September 29, 2026

The hardest part of healthcare interoperability isn’t technical

By Srihari Muthyala, director of Technology, Cambia Health Solutions

Every day, thousands of prior authorization requests sit in limbo. A patient needs an MRI. Their doctor submits the request. Then everyone waits, sometimes for days, while information that already exists in multiple systems gets manually reviewed, re-entered and routed through approval chains.

It’s 2026, where AI can diagnose diseases from medical images and robots can perform surgery. Yet we’re still playing telephone with basic healthcare data. And when that happens, everyone loses. Providers lack complete information, patients can’t access their own records, and payers miss the full clinical picture.

The disconnect comes from use of multiple systems that were never designed to talk to each other. That’s finally changing — but only if everyone in healthcare, not just IT departments, does their part to make it work.

Testing what’s possible when systems connect

Earlier this year Cambia joined 15 other Blue Cross Blue Shield plans at the 2026 Centers for Medicare & Medicaid Services (CMS) Connectathon — a massive tech rehearsal where health plans, software vendors and healthcare providers test whether their systems can exchange information using standardized FHIR (Fast Healthcare Interoperability Resources) APIs.

We partnered with organizations like MEDHOST, Darena Health and CorroHealth to run real-world scenarios, processing 64 Coverage Requirements Discovery responses and validating prior authorization workflows across different platforms. We stress-tested the actual technology that will power healthcare data exchange starting Jan. 1, 2027, when CMS mandates electronic prior authorization for certain services.

The results proved what we hoped: Systems can talk to each other, information can flow seamlessly, and prior authorizations that used to take days can happen in real time.

Interoperability needs more than tech teams

So what will it take to bring all this progress to scale?

In a recent blog post, my colleague Ylan Kazi, VP of Clinical Analytics and Data Innovation, wrote about the need to move beyond simply optimizing existing processes and instead fundamentally rethink how healthcare should work.

I couldn’t agree more. We can build the most elegant APIs and implement perfect FHIR standards, but if the rest of the healthcare ecosystem keeps operating in silos, we’ll just automate the same broken processes.

To be clear, breaking down siloes is no small task. One of the biggest surprises in my career has been discovering that the hardest part of interoperability is not building connections between systems. It’s building alignment between organizations, processes and people.

Yet that’s what this moment demands. Real interoperability won’t happen because IT flips a switch. It will happen when every part of the organization starts designing for connection.

Here’s what that might look like:

• Clinical teams designing care pathways and documentation requirements with data flow in mind — right from the start.

• Policy and compliance teams crafting coverage policies and prior authorization criteria that providers can easily discover and systems can interpret.

• Operations and member services designing workflows that assume seamless data exchange rather than building in manual workarounds.

• Product and network teams making interoperability a non-negotiable requirement when evaluating partnerships and pushing back on proprietary systems that lock information away.

The Connectathon showed us the technology works, and we’re confident we’ll be ready for Jan. 1. But readiness can’t stop at compliance. The goal isn’t simply to make prior authorization easier to process. The goal is to make it nearly invisible to providers and patients.

I’m encouraged to see momentum building across the industry to turn this vision into reality. There’s a clear consensus that the healthcare system can and must work better than what we have today. We have the technology to prove it. What we need now is for everyone to help make it happen.