Strategic collaborations between payers, providers and health IT vendors are accelerating gains in healthcare efficiency, quality and financial performance, according to the latest KLAS Points of Light report.
The initiative recognized 25 partnerships in 2025 that demonstrated measurable impact in areas such as value-based care (VBC), prior authorization and data interoperability – each of which has become more urgent under new CMS mandates.
The report identified six major areas of payer-provider friction, with nearly half the featured collaborations focusing on value-based care initiatives such as HEDIS tracking, risk adjustment and closing care gaps.
These efforts frequently used tools like predictive analytics, real-time risk scoring and structured bidirectional data sharing to boost outcomes.
Another third of the partnerships tackled the historically burdensome processes of prior authorization and utilization management, leveraging AI-driven decision engines and EHR-integrated tools to reduce delays and clinician workload.
WHAT'S THE IMPACT
Interoperability proved to be a dominant theme: 24 out of the 25 collaborations involved some form of clinical data exchange, an increase from 2024.
Technologies such as FHIR-based APIs and provider directory solutions were commonly used to address CMS-0057-F requirements.
Other focus areas included network management, payer-to-payer data sharing and payment efficiency, with some partnerships building new digital infrastructures in anticipation of 2027 mandates.
For example, in Case Study 2, an in-home health assessment provider partnered with Humana to replace a slow weekly data exchange with a FHIR-based Clinical Data Exchange API.
By enabling real-time sharing of member data, the collaboration improved data accuracy, operational efficiency and health outcomes for Humana's members.
The report also underscored a growing trend toward AI-enhanced automation, with nearly one-third of partnerships using intelligent tools to support clinical reasoning, documentation and workflow improvement.
Among the most common benefits were enhanced workflow efficiency, improved patient experience and stronger interoperability.
Automated processes and integrated workflows helped eliminate manual tasks and drastically reduced turnaround times, for instance, compressing prior authorization delays from weeks to mere seconds.
These improvements cut administrative burdens, enhanced data accuracy, and supported smoother coordination between payers and providers.
Clinically, better access to real-time, comprehensive data enabled faster and more informed decisions, leading to improved care quality and patient engagement.
In Case Study 8, for example, an unnamed healthcare organization partnered with payers Moxe Health and Cotiviti to ease the annual burden of medical record requests by automating the release of information for quality and risk adjustment.
The result was a faster, more efficient process that saved time for the parties involved.
To streamline care-gap closure and reduce clinician burnout, the unnamed healthcare organization in Case Study 18 worked with Humana and Veradigm to embed real-time alerts into its EHR.
The integration improved clinical decision support, resulting in better patient care and a lighter administrative load for providers.
THE LARGER TREND
The KLAS report noted that successful strong payer-provider partnerships relied on clear communication, early stakeholder involvement and shared goals, which starts with co-designed roadmaps, upfront transparency, and the inclusion of legal, IT and clinical teams to streamline workflows and build trust.
The report said organizations that used a pilot-first approach were set up for scalable growth, allowing teams to refine tools before expansion.
Meanwhile, monitoring progress with real-time dashboards and defined metrics helped quantify ROI, track performance and resolve issues early, ensuring lasting impact and continuous improvement.