Better HEDIS Performance Starts with Better Data
Most health plans have spent years investing in data infrastructure: new platforms, integrations, and vendor relationships. Yet too much quality data still arrives late, sits in disconnected systems, and requires chasing down records before it can be used. That gap matters more as performance benchmarks rise and HEDIS reporting becomes increasingly digital. Better performance depends […]
What Black Book’s Payer Interoperability KPIs Tell Health Plans About Making Clinical Data Work in Production
Black Book’s 2026 payer interoperability research evaluates vendors across 18 key performance indicators. In this series, I’m looking at those KPIs in five practical areas through the lens of what it actually takes to build, operate, and scale payer interoperability infrastructure. Onyx ranked #1 overall in the research, leading 11 of the 18 KPIs. In Part 1, I looked at regulatory readiness, […]
What We Heard at MESC 2026: Medicaid Interoperability, Consent and Trusted Health Data Exchange
At MESC 2026, two things were top of mind for most attendees: implementation of HR-1, and CMS Interoperability. Many of our conversations about Medicaid interoperability focused on a practical question: what does it take to make health data exchange work across real organizations, networks and workflows? Consent. Identity. Security. Purpose of use. Attachments. Payer-to-payer exchange. None of these are new challenges. What stood out was how […]
What Black Book’s Payer Interoperability KPIs Tell Health Plans About Building for Evolving Mandates
Black Book’s 2026 payer interoperability research evaluated vendors across 18 key performance indicators, based on feedback from 764 qualified payer respondents. Onyx ranked #1 overall and earned the top score in 11 of the 18 KPIs. The 18 measures span much more than basic API functionality. They look at everything from regulatory readiness, standards conformance […]
Healthcare Has a Data Translation Problem
Across the conversations we’re having with health plans, states, and technology partners, one issue keeps coming up: healthcare data may be moving more freely, but that does not mean every system interprets it the same way. Data comes from EHRs, claims systems, labs, pharmacies, public health platforms, and other sources. Even when organizations use standards like […]
The CMS-0057 API Health Plans Are Already Using for Value-Based Care
CMS-0057 requires health plans to make claims, encounter, clinical, and prior authorization information available to providers through standardized APIs. But Provider Access does not have to be built for compliance alone. Health plans are already implementing the API in production to support value-based care contracts—extending the same interoperability foundation to give at-risk providers the information […]
CMS-0057 and CRD: Giving Providers Answers Before the Patient Leaves
A prior authorization answer delivered while the patient is still in the office can create a very different care experience than one that arrives days later. Without real-time information, a provider may have to send the patient home, confirm requirements with the health plan, reconnect by phone, and schedule another appointment. That delay is not […]
CMS-0057: Bringing Claims and Clinical Data Together to See the Full Member Story
Health plans have never lacked data. They’ve lacked a complete picture. Member history is often spread across providers, health plans, and disconnected systems, making it difficult to understand the full care journey when important decisions need to be made. CMS-0057 begins to change that. Through Patient Access, Provider Access, and Payer-to-Payer APIs, the rule creates […]
When Members Search for Their Doctor, Will Your Plan Show Up?
Provider directory accuracy has always been hard. But for Medicare Advantage plans, CMS-4208-F2 changes the stakes. Under the CMS-4208-F2 final rule, MA organizations must make provider directory data available to CMS/HHS for use in Medicare Plan Finder, update that information within 30 days of known changes, and attest at least annually that the data is […]
The API Works. The Network Is What Makes CMS-0057 Matter.
For health plans preparing for CMS-0057, standing up secure APIs is only one part of the work. The larger challenge is making those APIs exchange data with organizations outside the plan’s own environment — securely, reliably, and at scale. “The network becomes really powerful. It allows you to really move beyond, ‘I can get connected,’ […]