Healthtech infrastructure for insurers and providers

🚀 The Blueprint for Modern Healthcare Applications Your healthtech solution is only as strong as its foundation. The attached infographic outlines the critical functional and non-functional requirements for building modern applications across Payer, Provider, EHR, and FHIR domains. Functional Requirements: ✅ Clinical Data Management: Patient records, labs, workflows, decision support ✅ Billing: Claims, coding, eligibility checks, payments, RCM ✅ FHIR: Standard data models, RESTful APIs, version compatibility ✅ Provider Tools: Scheduling, charting, e-prescribing, population health Non-Functional Requirements: ✅ Security & Compliance: HIPAA, encryption, audit logging, access control ✅ Performance & Scalability: Low latency, load balancing, monitoring tools ✅ Interoperability: HL7/FHIR support, API compatibility, data mapping ✅ Usability: ADA compliance, responsive design, multilingual UI Who Should Explore This? Developers & Architects: Ensure robust, scalable, and compliant systems Business Analysts: Translate complex clinical and billing needs into solutions Healthcare Leaders: Invest in future-ready infrastructure Follow this link to join community: https://lnkd.in/gNcR-yHh #HealthcareIT #DigitalHealth #FHIR #EHR #HIPAA #Interoperability #HealthTech #HealthcareInnovation #SoftwareDevelopment #USHealthcare #RCM

This morning I published a deep dive analysis on the massive health tech opportunities emerging from CMS Administrator Dr. Oz's keynote at the 2025 Quality Conference and the new 13th Scope of Work initiative. The big picture: CMS is fundamentally shifting from building government tech to creating an ecosystem that enables private innovation. With $1.7 trillion in annual spending and 161 million covered lives, this represents the largest health tech market opportunity we've seen. Key takeaways for entrepreneurs and investors: The Make America Healthy Again movement is expanding reimbursable services beyond traditional clinical care into prevention, nutrition counseling, and behavioral health interventions. CMS committed to deploying a smartphone-based patient communication platform within 12 months, creating immediate opportunities for app developers and patient engagement platforms. AI adoption is accelerating rapidly - Epic reported 80% of their sites already have AI deployed, with 86% reduction in documentation time at some locations. The provider directory modernization alone represents a multi-billion dollar market, with payers and providers currently spending $4.8 billion annually on inefficient directory management. Prior authorization reform is happening now, with major insurers committing to complete overhauls by end of 2025. Fraud prevention tech is becoming critical after the largest healthcare fraud bust in US history involving $15 billion in attempted theft. The 13th Scope of Work running through 2030 provides structured pathways for health tech companies to partner with Quality Improvement Organizations across disease prevention, patient safety, and care coordination. Bottom line: CMS is building the racetrack and wants private companies to be the racehorses. The window for health tech companies to align with these priorities is significant but time-limited given the accelerated implementation timelines. ________________________________ Click on my profile and the link in my bio for the full detailed essay. YouTube link for speech in comments (but the essay is faster to read!) ________________________________ Disclaimer: The views and analysis presented in this essay are my own and do not reflect the positions, opinions, or endorsements of my employer or any affiliated organizations.

Imagine this: You’re in your doctor’s office. You need a test, and the prior authorization is approved before you even leave the exam room.   That’s not a distant vision. It’s the future we’re building…powered by interoperability. BCBS companies are committed to creating a better system of health—one with technology that is faster and more connected. When data flows securely and seamlessly between doctors, hospitals, insurers, and patients, we unlock better decisions, better outcomes, and lower costs.   BCBS value-based care programs show the impact: 9.4% fewer ER visits and 13% lower use of ERs for non-emergent care.   We’ve invested in the digital infrastructure to make this possible, from real-time analytics and interoperable platforms to AI-powered tools and remote monitoring. Together, we can build a health system that’s more personalized, efficient, and equitable for everyone. Learn more about how we are building better care via data sharing and technology: https://lnkd.in/eCA44umq

🧵 The digital bar is high—and healthcare must rise to meet it. A new report from J.D. Power shows that health insurers are still falling behind other industries in delivering a strong digital consumer experience. This isn’t just a UX problem—it’s an infrastructure problem. Consumers expect the same intuitive, personalized experience they get from retail or banking. But healthcare’s data fragmentation makes that challenging without investment in the underlying infrastructure: ➡️ Integrated, longitudinal member data ➡️ Scalable analytics to identify and prioritize impactful interventions ➡️ Tools that can adapt to individual member needs in real-time Health plans can’t afford to focus on digital front-ends alone. To truly close the experience gap, they need modern infrastructure that enables smarter engagement—backed by trusted, timely data. We’re helping our partners do just that. 📖 Article via Fierce Healthcare: https://lnkd.in/gQXQ7uzg #HealthcareInnovation #DigitalHealth #HealthPlans #DataInfrastructure #ConsumerExperience