Humana, Providence unveil interoperable data-sharing framework

Chad Van Alstin | October 20, 2025 | Health Exec | Digital Transformation

A major payer and provider data exchange partnership was unveiled Monday, with the participating parties saying it could set a “new standard for interoperability in support of value-based care.”

Humana and Washington-based health system Providence said the rollout will begin this month, with an initial focus on Medicare Advantage enrollees. The system, which allows for data to flow between the two groups through a secure API, will automatically identify when a patient at one of Providence’s 51 hospitals is covered by a Humana Medicare Advantage plan, which will ideally improve care coordination and reduce reimbursement snags.

The companies said “future phases” of the integration will “expand data exchange capabilities to further reduce administrative burden and enhance clinical decision-making,” made possible by leveraging national HL7 Fast Healthcare Interoperability Resources (FHIR) standards for data interoperability and security. Both the payer and the health system emphasized that simply sharing information is not enough; ecosystems such as this should also reduce clinician burnout and improve patient care delivery.

"True interoperability should serve clinicians, patients and payers,” George Renaudin, president of insurance at Humana, said in a statement. “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.”

The data integration framework is built on the Da Vinci Project Implementation Guides, an HL7 initiative that uses FHIR-based guidelines to standardize data exchange between healthcare payers and providers. The resulting system enables modern, two-way APIs for real-time, interoperable workflows like prior authorization, coverage checks and data sharing.

Federal government pushing for interoperability

Humana and Providence said this model is “easily replicable” and has the potential to be adopted across the healthcare industry. Its establishment is part of a “Digital Health Ecosystem” initiative from the Centers for Medicare & Medicaid Services seeking to eliminate paper processes and improve the exchange of information across all of healthcare.

Some 60 groups pledged to make inroads toward that goal in the near future, including Humana and Providence. CMS is expecting groups to show progress in the first quarter of 2026, with a Final Rule taking effect Jan. 1 that will require payers to open up their databases to API integrations, in an effort to reduce disparate patient record keeping.

The rule also aims to improve the Medicare Advantage prior authorization process, which often leads to delayed care or reimbursement for health systems. This is often due to questions over the necessity of care—many of which will ideally be answered by consolidating the medical history of patients.

While EHRs have patient records, they’re likely not as complete as the patient data controlled by insurance companies, which is why payers are the primary focus of the CMS initiative. To date, five have signed up for the Digital Health Ecosystem pledge.