Humana and Providence on Monday unveiled a new data exchange partnership the major payer and provider said could become a blueprint for the broader industry.
The data sharing ecosystem is slated to go live later this month in an initial rollout focused on automating member attribution for Humana Medicare Advantage members, which the companies said will help the 51-hospital system’s providers understand which patients are considered by Humana to be under their care.
Additional capabilities on the data exchange collaboration’s road map will focus on reducing administrative burden and bolstering clinical decision-making, they said.
"The healthcare industry is overwhelmed by fragmented, inconsistent data formats that make care coordination costly and slow,” Michael Westover, vice president of population health informatics at Providence, said in the announcement. “Because we want to be successful in value-based care contracts, Humana and Providence are building a shared foundation of administrative, financial and clinical data using national standards and modern technology.”
More specifically, the pair said they’re using HL7 Fast Healthcare Interoperability Resources (FHIR), Da Vinci Project Implementation Guides and other “modern” application programming interfaces (APIs) to build out their infrastructure.
That framework “will be easily replicable, serving as a scalable model that can transform care across the healthcare industry,” they said.
The partners said their initiative makes good on the interoperability pledge they and 58 other health and tech organizations made this summer to the White House and the Centers for Medicare & Medicaid Services (CMS).
At the time, the CMS outlined voluntary criteria for data exchange, accessibility and personalization—notably, those included a goal for networks to provide access to data and other capabilities through FHIR APIs by July 4, 2026. Until then, the agency asked the participating companies to have some type of advancement toward the interoperability goals ready for display by the first quarter of 2026.
Further, under the CMS Interoperability and Prior Authorization Final Rule, payers will soon be required to implement several processes and API capabilities intended to open up fragmented data systems and cut down on manual processes.
"True interoperability should serve clinicians, patients and payers,” George Renaudin, Humana’s president of insurance, said in the announcement. “Together with Providence, we’re enabling providers to deliver more effective care and helping our members spend less time on paperwork and more time on their health."