What Real Payer Interoperability Takes
Standards have advanced the industry. They haven’t closed the gap between theoretical access and the clinical data payers need to run their programs.
Ask any payer running risk adjustment, HEDIS, or payment integrity at scale, and you’ll hear the same thing: FHIR adoption hasn’t translated into reliable, complete clinical data access. Provider maturity varies, EHR capabilities vary, and even where standards-based APIs exist, completeness and performance are inconsistent. The gap between theoretically accessible and operationally retrievable is where enterprise payer programs live, and where they break.
Closing that gap is what Datavant’s interoperability program is built to do.
A standards-first, not standards-only, approach
Where FHIR APIs are mature, Datavant uses them. Where they aren’t, the program supplements with vendor-specific APIs, direct-to-database agents, web-based extraction, SFTP exchanges, and a unified Site Connect Framework spanning 75+ EHR platforms. The flexibility isn’t a fallback — it’s the design that lets payers retrieve complete data across the full provider landscape, not just the digitally mature top of the curve.
Network scale that reflects reality
- 80,000+ hospitals and clinics
- 75+ digitally enabled EHR platforms, including Epic, Oracle Health, athenahealth, and Meditech
- 75% of the 100 largest U.S. health systems connected
Equally important: providers participate because Datavant consolidates clinical data exchange across payer, legal, life insurance, and government requesters. Less fragmentation, less burden, more trust — and a foundation that lasts.
Use-case-ready, not just connected
Two fulfillment methods power the full payer enterprise. Template-Based Retrieval is optimized for scale across recurring, high-volume workflows like risk adjustment and HEDIS. Record Type Digitization (RTD) is optimized for precision when use cases like payment integrity or care management demand tailored record composition or full longitudinal context.
Every request flows through a managed lifecycle — Request, Retrieval, Processing, Quality, Delivery — with automated validation, real-time monitoring, and continuous yield optimization. A privacy-first, neutral intermediary architecture enforces HIPAA alignment, minimum-necessary principles, and full auditability throughout.
Interoperability that scales
Payer interoperability is foundational infrastructure now, not a back-office program. The payers that win will combine network scale, operational rigor, and trusted, privacy-first execution — not a single connectivity method or one-off integrations.
Want the full technical overview? Download the white paper or visit datavant.com to connect with our team.
