
The success stories emerging from payer-provider collaborations offer a hopeful counterpoint to the fragmentation and frustration so often heard about in healthcare. These strategic alignments between payers, providers, and health IT vendors prove that streamlined operations, better care delivery, and stronger financial outcomes are not just possible but repeatable.
Each year, the KLAS K2 Collaborative Points of Light report highlights real-world partnerships that have delivered measurable impact. These case studies are diverse in approach and context, but they share a common foundation: a deep commitment to solving long-standing healthcare challenges together.
Five Common Challenges
The challenges addressed in these partnerships fall into five broad categories: value-based care, prior authorization/utilization management, provider network management and patient registration, payer-to-payer data sharing, and payment efficiency/data access.
Of these challenges, two are most common: Value-based care and prior authorization. Nearly half of the recognized partnerships focused on improving clinical data exchange and documentation to support value-based initiatives. Their solutions included point-of-care alerts, predictive analytics, and real-time risk scoring—all contributing to better coding accuracy, faster care-gap closure, and improved Star Ratings.
Meanwhile, about one-third of the collaborations aimed to untangle the red tape of prior authorization and utilization management. These groups employed AI reasoning engines, real-time data exchange via FHIR, and EHR-integrated authorization tools to reduce delays and lighten the administrative load on clinicians.
Real Outcomes, Not Just Intentions
What unites these diverse projects is their measurable success. Most partnerships reported dramatic gains in operational efficiency: redundant manual tasks were eliminated, turnaround times shrank from weeks to hours, and administrative burdens eased.
But the improvements went beyond logistics. Many organizations saw meaningful gains in care quality and coordination, and their patient experience. With better data, clinicians made faster and more accurate decisions. Patients were directed to the right specialists more quickly, and once-overlooked populations became newly engaged.
Data sharing, once a persistent hurdle, also improved significantly. More mature interoperability models allowed stakeholders to move from simply sharing information to using it to drive action.
And in the world of value-based care, partners reported stronger CMS, HCC, and HEDIS ratings, more proactive interventions, and enhanced clinician satisfaction. By aligning on data, incentives, and workflows, these organizations have advanced the quality of care their patients receive.
Illustrating Impact: Partnership Examples
The Points of Light report shared 25 examples of partnerships that exemplify the power of providers, payers, and their vendors, coming together to solve mutual problems. Here are three standout stories from those case studies:
Cutting Registration Time and Errors with the Epic Payer Platform
Manual patient registration at Healthcare Organization 7 caused costly delays and coverage errors. In partnership with Humana, Epic, and the CARIN Alliance, the organization used the Epic Payer Platform to access coverage data and digital insurance cards from the payer. The result? Faster registrations, with less friction for staff and a smoother experience for patients.
Streamlining Prior Authorization with Epic Payer Platform eMPA
Ballad Health was overwhelmed by their process of managing prior authorizations. With support from Ensemble and UnitedHealthcare, they implemented Epic’s electronic medical prior authorization (eMPA) tool. This led to significant reductions in time spent on prior authorizations, decreasing the administrative burden.
Building a FHIR-Based Network for Interoperable Prior Authorizations
To support CMS’ interoperability rule (CMS-0057-F), eHealth Exchange partnered with several payer and provider organizations to create a networked FHIR service. Instead of countless point-to-point connections, participants now use a single integration to share prior authorization data. This foundational work significantly streamlines trusted exchange.
Each of these examples shows that collaborative thinking, supported by the right technology and shared goals, can lead to profound improvements for all sides.
Best Practices: What Makes These Partnerships Work?
Behind each of these successes are lessons in change management any healthcare organization or payer can learn from. While every collaboration is different, several best practices emerged:
Build Trust Through Open Communication. Many collaborations talked about the importance of open, early communication. Partnerships that started with co-designed roadmaps, clearly defined expectations, and strong kickoff meetings were better equipped to navigate complexity. Including all stakeholders from legal, IT, clinical, and executive teams helped create alignment from day one.
Secure Buy-In at All Levels. Strong executive sponsorship helped provide direction, accountability, and resources. But successful collaborations didn’t stop at the top. Engagement from end-users was critical for tool adoption, and workflow relevance. Long-term success depends on keeping up with this consistent collaboration and communication between all levels.
Start Small, Scale Smart. Most successful projects began by implementing focused pilots, allowing teams to test hypotheses, refine tools, and demonstrate quick wins. From there, thoughtful scaling that anticipated future needs helped plan for customizations and internal resources. This was further anchored by a methodical, data-driven rollout and robust training, allowing for broader deployment without sacrificing quality or trust.
Monitor, Measure, and Improve. Baseline benchmarks and clear success metrics helped teams prove ROI and maintain momentum. Real-time dashboards enabled proactive problem-solving and helped maintain stakeholder confidence. In short, these partnerships didn’t just implement new tools—they built systems to evaluate and evolve them.
A Brighter Path Forward
These partnerships offer more than inspiring anecdotes—they represent a practical playbook for transformation. By working together, payers, providers, and vendors are rewriting the rules of engagement in healthcare, moving from friction to collaboration, from inefficiency to agility, and from fragmentation to alignment.
For those ready to tackle healthcare’s toughest problems, these stories offer both validation and a roadmap. The future may still hold challenges—but as these partnerships prove, it also holds great promise.
About Aurence Wilford
Aurene Wilford is KLAS’ Insights Director for the K2 Payer/Provider Collaborative. As a Research Psychologist she has worked in healthcare research for over 20 years and for the past three years has focused on highlighting the successes of payer, provider, and health IT partnerships.