Clinical Data Interoperability:
Unlocking Health Plan Value-Based Reimbursement
By Katrina Parrish, MD, Chief Medical Informatics Officer, The SSI Group
November 19, 2025
From 2020-2025 the adoption of value-based care (VBC) models by payers has been steady, due to rising healthcare costs, regulatory pressure, and the need for better member health outcomes. As of 2023, approximately 39.2% of private health plan payments in the U.S. were made through VBC arrangements, up from 34.6% in 2022, and early reports suggest an increase in adoption from 2024 to 2025.1
Value-based care has proven to enhance provider collaboration and member care quality, and also drive measurable gains in payer revenue, margin recovery, and financial sustainability. For organizations that lack robust data exchange, there is an opportunity to improve VBC performance. With seamless clinical data interoperability, payers gain operational and financial advantages to reach their full potential.
The Cost of Poor Data Interoperability
Health plans relying on chart chasing, incomplete provider data, and slow information exchange are not getting the most out of their VBC programs and with thin margins, efficiency is even more important. Time-consuming manual processes often drain resources and make it harder to hit quality benchmarks. When access to clinical data is limited or delayed, it hinders timely interventions, and risk adjustment is less precise.
Alignment with healthcare providers also suffers. In a study conducted with more than 400 providers and payers, 48% of providers reported that payer gaps in data availability have produced negative effects on VBC performance.2 Reducing provider abrasion with automated processes is a clearer path to success. In the value-based world, where contract performance directly influences reimbursement, shortcomings mean missed revenue opportunities.
The ROI of Clinical Data Interoperability
Reduced Administrative Burdens
Automated, interoperable data exchange eliminates manual chart retrieval, freeing up staff time and reducing overhead.
Faster Reporting Cycles
Annual reporting can be time-consuming and a drain on staff resources. Ongoing access to FHIR-based clinical data decreases workloads and time to submission.
Improved Risk Adjustment Accuracy
Access to complete clinical records through interoperable systems enables more precise coding and documentation of member conditions. This improves risk stratification and ensures plans receive appropriate reimbursement for high-risk populations.
Enhanced Quality Ratings and Incentives
Real-time data sharing allows health plans to proactively close care gaps, improve HEDIS scores, and qualify for performance-based bonuses. Accurate reporting can also strengthen competitiveness and NCQA/CMS Stars ratings, resulting in bigger payouts.
Stronger Value-Based Care Performance
Clinical data interoperability that supports data integrity leads to better care coordination, smarter population health management, and interventions in advance of reporting deadlines. Focusing on these areas helps payers succeed in value-based care, improving outcomes for both members and the bottom line.
The Foundation for Better Care and Stronger Financial Results
Modern interoperability platforms powered by APIs, FHIR standards, and compliant cloud-based data exchange make seamless clinical data access possible and scalable. With the right technology partner, clinical data becomes timely, secure, and actionable.
For health plans, automated clinical data aggregation is an essential technology upgrade for effective VBC. Ready access to clinical data improves care quality, future-proofs operations, and produces stronger financial results.
Is your data collection working as smoothly as you’d like?
Let’s discuss how SSI can help you tackle interoperability challenges and make things easier. Send me at note at katrina.parrish@ssigroup.com.
To learn more about the impact of IT on clinical data, check out
Why Technology and Clinical Data Strategy Must Align for Healthcare Quality Improvement
References
1AHIP. (2024, November 14). Survey shows health plans are expanding value-based arrangements to deliver higher-quality, more affordable health care. AHIP.
2Jackson, R., Dotson, K., & Shaikh, M. (Jan. 2024). Why providers are struggling to succeed under value-based care. HFMA.
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