Engagement, Education & Adoption

In an increasingly regulated environment, U.S. payers are under immense pressure to meet evolving compliance mandates while balancing cost, accuracy, and member/provider satisfaction. One of the most transformational mandates on the horizon is CMS 0057F, which imposes sweeping changes to how prior authorizations, patient access, payer-to-payer, and provider interoperability are handled—with an effective date looming on January 1, 2027.

While the regulatory deadlines are firm, the pathway to readiness is anything but straightforward. Payers are navigating complex technical landscapes, juggling legacy infrastructure, disparate data feeds, and multiple data standards—ranging from HL7v2 (ORUs, ADTs) to FHIR. Simultaneously, they're tasked with conducting vendor evaluations, platform selections, and implementation roadmaps—all while seeking to understand how AI and machine learning may further streamline workflows, improve data accuracy, and reduce administrative burden.

But successful implementation is not just about standing up new technologies—it’s about activating them. Without an intentional, well-structured engagement and adoption strategy, payers risk rolling out expensive, technically sound solutions that ultimately fail to resonate with providers, fall flat on utilization, and introduce unnecessary confusion or cost.

That’s where Horizon Health Solutions excels.

We go beyond compliance checklists to help payers strategize for adoption at scale. Our approach begins with aligning the data modernization journey to the payer’s highest-value use cases, ensuring the foundation is not only compliant but purposeful. We then work closely with cross-functional stakeholders—product owners, operations leaders, provider relations teams—to design an executable activation and engagement plan that drives real behavioral change across the ecosystem.

Take prior authorization automation as a prime example. The opportunity is clear: faster approvals, less manual intervention, and improved turnaround times for providers and patients alike. But what happens if a provider’s EMR isn’t compliant or integrated? Will providers know how to access the new functionality? Are alternative access points available? How do these changes impact clinical workflows, revenue cycle timing, or even quality metrics?

These are not just technical questions—they’re human ones. And they demand clear answers.

Horizon Health Solutions has developed a robust, scalable education and training framework tailored to these exact challenges. We co-develop engagement strategies with our payer partners to ensure internal stakeholders, downstream vendors, and provider groups alike are all aligned. Our approach includes tiered training (101, 201, 301), value-based messaging, and workflow-driven communication to make adoption intuitive and valuable.

We don’t just support technical readiness—we ensure organizational readiness. That means helping payers avoid common pitfalls such as provider pushback, delayed adoption, and underutilized tools. It also means delivering a seamless, proactive provider experience—one that highlights how automation improves patient outcomes, expedites revenue, and reduces friction.

By bringing together regulatory fluency, operational insight, and deep provider empathy, Horizon Health Solutions enables payers to transform mandates into meaningful, scalable outcomes.