Interoperability as a Strategic Imperative for Healthcare Payers

Interoperability has shifted from being just a compliance requirement to a critical enterprise-wide strategic priority for healthcare payers. According to Gartner’s 2024 U.S. Healthcare Payer Interoperability Benchmarks, advancing interoperability programs is no longer optional—it’s essential for achieving operational efficiency, enhancing care management, and meeting rising regulatory expectations. However, as the report highlights, scaling these programs comes with significant barriers and an evolving set of priorities.

Key Findings from Gartner’s Research

Compliance Leads the Use-Case Priorities

Gartner’s findings reveal that compliance remains the top interoperability use case for payers, with respondents ranking it three times higher than any other priority. While compliance is pivotal, the focus is beginning to expand towards enterprise-wide strategies that deliver broader business value, such as better care management processes tied to quality metrics and care gap closures.

Growing Recognition of Interoperability’s Strategic Role

Interoperability is increasingly recognized as a key enabler of business transformation. Most payer organizations have started developing enterprise interoperability strategies, supported by aggressive investments in capabilities and skills. Yet, despite these efforts, the majority of interoperability initiatives still fail to meet expected returns on investment (ROI). Gartner attributes this performance gap to implementation challenges and barriers to organizational scale.

Persistent Barriers to Scale

While investment in standards-based frameworks like HL7/FHIR connectivity is gaining momentum, scaling interoperability remains challenging. Provider resistance, legacy data environments, and funding constraints rank as the top barriers preventing broader adoption. Notably, providers prioritize patient engagement and care management use cases over initiatives that directly benefit payers, such as authorization and utilization management optimization.

Recommendations for Healthcare Payers

To overcome these challenges and maximize the value of interoperability initiatives, Gartner provides several actionable recommendations for payer organizations:

1. Demonstrate ROI Beyond Compliance
   Payers need to align interoperability investments with broader business objectives, such as medical cost containment and administrative cost reduction. Establishing clear outcomes metrics—OKRs and KPIs—can help demonstrate how interoperability delivers tangible value to quality and care programs.

2. Engage Cross-Functional Leadership
   Gartner emphasizes the importance of positioning interoperability as an enterprise priority rather than an IT-centric initiative. Engaging leaders from government programs, clinical quality, risk management, and provider networks in the strategy ensures alignment with broader business goals.

3. Propose Provider Incentives to Scale
   Provider collaboration is critical to advancing interoperability. Gartner recommends exploring financial strategies, such as subsidizing interfaces, offering upfront payment rates, or adjusting prior-authorization requirements to incentivize participation. Collaborating with key provider partners to quantify costs and understand constraints can aid in addressing resistance.

Building the Framework for Success

The challenges of interoperability go beyond technical integration—they require a cultural shift within payer organizations. Moving from a compliance-driven mindset to a strategic, value-oriented approach is essential for unlocking the full potential. Effective collaboration with providers, strategic investment, and clear communication of value will position payers as leaders in the evolving healthcare ecosystem.

As Gartner’s research makes clear, payers must move intentionally to make interoperability a core component of their enterprise strategy. The benefits—improved care management, reduced administrative burden, and enhanced patient outcomes—far outweigh the challenges. For healthcare payer executives, now is the time to act decisively and prioritize interoperability as a business imperative.

For more insights, Gartner’s full report* offers a detailed analysis of payer-specific benchmarks, challenges, and success strategies for advancing interoperability initiatives effectively.

* Full report access limited to Gartner members.