What a few days in Chattanooga taught us about CMS-0057, the P2P network gap, and what it takes to build something none of us can build alone.
They say you can see seven states from Rock City on a clear day. I had the chance to visit during the 2026 eSolution Xchange conference, and at the time, I wasn’t thinking about interoperability or CMS mandates.
But somewhere on the flight home, it clicked.
That view is healthcare right now.
We’ve made the climb. We’re standing at the lookout point of CMS-0057, staring out at a future where data finally moves the way it’s supposed to… cleanly, seamlessly, across every plan and provider. We can see where we’re going. The vision is clear.
The view is stunning, but the path to get here? It’s a bit rocky, uncertain, and certainly not easy.
Southern Hospitality and Health Data Interoperability
A massive thank you to BlueCross BlueShield of Tennessee and the broader Blues community for hosting something genuinely special. As always, this wasn’t just another conference. It felt like a room full of people who know the stakes and are actually doing the work.
And yes, as a North Carolina native, I feel obligated to report: the grits passed inspection. High praise.
Like FHIR mandates, grits are polarizing but banana pudding… now that’s the great equalizer. A true Southern staple built for sharing. It brings people together every time.
That same energy carried into the conversations. Open, honest, and grounded in a shared goal: getting health data interoperability right while the clock is ticking.
The Missing Path to Payer-to-Payer Data Exchange
As much as I could happily stay on the topic of Southern food indefinitely, the real conversation didn’t take long to find us.
Because here’s what was clear walking out of those sessions: the Blues plans aren’t waiting around. Whether they’ve partnered, selected an interoperability vendor, or are building internally, they’re deep into the work required for CMS-0057. The strategy isn’t theoretical anymore, it’s in motion.
And with that, the conversation has evolved.
Prior authorization may have been the headline act for a while, but the energy has shifted. The real question around payer-to-payer data exchange: how are we actually going to connect to each other?
That’s where things get… interesting.
There’s no shortage of options: networks, hubs, vendors, all with good intentions and strong points of view. But, as an industry, we haven’t landed on the path. Not the path. Not the one that works cleanly, consistently, and at scale for everyone.
Which leaves us in this in-between moment. Everyone agrees the data needs to move, especially for things like Digital Quality Measures (DQMs) and HEDIS, where the value is immediate and tangible. But without a shared approach to connectivity, we’re still stitching together point-to-point solutions and hoping they add up to something cohesive.
In other words: we can see the destination.
We’re just not all taking the same road to get there.
The 1upHealth Perspective on CMS-0057: Time to Start Laying Track
There’s still a lot of talk about what should exist…a central hub, a clean handoff, one network to connect it all.
But it’s just not here. And CMS-0057 is already in motion, with real requirements for payer-to-payer exchange, not someday, but very soon. Like 1/1/2027 soon.
So the plans making progress? They’re not waiting around for the “perfect” answer. They’re starting to connect, to test, and to learn as they go.
And honestly, that’s where things started to feel really encouraging.
At 1upHealth, this is exactly where we lean in. We see ourselves as a true partner, not just a platform. Our customers have more important things to focus on: their members, their operations, and everything else on their plate. They shouldn’t have to solve industry-wide connectivity challenges on their own.
Advancing Payer-to-Payer Data Exchange Through Collaboration
That’s why showing up matters to us. Our team is actively engaged across the industry’s most important payer-to-payer working groups, including Da Vinci PDEX, CARIN Payer Interoperability Touchpoint, CMS Aligned Networks Payer Workgroup, Trebuchet P2P Pilot, and the Sequoia Payer-to-Payer FHIR API Implementation Workgroup, with ongoing conversations happening across the ecosystem every day.
Because payer-to-payer data exchange doesn’t get figured out in theory. It gets figured out by reaching out plan by plan, getting connections live, and testing real scenarios. Not by waiting for the biggest players to decide the path. By actually doing the work.
And what stood out most at the eSolution Xchange? That mindset is catching on.
Across the Blues plan, hands went up, not just to talk about interoperability, but to participate in it. To test. To collaborate. To help shape what actually works.
It felt less like waiting for direction and more like the industry starting to move together. And that’s a pretty good place to be.
Sometimes in healthcare, progress moves so slowly you can’t actually see it happening. And if you can’t see it, then it gets a lot easier to question whether it’s happening at all.
That’s why moments where you can see it matter so much.
Moving from “Can it Work?” to “It Is Working” in Electronic Prior Authorization
One of the highlights of the event was watching my colleague Jeremy Yoon take the stage and demo 1up Electronic Prior Authorization flowing live through the Blue Cross Blue Shield Association (BCBSA) Data Hub with real data, real systems, working in real time.
And you could feel the shift in the room.
Because for all the conversations around CMS-0057, FHIR APIs, and what should be possible, there’s still a lingering question: does this actually work in the real world? (And to be fair, that’s a valid question as this rule is pushing the industry toward entirely new, API-driven exchange models.)
It moved the conversation from “can this work?” to “this is what it looks like when it does.”
And that kind of clarity? It’s fuel.
Because once you’ve seen it working, it’s a lot harder to go back to waiting.
Join 1upHealth as We Build the National Payer-to-Payer API Network
It won’t be perfect. It doesn’t have to be. What matters is that we start.
We’re kicking off our payer-to-payer network initiative and are actively looking for health plans who want to get in, connect, and test. Because the reality is, the only way this industry figures out payer-to-payer exchange is by actually doing it, moving real data between real systems and learning from it.
- To the plans: Join us. The sooner we start, the faster we learn.
- To the vendors: Interconnect – don’t isolate.
- To everyone: Progress doesn’t come from waiting. It comes from trying.
We have the vision. We have the mandates. And, thanks to Chattanooga, we have the grits and the banana pudding to see it through.
Ready to test? Let’s talk.
