces and having others help you bring it up the hill and plant it like Sisyphus,” he said.
Mr. Singh added that shifting how interoperability projects are funded and evaluated was critical in his previous role.
“One of the fundamental changes we made was to start treating interoperability like any other project — with a cost-benefit analysis,” he said. “It didn’t have to come from a compliance budget. We asked: does a $1 million investment give you a 5x return, an 8x return, a 4x return? That discipline forced us to think more clearly about value drivers and move beyond just checking the box.”
As interoperability requirements continue to expand, panelists urged healthcare leaders to look beyond compliance and reframe interoperability as a foundation for transformation. The organizations that do so will be best positioned to deliver coordinated, data-driven care in an increasingly connected ecosystem.
