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From Mandate to Momentum

How Health Plans Can Align Compliance, the Prior Authorization Reduction Pledge, and Business Goals 

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Health plans and the health tech vendors who support them are juggling three critical tracks right now: 

1. Compliance requirements like those under CMS-0057
2. The new industry pledge by CMS and major payers to reduce prior authorization burdens across government and commercial plans
3. Their own strategic objectives and interoperability roadmaps are aimed at improving provider collaboration, operational efficiency, and member experience 

Too often, these tracks are treated as separate initiatives. This session will help health plans understand how to connect the dots—leveraging the work and investments they’re making for CMS-0057 compliance to support both the industry’s prior authorization commitments and their broader business strategies. 

Key topics this panel discussion explored: 

• Common challenges payers face in implementing CMS-0057, and how these same hurdles can slow progress on PA reform and strategic interoperability goals 

• Practical ways to repurpose the APIs mandated under CMS-0057 to support faster, more transparent prior authorization processes 

• How payers can tackle skepticism from providers and patient advocacy groups who doubt the industry’s commitment to meaningful PA reductions 

• The critical role of data quality, governance, and breaking down organizational silos in turning compliance work into strategic advantage 

• Steps health plans can take to align their regulatory, operational, and strategic efforts for maximum impact 

This isn’t just about checking boxes for CMS compliance or issuing public pledges. It’s about using regulatory requirements as a springboard for transformation, streamlining prior authorization, strengthening provider relationships, and delivering better experiences for members.