In late July, the Centers for Medicare and Medicaid Services (CMS) announced it had achieved commitments from some of the largest healthcare and information technology organizations to create a next-generation digital health ecosystem. CMS aims to enhance information-sharing between patients and providers and help patients make informed health decisions using individualized tools.
The announcement builds on an earlier CMS Health Technology RFI, which received more than 1,400 comments.
What do health plans need to know about the digital health ecosystem outlined by CMS? Read on to find out:
Who are the key players in the digital health ecosystem announced by CMS?
CMS structured the ecosystem around voluntary criteria of the CMS Interoperability Framework for different categories of participants:
CMS Aligned Networks
These are health information networks, exchanges, and other health technology platforms that commit to implementing the Framework criteria, including clinical and claims data, and responding to patient, provider, and payer requests. Twenty-one networks have already pledged to become CMS Aligned Networks.
EHRs & Providers
EHRs must make electronic medical information accessible to CMS Aligned Networks. That includes providing structured data via FHIR and unstructured clinical documents (e.g., PDFs, JPGs, TIFs), and provide appointment/encounter notifications within 24 hours. Seven EHR companies have committed to facilitating data exchange and helping “kill the clipboard.”
Providers
Providers must join CMS Aligned Networks and support patient-centered workflows for real-time access to electronic medical information. Eleven health systems or providers have committed to participating.
Payers
Participating payers must join or create a CMS Aligned Network. They must also make claims data accessible to these networks in alignment with Patient Access and Provider Access API standards. Health plans also commit to implementing the Framework criteria and responding to patient, provider, and other payer requests.
Patient-Facing Apps
These apps will integrate with CMS Aligned Networks to deliver immediate value to patients through secure, user-centered, and connected tools. They must support data exchange with patient identity verification using CMS-approved services for strong digital credentials. Thirty companies have pledged to promote real health outcomes with technology.
What are some specific initiatives and tools?
The initiative focuses on several practical use cases:
“Kill the Clipboard”
CMS aims to eliminate manual check-in forms and fragmented data collection by enabling patients to share their verified health and identity information directly with providers at the point of care using modern digital tools built on FHIR, and to receive their visit record back. The use of digital insurance cards and health history via QR codes, Smart Health Cards, or Smart Health Links is part of the Kill the Clipboard initiative.
Conversational AI Assistants
These AI-powered assistants will deliver personalized, context-aware guidance by securely accessing and interpreting patients’ medical history for tasks including symptom checking, care planning, coordination, and chronic disease support.
Diabetes & Obesity Prevention and Management
CMS plans to enable tailored, data-driven support for individuals at risk or living with diabetes and obesity, powered by direct access to clinical data from trusted networks.
Data Accessibility and “Blue Button Claims Data”
A core principle is patient access and empowerment, allowing patients to access and share their electronic medical information, including claims, explanations of benefits (EOBs), prior authorizations, and clinical data, using applications of their choice. Patients will use a single digital identity credential to access their information, eliminating multiple portal accounts. The system will also provide an accounting record of all network-facilitated transactions, detailing who accessed data, when, and for what purpose.
Blue Button claims data is electronic health information from patient claims and EOBs that CMS is making accessible. CMS is developing infrastructure to reduce the time between when claims are received and when they become accessible through Blue Button, accelerating data availability for patients and developers. CMS plans to share Blue Button claims data through CMS Aligned Networks as early as the first quarter of 2026. This integration requires payers to make claims data accessible to CMS Aligned Networks in alignment with Patient and Provider Access API standards.
Other Foundational Efforts by CMS
CMS is also building foundational elements to support this ecosystem, including:
- An Enhanced Plan Finder on Medicare.gov to help beneficiaries select plans.
- A National Provider Directory with a FHIR-based API to help apps find provider networks and endpoints, and to improve data quality.
- Modern Digital Identity for Medicare.gov to enhance security without disrupting current user accounts.
- FHIR-based digital insurance cards.
- Integrating digital identity and the National Provider Directory into the Data at the Point of Care (DPC) program.
What impact will this new technology ecosystem have on health insurers?
The new health tech ecosystem initiative announced by CMS will impact health plans, requiring their active participation and adaptation to new data exchange standards and patient-centric approaches.
Here’s a breakdown of the key impacts on health plans:
Participation and Alignment with the Framework
Major payers, including Aetna, Elevance Health, Humana, Medicare (CMS), and UnitedHealth Group, have already voluntarily pledged to participate in this initiative as “early adopters.” Participating payers are required to join or create a CMS Aligned Network, a type of health information network, exchange, or health technology platform that voluntarily commits to aligning with the CMS goals for interoperability within the new digital health ecosystem. They must implement the CMS Interoperability Framework criteria.
Enhanced Data Exchange and Access
Health plans must make claims data accessible to CMS Aligned Networks, adhering to Patient Access and Provider Access API standards. They are also required to respond to patient, provider, and payer requests for information.
The initiative aims to remove roadblocks and streamline data access for payers and their delegated partners. Payers and value-based care organizations will be able to query for specific quality data elements necessary for payment or healthcare operations. They can also query for relevant data tied to a claim submitted in the last 60 days and receive associated clinical data.
CMS plans to share Blue Button claims data through CMS-Aligned Networks as early as the first quarter of 2026, accelerating data availability for patients and developers.
FHIR-based digital insurance cards could be available as soon as this year to app developers and Medicare.gov users. By July 4, 2026, networks (which include health plans) must provide or facilitate access to data using Fast Healthcare Interoperability Resources (FHIR) APIs.
Focus on Patient Access and Empowerment
A core goal of this initiative is to enable patients to easily access and share their health information, including claims, explanations of benefits (EOBs), and prior authorizations, using applications of their choice. Health plans will need to facilitate this direct patient access to their payment-related information.
The system aims to allow patients to access data using modern digital identity solutions, removing the need for multiple accounts and passwords for each healthcare website. CMS wants to simplify the patient experience, but requires backend integration from payers.
Operational and Business Impacts
The initiative builds on efforts to improve healthcare quality, reduce medical errors, lower healthcare costs, and promote a more effective marketplace and greater competition.
The push for interoperability and digital tools, such as “Kill the Clipboard” features, aims to reduce provider burden and bring healthcare into the digital age, moving away from slow, costly, and incompatible existing systems. CMS wants to deliver efficient interactions between providers and payers.
CMS designed its planned ecosystem to provide personalized support to patients anytime, anywhere, and help manage chronic conditions like diabetes and obesity through apps and digital tools. Health plans could see better patient outcomes and potentially reduced long-term costs.
Health plans will also benefit from streamlined data flow and improved data quality within a national provider directory. This can enhance coordination of care.
Privacy and Security Considerations
CMS designed the ecosystem to be entirely opt-in, with no centralized government-run database for patient records. However, digital privacy advocates have expressed skepticism about data security. They are concerned that the initiative could lead to the further use and monetization of sensitive and personal health information by tech companies and the federal government. CMS has stated that entities must share patient consent preferences. Networks must enforce access control and consent policies appropriate to the data access context. They also require HITRUST certification or equivalent security validation.
Learn more:
- Trump administration is launching a new private health tracking system with Big Tech’s help
- White House, Tech Leaders Commit to Create Patient-Centric Healthcare Ecosystem
- President Trump Delivers Remarks on Making Health Technology Great Again
- White House and CMS to launch Health Tech Ecosystem Initiative to expand use of digital health with a focus on consumers
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