Providence, Humana simplify data exchange with FHIR-based model

Standardizing member attribution: a deceptively small task

The organizations kicked off their collaboration by focusing on one essential problem: member attribution.

Standardizing member rosters may seem like a minor technical fix. But the impact is significant. Providence reports managing over 80 different member rosters of varied formats across its contracts. Each requires custom processing.

"[Member attribution] seems simple, but it's the core of everything we do," Westover said.

To address that complexity, Providence implemented an FHIR-based API that allows Humana to submit member attribution data in a structured, automated format. Based on HL7's Member Attribution Implementation Guide, the API supports versioning, validation and updates to roster data. This eliminates the need to manually process dozens of inconsistent Excel files, allowing systems to match and manage member lists through a single, consistent endpoint.

"We're using FHIR to actively confirm which members we're jointly responsible for — and that powers everything downstream," Westover said.

This will not only reduce the need for what Westover describes as "an army of 30 people just bringing the data in," but it will also improve patient care.

"We're not calling the wrong patient, asking, 'How did your hospital visit go last Tuesday?'" Westover said. "When you improve patient matching, you reduce the risk of delivering the wrong care or missing care altogether."

The member attribution portion of the collaboration is currently live. According to Providence, it's already improving the quality of data available to support patient care.

"With this shift, we saw a 47% increase in usable clinical data — and no extra work for providers," said Westover. Further use cases are planned. "Next up is claims data, quality measures and integration with the EHR," he added.

Bridging the gap between policy and practice

The collaboration project is closely aligned with federal initiatives to improve interoperability across the U.S. healthcare system.

"The direction from CMS is clear," said Chris Walker, assistant vice president of interoperability at Humana. "If you're in value-based care, you need to be interoperable. We're aligning with CMS, ONC and the White House pledge — not just in principle, but through real infrastructure."

With this work, Providence and Humana are actively developing and testing the standards needed to bring national initiatives like TEFCA and the CMS Interoperability Framework into real-world use.

"We're doing the work that shows what payers and providers need to share, and how to do it in a standardized way," Westover said. "I hope the national networks are paying attention."

Westover reported that this work is ahead of national initiatives in some ways. For example, TEFCA does not currently support member roster data.

"They're not exchanging this kind of data, and there's no implementation guide for it yet," Westover said. "We're not waiting for TEFCA to mature. We're testing the future now with boots-on-the-ground solutions."

Looking to the future

With the member attribution model in place, Providence is preparing to scale. Westover reported Regence, Community Health Plan of Washington and Premera have declared interest in using the collaborative framework to exchange data with Providence.

As advice to healthcare leaders looking for ways to advance interoperability in their organizations, Walker emphasized that the project's success came from solving one concrete problem, using national standards and building a reusable model from the start.

"Pick a spot. Pick a partner. Lean in," he said.

Westover added that though data sharing may start small, the impact will grow exponentially as it scales.

"This is built to be repeated — the more partners we plug in, the more powerful it becomes," he said.

What began as a fix for a specific operational challenge is now serving as a blueprint for scalable, standards-based interoperability. Westover and Walker hope that the collaborative framework will offer a repeatable path forward to improve care, reduce waste and put better data in the hands of those who need it most.

Elizabeth Stricker, BSN, RN, comes from a nursing and healthcare leadership background, and covers health technology and leadership trends for B2B audiences.