An antidote to the One Big Beautiful Bill: Breaking healthcare silos through innovation | Viewpoint

The complex and often fragmented world of healthcare struggles with cost pressures, workforce shortages, and transforming legacy systems.

While pre-existing challenges like inflationary gaps in Medicare/Medicaid reimbursements have been difficult, they’re overshadowed by the $1 trillion in federal spending cuts anticipated under the newly enacted One Big Beautiful Bill Act (OBBBA) through 2034. This could have devastating implications for payers and providers without effective planning strategies and new operating models.

Early planning starts with four practical steps that can prepare organizations for success:

1. Convene a governance committee to ensure compliance and promote cross-functional collaboration
2. Define clear outcomes to enable shared goals, innovation and accountability
3. Assess IT tech stack needs and define KPIs to automate processes, ensure compliance, accelerate decision making, and measure performance
4. Identify the right partners to minimize risk and implement technology, infrastructure, analytics, and KPIs

Transcending the pull of silos

The need to break down silos is central to meeting the OBBBA challenge. When organizational silos persist, collaboration is threatened, resulting in reduced efficiency from process duplication, decision-making disparity due to limited cross-team input, and restricted creativity, which stifles innovation.

Overcoming the difficulties that result from organizational silos – essential for the anticipated challenges of OBBBA – requires considering their key causes and ways to address them.

1. Legacy systems and fragmented technology

The use of outdated or incompatible systems impedes innovation and the processing of data stored in different formats. When updated platforms are in place, innovative strategies are possible as new technology enables scalable, real-time collaboration. Flexible infrastructure and advanced tools – Gen AI, machine learning, and Agentic AI – unlock automated workflows, on-demand data, and accelerated time to market.

Transforming Legacy Systems:

• Enable interoperability platforms and APIs that promote seamless data exchanges between payers, providers, and patients using standards like HL7 FHIR
• Implement AI for automation and predictive insights for claims processing, fraud detection, and prior authorizations
• Centralize data into a unified, scalable platform to improve analytics and real-time decision-making

2. Cultural and organizational resistance

Over time, departments or teams develop their own processes, tools, and priorities. Silos are often less about an organization’s structure and more about its culture.

Overcoming Cultural Resistance:

• Enable collaborative versus hierarchical leadership to promote decision-making more inclusive teams
• Invest in learning to advance teamwork and more collaborative interactions
• Replace fragmented, department-specific communication with standardized, transparent, and real-time exchanges

3. Misaligned leadership, governance, and competing incentives

Different departments may have conflicting goals or KPIs, discouraging collaboration. In contrast, a shared vision and strategy can guide teams through uncertainty.

Aligning leadership, governance, and incentives:

• Establish shared KPIs that reflect both clinical and operational success
• Create cross-functional governance teams to oversee strategic initiatives
• Tie incentives to cross-functional outcomes, such as member or patient satisfaction, operational efficiency, and care quality

4. Data privacy and compliance concerns

HIPAA, GDPR, CMS and state laws enact strict rules on data sharing, consent, and encryption. Organizations may limit data exchange across departments to avoid penalties, even when regulations allow broader sharing.

Ensuring data privacy and compliance:

• Embed data privacy into core operations, integrating compliance requirements into workflows and technology from the start
• Reinforce cybersecurity measures to minimize concerns over data privacy risks, employing AI for detection and encrypting protected health information

5. Financial and resource constraints

The investments required to upgrade systems, train staff, and enable collaborative processes are significant. Time, budget, and staffing limitations can make cross-functional initiatives feel like a luxury, and a lack of resources can make it difficult to see duplication.

Enabling financial and resource flexibility:

• Establish opportunities for shared resources to avoid duplication across departments
• Prioritize high-impact investments and tools that improve interoperability, such as integrated systems
• Optimize processes by automating repetitive tasks to free staff for collaborative work

Offsetting the major causes of organizational silos is necessary to address the challenges of OBBBA. Collaboration between government, payers, providers, vendors, and nonprofits is necessary to adapt to the legislation’s significant changes.

The impact of innovation

Technology transformation is a key enabler of innovation because it serves as the foundation on which new ideas can be built, tested, and scaled. Innovation breaks down silos by reshaping how people, processes, and technologies interact.

Advanced technology, like process mining and predictive analytics, provides cross-organizational visibility and real-time data access, enabling faster decisions and positive patient experiences.

Solutions that break down silos and support innovation achieve this by providing visibility across organizations and activating synergy across operations. Advanced technology creates cross-organizational visibility, showing stakeholders where bottlenecks occur.

With real-time access to accurate data, teams can develop creative strategies, arrive at more informed and faster decisions, and deliver consistent, positive experiences to members and providers. When organizations integrate innovative tools effectively with operations, human insights and expertise can thrive.

Organizations clinging to fragmented data will struggle under OBBBA. The antidote lies in the interconnected strategies of collaboration and innovation. By fostering cross-functional practices and integrating intelligent automation, AI, and advanced analytics, healthcare leaders can build resilience, transcend barriers, and thrive under OBBBA.

Chris Shiffert is chief growth officer at Sagility.