Unlocking business value through interoperability: 3 key strategies

As healthcare organizations navigate the evolving digital landscape, interoperability has become more than a regulatory requirement—it’s a strategic imperative. Health plans that effectively leverage interoperability to drive efficiency, improve data quality, and deliver measurable business value will be best positioned for success across programs that rely on robust digital data exchange.

Below are three essential strategies—highlighted in our recent RISE webinar—to help payers maximize the value of their interoperability investments as key industry deadlines draw closer.

Integrate a multi-standard approach

While FHIR is gaining traction, much of today’s clinical data is still exchanged in CDA format. A successful interoperability strategy must accommodate both legacy and emerging standards, bridging the gap between provider workflows and payer systems to ensure that data is not only exchanged but also usable and relevant.

It is equally important to address the nuances of patient matching. Some systems depend on exact demographic matches, while others use probabilistic algorithms to locate records. Understanding these differences is critical to improving match rates and retrieving complete, actionable data.

Build a foundation of governance and performance monitoring

Execution is where strategy becomes reality. Strong data governance should start with a cross-functional task force that includes IT, legal, clinical, and operational stakeholders. This team should proactively monitor regulatory changes, engage in industry initiatives like HL7 DaVinci, and ensure that data use agreements remain comprehensive and adaptable.

Equally important is tracking performance. Metrics such as data completeness, system uptime, and medical record retrieval success rates enable organizations to identify gaps and optimize their interoperability programs. Dedicated dashboards and analytics tools can provide real-time visibility and support continuous improvement.

Choose the right partners and infrastructure

To optimize results, health plans should diversify their data sources, combining grassroots provider integrations with strategic partnerships. However, not all data partners deliver the same value. A recent Cotiviti study of continuity of care documents revealed significant variability in data quality across channels. National networks and direct provider integrations consistently delivered the most complete records, while other channels needed more support to improve data completeness and quality

Regular audits and data scorecards can help ensure that all partners and channels are delivering the quality and completeness needed to support risk adjustment, quality reporting, and other critical use cases.

Looking ahead

The shift to digital quality reporting by 2030—and the industry’s growing reliance on real-time clinical data—means interoperability is no longer a “nice-to-have.” It’s the backbone of modern health plan operations.

By investing in scalable infrastructure, establishing strong governance, and working with the right data partners, health plans can not only meet compliance mandates but also drive operational efficiency, improve member outcomes, and stay competitive in an increasingly digital landscape.

Watch our recent RISE webinar on unlocking business value from interoperability investments as we explore:

• How to build a scalable interoperability strategy
• Best practices for data governance and partner collaboration
• Insights from Cotiviti’s latest data quality study