Health IT & Interoperability

CMS is tightening the operational infrastructure around Medicare Advantage and interoperability: a proposed rule would improve MA provider directory accuracy and add PBM transparency, while stakeholders are being pushed to prepare now for 2027 federal requirements on prior authorization, Star Ratings, and related digital process changes. At the same time, CMS’ prior authorization pledge gained additional backing from major employers and health care organizations, signaling growing pressure for standardized, electronic prior auth workflows that reduce administrative burden and improve access—key for ACOs, MA plans, and risk-bearing providers managing network adequacy, quality, and utilization. These moves reinforce that VBC organizations need to treat interoperability, directory data, audit readiness, and AI-enabled risk adjustment as core operating capabilities rather than compliance side projects. CMS MA directory proposal | prior authorization pledge