Interoperability: The future of healthcare is here

Healthcare interoperability adoption and implementation

The U.S. healthcare system is fragmented and disjointed, which makes it difficult for stakeholders (healthcare payors, providers, pharmacy benefit managers, life sciences companies and third party vendors) to safely share patient data. This has led to operational inefficiencies that negatively impact the patient experience and their quality of care.

Interoperability seeks to remove barriers and breakdown silos to facilitate the exchange of data, while still protecting patient privacy. The goal is to ensure that healthcare IT systems can improve their ability to exchange, process and interpret shared data between devices, applications and health systems. Ultimately, building a more connected healthcare system.

Helping healthcare payers prepare for CMS’ final Interoperability and Patient Access rule

PwC's short assessment tool helps payers prepare for CMS' final interoperability rule. Our readiness assessment accounts for the capabilities a payer must establish as well as broader people, process, and technology changes necessary to support those new capabilities.

Receive a high-level snapshot of your overall interoperability readiness and high level recommendations for your organization.

Take the survey

Build a patient-centered, more efficient care delivery system

Centers for Medicare & Medicaid Services mandates for interoperability and access to health data can empower patients and create market opportunities for differentiation.

Members / Patients
Patients will be empowered to choose
which entities outside of their care provider to authorize access to their medical information and history.

Providers will be required to make admission, discharge, transfer, and emergency visit event notifications available to the patient’s designated care providers, and make transparent their stance on information blocking.

Health plans will be required to share historic claims, clinical, and encounter data with member and other payers and expose their provider directories.

New Entrants / Vendors
Third-party developers will disrupt the ecosystem with data-powered innovations and new market plays with unprecedented access to patient / member / consumer data.

Have a strategic focus

Organizations should use the regulatory requirements as a starting point to think through their own strategy to leverage and share data with other industry stakeholders as well as patients.

Do you want to influence regulations and lead in adoption?

  • Late adopters: Respond when regulation stabilizes or industry accepted solution is developed
  • Tracking and monitoring: Proactively track, monitor, and meet regulatory standard and compliance risks
  • Early adopters: Address, adopt, and comply to working standards from CMS/ONC
  • Industry Leaders: Influence industry rules and standards via working groups


How do you create enterprise value through greater interoperability?

  • Internal Efficiency: Create value through increased scale and governance
  • Enhanced Processes: Leverage exchange of expanded dataset across stakeholders for operations
  • Scale Operations: Extend and scale current services into other areas to drive value
  • Product and Services Innovation: Develop new products and services leveraging IO framework and data access


How do you want to drive market disruption?

  • Commercial Utility: Provide interoperability services to help meet market need
  • Partnerships / Joint Ventures: Launch partnerships to develop differentiated systems
  • Thought Leadership: Focus on innovation from industry working groups
  • Set the Standard: Require a ‘seat at the table’ for strategy and governance


Have a deeper conversation about what interoperability means for your organization

Have a deeper conversation about what interoperability means for your organization

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Contact us

Kelly Tsaur

Principal, Health Services Payer, PwC US

Zach Sachen

Principal, Health Services Technology, PwC US

Claudia Douglass

Principal, Health Services Provider, PwC US

David Curé

Partner, Health Services Risk and Regulatory, PwC US

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