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 and 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 exchange, 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 such as HL7v2 (ORUs, ADTs) and FHIR. At the same time, they are tasked with evaluating vendors, selecting platforms, and developing implementation roadmaps, all while trying to understand how AI and machine learning can streamline workflows, improve data accuracy, and reduce administrative burden.

But successful implementation is not just about launching new technologies. It is about activating them. Without a thoughtful, well-structured engagement and adoption strategy, payers risk deploying expensive, technically sound solutions that fail to resonate with providers, underperform in utilization, and create confusion or additional costs.

That is where Horizon Health Solutions excels.

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

Take prior authorization automation as an example. The opportunity is clear: faster approvals, fewer manual steps, and better turnaround times for both providers and patients. But what if a provider’s EMR is not compliant or integrated? Will providers know how to use the new features? Are alternative access points available? What impact will this have on clinical workflows, revenue cycle timing, or quality metrics?

These are not just technical questions; they are human ones. And they require clear, actionable answers.

Horizon Health Solutions has created a robust, scalable education and training framework designed specifically for these challenges. We co-develop engagement strategies with our payer partners to ensure that internal teams, downstream vendors, and provider groups are all aligned. Our approach includes tiered training (101, 201, 301), value-focused messaging, and workflow-driven communication that makes adoption both intuitive and impactful.

We do not just ensure technical readiness. We support full organizational readiness. That includes helping payers avoid common pitfalls such as provider resistance, delayed rollouts, or underutilized tools. It also means delivering a seamless, proactive provider experience that highlights how automation can improve patient outcomes, accelerate revenue, and reduce administrative friction.

By combining regulatory expertise, operational insight, and deep provider empathy, Horizon Health Solutions helps payers turn mandates into meaningful, scalable results.