Ahead of the K2 Collaborative Payer/Provider Summit, we give the “Points of Light” award to select strategic partnerships between payers, providers, and their vendors. Our goal is to celebrate the work they are doing that improves data sharing, operational efficiency, quality of care, and financial performance.
Our Points of Light 2026 overview report is a great resource that summarizes these case studies and offers a view at the landscape of recent payer and provider collaborations within the K2 Collaborative. 2026 is unique; nearly 80% of this year’s studies focused on optimizing value-based care (VBC) strategies. (For comparison, 48% of 2025’s case studies focused on VBC.)
Check out the full list of 24 individual case studies linked below, organized by the challenge addressed.
Clinical Data Exchange for Improving VBC Strategies
Faith-Based Risk-Bearing Health System 1, Healthcare Organization 1, and PointClickCare addressed major post–acute care visibility gaps. They standardized care-transition workflows and enabled real-time clinical data sharing through PointClickCare’s PAC Management and an AI-driven discharge tool. These tools replaced manual processes with automated alerts, daily risk scoring, and integrated discharge workflows, improving coordination across acute care, SNF, and ambulatory care teams. The collaboration reduced administrative burden, lowered total cost of care, and decreased ED visits and SNF readmissions. Faith-Based Risk-Bearing Health System 1 achieved annual shared savings, consistently ranked in the top national quartile for readmission metrics, and expanded their post-acute care network while strengthening partnerships among payer organizations, healthcare organizations, and SNFs.
Manual legacy data-exchange processes and a history of fragmentation created friction between Humana and Healthcare Organization 3, impeding care coordination and data accuracy. By jointly adopting HL7 FHIR, Da Vinci guides, and modern APIs, the collaborators put in place a standardized, automated framework for member attribution and future bidirectional exchange. This shift has accelerated data intake, reduced administrative burden, and significantly improved the completeness and reliability of clinical information, strengthening quality-measure performance and supporting the partners’ broader VBC goals.
Winn Community Health Center, Louisiana Blue, and Stellar Health deployed a unified, payer-agnostic platform to consolidate gap lists, embed clear criteria, and enable monthly micro-incentives tied to discrete clinical actions. Joint governance, shared data feeds, and integrated operational workflows gave providers a single source of truth and gave the payer organization real-time transparency into engagement and ROI. This collaboration improved HEDIS and Star performance; increased condition assessments to strengthen clinical documentation, HCC coding accuracy, and risk-adjustment data integrity; and reduced administrative burden across teams.
Payer and healthcare organizations were facing high administrative burden and delayed quality insights due to fragmented, payer-specific supplemental data feeds and incomplete claims lacking structured clinical detail. To address these challenges, Epic, Humana, and Ochsner Medical Center in New Orleans collaborated to implement the CAnD standard within Epic Payer Platform. The collaboration made it possible to retire the custom combined file, improved clinical data quality, accelerated access to historical evidence, reduced reporting burden, and established a scalable, standards-aligned foundation for quality measurement.
Healthfirst partnered with Hyphen and independent pharmacies, including Andy Pharmacy II, to tackle persistent medication nonadherence and limited payer visibility within pharmacy workflows. By co-developing the Pharmacy Assistant solution and embedding it directly into existing pharmacy management systems, Hyphen and Healthfirst delivered real-time, member-specific insights at the point of care, enabling pharmacists at Andy Pharmacy II and other independent pharmacies to address adherence risks, care gaps, immunizations, and affordability issues without disrupting workflows.
The Pediatric Health Network (PHN) needed to be able to submit timely, accurate EHR data to Payer Organization 7 to meet their value-based care (VBC) agreement and earn shared savings. However, due to a fragmented EHR ecosystem, the payer was receiving incomplete and delayed data, which hindered care gap closure and reimbursement. To address this issue, the organizations partnered with MRO, a certified clinical data aggregator. This partnership enabled the organizations to achieve more streamlined data sharing and drove substantial improvements in their ability to meet quality measures.
Humana historically relied on fax messages to notify healthcare organizations about medication-related care gaps, but this method led to low response rates, limited visibility into clinician decisions, and provider abrasion. To resolve these challenges, the payer partnered with DrFirst to co-develop NewRx Insights, a pharmacy-agnostic, bidirectional messaging tool that natively integrates within clinicians’ prescribing workflows. Using this tool has resulted in higher clinician compliance rates, more efficient care-gap closure, and reduced administrative burden.
Humana and Guthrie struggled with fragmented portals, duplicate logins, and low digital engagement among members. To combat this, the organizations worked with Epic to develop Happy Together with Health Plans, an integration that embeds payer portal capabilities into MyChart. By aligning security, interoperability, product, and testing teams and meeting regularly throughout the project, the collaborators enabled account linking, digital ID, and benefit visibility within an existing workflow. This initiative drove organic member adoption, reduced front-desk friction, and established a scalable foundation for integrating payer–provider resources.
Brain & Spine Network, MedBen, and Cedar Gate Technologies, an IQVIA Business, partnered to curb escalating brain and spine specialty costs and improve fragmented care navigation by implementing a prospective bundled-payment, Center of Excellence model. Using Cedar Gate’s bundle design capabilities and managed services, the collaborators defined standardized episodes and conservative-first care pathways, and Brain & Spine Network delivered coordinated clinical workflows and high-touch navigation. MedBen reinforced adoption through benefit design changes that reduced member cost sharing and administrative burden. Together, this alignment of incentives reduced unnecessary surgeries, shifted care to lower-cost outpatient settings, and improved the member experience.
- Standardizing MIPS Reporting & Technology Infrastructure Across Orthopedic Practices (Case Study 11)
Healthcare Organization 11 struggled to achieve MIPS compliance due to frequent rule changes and fragmented reporting, and these difficulties caused high administrative burden and financial risk. To enhance their compliance efforts, the organization partnered with Sharecare to standardize quality measures, integrate Sharecare’s VBC platform across the organization’s EHRs, and implement end-to-end MIPS submission support. The collaborators were able to eliminate negative payment adjustments for all of Healthcare Organization 11’s orthopedic practices, improve the practices’ MIPS scores year over year, and strengthen enterprise-wide alignment and documentation quality.
Manual, unstandardized workflows for assessing pregnancy risk were delaying the submission of risk forms and, thus, timely care for pregnant patients. Through a jointly funded, statewide initiative, the healthcare and payer organizations in this case study partnered with Azara Healthcare to automate the creation of risk forms by populating needed data from existing EHR documentation. This automation helped standardize and scale submission of pregnancy risk forms across Ohio, leading to improved submission rates, time savings, and better maternal care.
- Streamlining Behavioral Health Care Coordination Through Interoperable Data Exchange (Case Study 13)
Behavioral health providers at Western Arkansas Counseling and Guidance Center lacked real-time visibility into hospital and ED encounters and relied on manual clinical data submission for quality and risk adjustment reporting, limiting HEDIS and value-based performance visibility for
Arkansas Total Care (a Centene Health Plan). The collaborators leveraged the statewide HIE (SHARE) to enable real-time ADT and CCD exchange. As a result, Western Arkansas Counseling and Guidance Center significantly improved post-discharge follow-up performance. Additionally, Centauri Health Solutions curated and transformed the clinical data so it could be immediately operationalized by the health plan for HEDIS performance and risk adjustment activities.
Aetna CVS Health, Healthcare Organization 14, and athenahealth reduced administrative burden in VBC by replacing manual, fragmented workflows with automated, standards-based encounter-level CCD exchange. Using C-CDA, FHIR, and Da Vinci implementation guides, the collaborators enabled real-time data sharing, reinforced discrete documentation practices, and established ongoing performance reviews. Since go-live, the initiative has scaled broad exchange of encounter-level data, accelerated identification and closure of diagnosis and care gaps, and eliminated the need for providers to submit supporting documentation through payer portals.
Florida Woman Care had a large backlog of medical record requests, exacerbated by manual workflows and limited staffing. This delayed quality reporting and created financial and regulatory risk for both the organization and their payer partners. To address these challenges, the organization partnered with Datavant to centralize request intake and automate record retrieval and delivery directly from the EHR. The collaboration resulted in a significant majority of requests being fulfilled digitally in 2025 and significant time savings for staff.
Suspected conditions were being captured in payer data but not formally documented in clinical notes, leading to an incomplete picture of risk and care gaps. To address this challenge, Centene worked with Epic to integrate deduplicated suspected conditions into clinicians’ native workflows. This ensured that clinicians at Healthcare Organization 17 and other organizations had needed insights at the point of care, leading to better documentation of patient conditions and improved performance with quality metrics.
The collaborators in this case study replaced manual chart reviews and fragmented record requests with automated, group-based data sharing (Bulk FHIR) aligned to national digital quality standards. Using a secure, TEFCA-aligned network and a single connection between organizations, the teams built and tested systems that could exchange large volumes of standardized clinical data for quality reporting. Through ongoing validation and governance, they successfully shared data for more than 5,000 members while ensuring privacy protections were in place. The effort reduced chart-chasing costs, improved record-procurement performance, and shortened reporting timelines.
Sentara Health, an integrated payer-provider in Virginia, faced fragmented outreach across their health plan, CIN, ACO, and care delivery system, resulting in duplicated communications, delayed care gap closure, and administrative burden that impacted both quality and financial performance. Partnering with Upfront, the organization established formal enterprise governance, aligned decision rights, standardized eligibility and suppression rules, and built a reusable engagement framework validated through preventive care programs. With payer sponsorship and shared financial accountability, outreach was consolidated under a unified structure. This reduced duplication, streamlined deployment of new initiatives, and created scalable infrastructure to improve coordination, efficiency, and enterprise alignment.
Sentara Health saw rising potentially preventable ED (PPED) use that increased costs, strained ED capacity, and pressured its medical loss ratio, despite available but underutilized clinical assets. Partnering with N1 Health, the organization used predictive analytics and consumer intelligence to segment high-risk members and deploy targeted phone calls and digital outreach. This led to warm transfers to primary care, urgent care, telehealth, and mobile community clinics. Executive leadership aligned payer and provider workflows and expanded in-network access to alternative sites of care. The initiative reduced PPED visits by over 50% and generated $515,000 in savings.
Payer Organization 24, Veradigm, Insiteflow, and Healthcare Organization 24 partnered to close care gaps by integrating payer-derived SDOH data into provider workflows. Previously, these data points were siloed from independent practices, limiting whole-patient visibility and reducing the effectiveness of quality initiatives. The collaborators embedded SDOH-triggered reminders directly within the EHR, supported referral connections to community resources, and provided structured provider training and embedded care management. As a result, providers gained greater awareness of social barriers, increased engagement during patient encounters, and improved care gap closure among members with identified SDOH challenges.
Prior Authorization
Ochsner Medical Center in New Orleans, Louisiana Blue, and Epic streamlined prior authorization by enabling electronic delivery of authorization letters through Epic Payer Platform, eliminating paper, fax, and portal-based retrieval. By configuring workflows that transmit PDF letters alongside authorization decisions directly into the EHR and to members via MyChart, the collaborators reduced turnaround times, enabled instant decision-making for most cases, and removed manual scanning and cataloging steps. Supported by daily coordination and staff training, the rollout delivered meaningful efficiency gains for Ochsner Medical Center in New Orleans, including 317 hours saved across 2,781 electronic requests and consistent, timely adjudication. Additionally, payer and provider alignment was strengthened for future expansion.
The healthcare and payer organizations in this collaboration were struggling with manual prior authorization workflows, which were increasing the administrative burden and delaying care coordination. To mitigate this challenge, the organizations partnered with Waystar to integrate the payer’s prior authorization workflow into the healthcare organizations’ EHRs. The stakeholders have piloted and achieved automation for imaging and cardiology use cases, leading to high rates of touchless decisions with quick turnaround times. Other outcomes include a reduced administrative burden and increased access to care.
Healthcare Organization 19, Centene, and athenahealth collaborated to replace manual, fragmented prior authorization processes with a standards-based, FHIR-enabled workflow embedded directly in the athenaOne EHR. Using the HL7 Da Vinci Burden Reduction implementation guides, the solution provides real-time insight into authorization requirements, network status, and member benefits at the point of order entry. The organizations worked closely to align technical specifications, CPT logic, and rollout strategy to ensure accuracy, scalability, and provider adoption. The alpha launch across 17 healthcare organizations, including Healthcare Organization 19, delivered near-instantaneous determinations, reduced administrative burden and financial risk, and streamlined workflows and improved readiness for evolving regulatory requirements.
Payer Organization 23 and Healthcare Organization 23 partnered with Rhyme to reduce the administrative burden of outpatient prior authorizations for diagnostic services, which required complex submissions and delegated benefit manager review. Although some services were exempt, limited transparency and transaction issues prevented truly touchless processing. The collaborators integrated a Gold Carding exception program into the healthcare organization’s EHR, enabling automated fast-pass approvals, shared performance dashboards, and automated clinical data extraction for audits. Within six months, touchless authorizations increased from 0% to 14.3%, generating approximately $114,000 in annual labor savings and accelerating patient scheduling.
Payment Integrity/Claims Management
After restructuring their billing workflows, Healthcare Organization 15 saw a surge in hospital billing credit balances that resulted in a backlog. This backlog threatened compliance with the organization’s credit-balance policy and caused administrative burden for Payer Organization 15. This case study looks at how TREND Health Partners worked with the organizations to implement a credit-balance resolution model that streamlined overpayment processing and helped the healthcare organization save hundreds of thousands of dollars while remaining compliant with their credit-balance policy.
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