By Lindsay Parker
A crisp energy filled the air – that electric sense of forward motion and the promise that anything is possible when teams unite. The Fall season is made for momentum, for collaboration, and for chasing bold goals. That’s exactly what I felt while attending eSolutions Xchange, the preeminent innovation conference for Blue Cross Blue Shield (BSCS) Health Plans, which took place in Kansas City last month. My time at the event reminded me that there is a lot of ground to cover, but we unlock even more opportunity when we bring everybody together.
Over three days, I had energizing conversations, gathered new ideas from industry experts, and saw firsthand the strides being made to advance interoperability in healthcare. I want to commend the BCBS Health Plans for engaging the right stakeholders, encouraging genuine collaboration, and turning the event into more than a conference — it ushered forth real progress with real purpose.
Kicking off with Kendall Gammon
The conference kicked off with Kendall Gammon, who drew from his 15-year NFL career with the Steelers, the Saints, and the Chiefs. What really resonated was his focus on mindset: The discipline, resilience, and teamwork that help both individuals and organizations power through tough challenges. It set the tone. If we want to meet the demands ahead, from regulation to innovation, we’ll need to think not only about what we can do, but how we do it with consistency, focus, and drive.
Interoperability Implementation has begun. Are you still on the sidelines?
It was no surprise that the conference zeroed in on interoperability, and CMS-0057 stood out as one of the most consequential shifts happening today. But it wasn’t through the lens of a compliance checkbox. It was about fundamentally changing how data flows, how prior authorization works, and how members, providers, and payers all interact.
It was exciting to see so many Blues Plans moving beyond talking about CMS-0057. They’re rolling up their sleeves and turning plans into action. If you’re still stuck in “assessment mode,” then you’re already playing catch-up. The moment to move is now. Bring your cross-functional teams together, lock in your data strategy, select the right technology partners, and start integrating. The leading Blues Plans and vendors have clearly embraced this mindset. They’re not just preparing, they’re already deep into implementation and testing. It’s not about just meeting the deadline. It’s keeping pace with the industry and staying ahead.
A spotlight on the BCBSA Interoperability Hub
One of the most exciting takeaways from Kansas City – along with the multiple bottles of local BBQ sauce I stowed in my carry on – was learning more about the Blue Cross Blue Shield Association Interoperability Hub. This is a forward-leaning infrastructure that solves real headaches for members getting care outside their home plan’s network. The Hub acts as a broker for seamless electronic Prior Authorization (ePA) and Provider Access transactions between BCBS Host and Home Plans, when members are out of their usual coverage territory.
Here are some of what the Hub enables:
- Handling Provider Access requests for “out-of-area” care completely via FHIR APIs: Host Plans take the request, Home Plans respond, and providers get the data they need without manual back-and-forths.
- Facilitating ePA exchanges so that authorizations happen more smoothly when care occurs outside a member’s home region: No more guessing, no more delays.
- Tracking and reporting on FHIR API traffic: Enabling Service Level Agreement (SLA) monitoring, performance metrics, and compliance oversight.
What’s powerful isn’t just what the Hub can do, but what it signifies. The BCBSA and the respective Blues Plans are stepping up as leaders in shared infrastructure, standardization, and trusted, efficient payer-to-payer cooperation.
At 1upHealth, we’re already hard at work preparing for integration with the BCBSA Interoperability Hub. We believe deeply in scalable, FHIR-native interoperability fabrics (or “plumbing” if you like) that can connect many plans without reinventing the wheel every time. Network connectivity isn’t just a feature, it’s a core value we’ve built into everything we do.
That’s why we’re excited to begin connecting to the Blue Cross Blue Shield Association Interoperability Hub on behalf of our Blue Cross customers. These connections mean smoother data flows, less duplicated effort, and better member experience because when the BCBS ecosystem works together, everybody wins.
The time to move is now: Winning the CMS-0057 game
My take? There’s no more room to “table this for later.”
The CMS-0057 final rule is already in full effect and the players who act now will be the ones winning big. These organizations will strategically test new tools, streamline operations, and set themselves up to maximize ROI from day one. Getting these APIs right isn’t just flipping a switch. It requires time, careful planning, and engagement from stakeholders across the entire organization.
Here are the top action items I see for success, and how partnering with a vendor like 1upHealth can help you move downfield faster, with less risk and more impact.
How 1upHealth helps payers do what you need to do
Align Your Teams
Get legal, privacy, clinical, operations, and IT all pulling in the same direction – now. Consent, governance, and data-sharing aren’t optional under CMS-0057. They’re foundational. That means working with vendors who understand the regulations inside and out, who offer platforms built for granular consent, and who support both federal and state-level mandates. There must be real systems for granting, revoking, and tracking consent in real time. A FHIR-native platform supports the necessary policy-based access controls, audit trails, version histories, and seamless integration so your consent status is always enforceable, transparent, and up to date.
Build a future-ready architecture
Your tech stack must handle everything: structured and unstructured data; provider identity verification; and delegation frameworks. A FHIR-native solution can accelerate API rollout and cut down redundant work. The best platforms don’t just store member data, they turn it into a strategic asset used across your enterprise.
Automate workflows
Manual prior authorizations? That’s a thing of the past. You need streamlined routing, automated decision trees, and centralized orchestration now. Choose vendors who are flexible, who meet you where you are, and who evolve with you as your workflows mature. Yes, it’s a big lift. But the path to ROI and better member experience is clear.
Act now and partner smart
Map your implementation. Test early. Don’t wait.
- The industry is already moving. Many Blues Plans and others are well past planning. They’re implementing and testing.
- Regulatory and public expectations are increasing. Operational inefficiencies will start to show if you lag.
- The payoff is real. When done well, compliance turns into a competitive advantage for better service, fewer delays, fewer costs, and happier providers and members.
Final thoughts
CMS-0057 isn’t just another rule. It’s a chance to make things better for everyone involved. Seeing how many Blues Plans are already diving into the toughest interoperability challenges head on made it clear: The future is happening now.
And yes, the BBQ was on point. And the sides? Total win. Looking forward to eSolutions Xchange 2026 taking place next April in Chattanooga, TN!
