Last week I attended the Fierce Health Care Summit and listened to payer leaders, policymakers, technologists, and clinicians talk frankly about the state of our industry. The recurring theme was unmistakable. Technology, innovation, and data exchange have enormous potential to reduce friction and unlock real gains across the ecosystem.
Several conversations stayed with me and helped clarify where payers are feeling pressure, where they see promise, and what it will take to move the system forward.
The Opportunity in Electronic Prior Authorization
If I had to pick one topic that came up in almost every session, it was electronic prior authorization. Leaders repeated this point often. Electronic Prior Authorization is essential for reducing abrasion, modernizing operations, and showing members and providers that payers are serious about fixing avoidable pain points.
One speaker summed it up bluntly. Prior authorization should be about better outcomes, not cost reduction. That begins with automating processes that cause unnecessary delay and frustration. Standardizing medical necessity criteria, enabling real-time decisions, and improving first pass approvals can ease friction for both providers and members.
I also heard strong agreement that electronic prior authorization will not succeed without provider-side incentives and mandates. The electronic ecosystem that policymakers envision is only possible if providers are fully enfranchised and supported.
AI is Powerful, but Governance is the Real Differentiator
AI generated plenty of discussion, but the message was not about hype or novelty. Payers want real value and transparent governance. They aren’t interested in black box algorithms that can’t be audited or explained.
I was encouraged to hear leaders talk about AI as a tool to remove friction rather than drive denial automation. The best applications are focused on improving the first pass approval rate, cleaning up claims before submission, strengthening payment integrity, and getting to yes faster.
Several panelists also pointed to member experience as a high value opportunity. Imagine a world where a member can finally see a clear, accurate estimate of what their care will cost.
The Call for Less Friction through Better Data
Across the Summit, I heard a clear desire to rebuild payer and provider trust. Payers want more complete clinical data, and they want more collaborative relationships, particularly in value-based care.
This is closely connected to a broader opportunity for payers to modernize how they engage with members and providers. Leaders acknowledged that the industry faces heightened expectations and increasing scrutiny, which makes it even more important to streamline processes and deliver clearer, more consistent experiences.
Many speakers emphasized that this is a moment to reshape the narrative by reducing friction, improving transparency, and investing in technologies that support better outcomes. Addressing inequities like the GLP-1 access gap. Improving the accuracy of provider directories. Strengthening preventative care strategies. And investing in thought leadership that puts population health and patient outcomes at the center.
One of the most aspirational ideas was the concept of continuous individual prior authorization. With the right data foundation, AI could proactively determine which services a member already qualifies for and bypass traditional approval cycles altogether. Achieving this vision depends on something payers still struggle with: access to clinical data at scale.
Discussions about Stars and quality underlined the importance of comprehensive, integrous data. Although AI is starting to influence trend identification and predictive modeling, especially in member experience and treatment responsiveness, being able to acquire and use clinical data at scale is the first step. It’s another reminder that better data and better governance deliver better outcomes.Â
Many leaders like 1upHealth’s own Dr. Donald Rucker, Chief Strategy Officer, suggested negotiating bulk FHIR exchange directly into contracts with providers…as a viable long-term strategy for getting access to this invaluable data. He said, “Payers should prioritize getting clinical data from providers in their next round of network contract negotiations. Bulk FHIR downloads of the US Core Data for Interoperability (USCDI) will be a great place to start.”
I heard optimism about the regulatory environment that governs this data access and exchange. The current administration is signaling support for digital innovation in healthcare and engagement from more participants in the ecosystem. This means payers have a chance to lean in and truly be part of the dialogue on modernizing health care interoperability.
The Future of Healthcare Data Exchange
What I heard at the Fierce Health Care Summit was honest and constructive. Payers recognize gaps in the industry, and many are ready to do the work to close it. The path forward depends on transparent AI, scalable clinical data exchange, stronger provider partnerships, and a relentless focus on removing friction for members.
The opportunity is real. I left the Summit optimistic that payers can improve trust and deliver better outcomes by committing to the technologies and partnerships that make the system work for everyone. And at 1upHealth, we remain focused on giving organizations the data foundation they need to make that future possible.
If your payer organization is interested in being part of the future of healthcare data exchange, please contact us to learn more.