As the volume and velocity of healthcare data continues to accelerate, health plans face mounting pressure to not only manage information effectively but also leverage it as a true strategic asset. At the center of this transformation lies provider data—long plagued by fragmentation, inaccuracies, and outdated processes.
We sat down with Keith LoMurray, VP of Platforms and Data at Kyruus Health, to discuss how health plans can modernize their data strategy, embrace AI, and unlock new opportunities for collaboration and member engagement.
Key Takeaways
- Solve Fragmentation Incrementally: Instead of massive consolidation projects, focus on real-time data ingestion and a unified data hub that syncs with existing systems.
- Evolve Directories into Marketplaces: The future provider directory is an all-in-one tool for members to research, check costs, and book appointments seamlessly.
- Use AI as a Universal Translator: AI can consume and standardize data from different sources, making true payer-provider interoperability achievable without forcing rigid data schemas.
- Adopt an Agile Mindset: Health plans must shift from a “perfection-first” culture to one that embraces rapid experimentation and iteration to harness AI’s full potential.Â
Tackling the Fragmentation Problem
Data fragmentation is a persistent challenge. What new approaches do payers need to consider to build and maintain a more reliable foundation for provider data?
Keith: The core of the problem is twofold. First, payers are not the source of truth for most provider data—things like locations, office hours, and whether a provider is accepting new patients can change constantly at the provider level. Second, internal fragmentation within health plans makes it difficult to maintain consistency across legacy systems and acquisitions.
Historically, the response was massive, multi-year consolidation projects. But these often fail to deliver value in the near term.Â
A better approach is incremental delivery:
- Real-time ingestion: Rather than relying on providers to push updates, payers should integrate directly with health systems, third-party partners, and even providers’ online presence to capture changes as they happen.
- A unified data hub: Â Instead of replacing every legacy system, health plans should create a provider data management platform that serves as the central source of truth, syndicating clean data across downstream systems via modern APIs.
This approach addresses fragmentation without the disruption of a full-scale system overhaul.
From Managing Data to Mastering It
With the volume and velocity of healthcare data exploding, how can health plans move from simply managing data to mastering it as a strategic asset?
Keith: Success starts with a clear, goal-oriented strategy. “Boiling the ocean” is a recipe for failure. Instead, leaders should define their most critical business goal, whether that’s improving member decision-making, reducing costs, or enhancing provider engagement.
For example, if the goal is to empower members, enriching provider profiles with details like photos, philosophy of care, availability, and scheduling is far more valuable than just keeping addresses accurate.Â
By creating a marketplace of data sources—combining internal information with third-party integrations—health plans can transform data from a static database into a driver of outcomes like improved member guidance and satisfaction.
The Next Evolution of Provider Directories
The traditional provider directory has evolved. What new demands will be placed on the data backbone moving forward?
Keith: The provider directory is evolving from a static, digitized phone book into a dynamic, actionable care marketplace. While data accuracy remains a foundational requirement and an industry-wide challenge that is yet to be solved, it is now merely table stakes. The next evolution is about creating a transactional, all-in-one experience where members can research, decide, and act.
Today’s members are frustrated by directories that force them to go elsewhere—like Google or a health system’s website—to get the full picture and book an appointment. The future experience must be a one-stop-shop. This means the data backbone must support a host of new, integrated data types in near real-time.
We’re moving beyond just names and addresses to integrating:
- Cost Transparency Data: Including advanced explanations of benefits (AEOB) so members understand costs upfront.
- Actionable Scheduling: Embedding real-time provider availability and direct booking capabilities, regardless of the underlying EHR or scheduling solution.
The goal is a seamless digital journey where a member can confirm a provider treats their condition, see what it will cost, understand their benefits, and book an appointment—all in one interaction.
AI as the Translation Layer
What’s one bold prediction for how AI will foster payer-provider collaboration?
Keith: AI will make true interoperability possible by acting as a universal translation layer. For years, payers and providers have wanted to share accurate data, but the lack of a scalable mechanism has been the barrier. Generative AI can consume data in any format, structured or unstructured, and standardize it without forcing everyone into one rigid schema.
This changes the game. Providers gain richer, more accurate profiles, and payers can ingest and distribute clean, consistent data without endless reconciliation.
Shifting Culture to Embrace AI
What strategic and cultural changes must health plan leaders make to harness AI’s potential?
Keith: The biggest barrier is mindset. The industry’s “perfection-first” culture, driven by compliance, creates paralysis. In an AI-driven world, success depends on agility. Leaders need to embrace experimentation, deploying solutions that are valuable even if not perfect, then iterating quickly based on feedback.
It’s about adopting a crawl, walk, run approach: start small, learn, and scale—while maintaining guardrails for compliance and security.
Building the Workforce of the Future
As AI reshapes the future of work, what investments in technology and talent are most critical?
Keith: A decade ago, AI strategy meant a centralized team of data scientists. That model is outdated. Today, the barrier to entry for AI is lower, with powerful solutions already embedded in platforms like AWS, Google Cloud, and Azure. The real differentiator is how you apply them.
The bigger investment is in talent. Organizations need to democratize AI by training their workforce to use it as a collaborative tool. Instead of a small group of gatekeepers, every employee should be empowered to experiment with AI to solve problems and improve workflows.
This cultural and skills shift, combined with thoughtful governance, positions health plans to use AI not as a replacement for people but as a force multiplier.
Looking Ahead
As AI and interoperability redefine the healthcare data landscape, payers face a clear choice: continue struggling with fragmentation and incremental fixes, or embrace a new paradigm of real-time, unified, and enriched provider data. Those who act boldly, reframing data as a strategic asset and empowering their people to collaborate with AI, will set the pace for the industry’s next era.
We’ll be exploring these topics further at eSolutions Xchange, taking place August 24 – 27, 2025 in Kansas City, MO. Join us there to continue the conversation.