A recent survey conducted by WEDI, a national association for health IT guidance and collaboration, underscores significant delays among both providers and health plans in preparing for The Centers for Medicare & Medicaid Services (CMS)’s Interoperability and Prior Authorization Final Rule (CMS-0057-F). The rule introduces new requirements-including Fast Healthcare Interoperability Resources (FHIR) implementation and prior authorization performance metrics, with deadlines beginning January 1, 2026.

Key Findings from the WEDI Survey

52% of providers have not yet started work on the required Application Programming Interface (API) implementations
44% of providers are unsure of total implementation costs and training needs.
43% of payers have not begun technical work on APIs
Only 31% of payers report being at least 25% through implementation.

Survey respondents identified several barriers:

Uncertainty around resource requirements and enterprise strategy
Workflow and business process redesign challenges
Gaps in internal technical capacity and vendor readiness

Context & Implications

The rules phased deadlines – starting with prior authorization metrics reporting, followed by full API implementation by January 2027, means most organizations are already behind schedule.

Return on Investment: What Early Adopters Are Seeing

Organizations that have moved early on implementation report meaningful gains in operational efficiency and care delivery:

85% of prior authorization responses are returned in near real-time
Up to 300% improvements in productivity for both provider and payer teams
Significant reductions in administrative burden and costs, including fewer phone calls and manual follow-ups
Enhanced provider-payer collaboration and improved patient experience through faster decision-making at the point of care

These early results point to the broader opportunity: aligning with the CMS rule not only meets compliance requirements but also creates a pathway to more streamlined, patient-centered operations.

Support for Stakeholders Navigating Implementation

Leavitt Partners, an HMA Company, provides technical, policy, and convening support to provider and payer organizations responding to the final rule. Our work is grounded in cross-sector engagement and pragmatic execution, with current projects focused on:

Readiness assessments and education
Electronic Health Record (EHR) and FHIR API integration strategies
Prior authorization workflow redesign
Multi-stakeholder testing and state-level alignment

Real-World Success: The One Utah Health Collaborative

As part of a state-wide initiative, Leavitt Partners is supporting the design and implementation of a FHIR API-based ecosystem to improve data exchange, prior authorization, and clinical decision support. Key components include:

single sign-on infrastructure
API directory
Real-time prior authorization integrated at the point of care
Measurable reductions in administrative burden

Looking Ahead

Implementation of the CMS Final Rule represents more than a compliance exercise—it’s a foundational step toward modernizing data exchange and improving care coordination. With timelines fast approaching, organizations may benefit from shared learning, coordinated planning, and targeted technical assistance.

At Leavitt Partners, we bring deep experience supporting interoperability initiatives at both the national and state level. Whether you’re just beginning to assess organizational readiness or actively working through technical implementation, our team can help you navigate policy requirements, align internal stakeholders, and design solutions that are both practical and scalable.

To explore how we can support your team or to participate in shared implementation efforts, contact the Leavitt Partners digital health team.

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