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Health Care
Mandates arrive on a schedule. Operating models do not.
Interoperability, cost structure, program recovery and integration work for health systems, payers and the companies that supply them.
The sector
We work with health systems, payers, post-acute providers and the companies that supply them — on the operating problems sitting underneath the compliance calendar. Interoperability. Cost structure. Programs that have stopped moving. Integration after a deal.
The reflex is to run each mandate as its own project, with its own team, its own vendor and its own end date. That meets the date. It also leaves the organization holding a stack of compliance artifacts and no change to how anything actually operates — which is precisely why the next mandate costs as much as the last one.
Start here
CMS-0057-F is an operating decision with a date attached.
The rule puts prior authorization, patient access and payer-to-payer exchange on a single clock. Most organizations are running it as an API delivery programme, which meets the date and changes nothing about how the organization works.
The difference between those two readings shows up two years later, when the next requirement arrives and the capability built for this one turns out not to be reusable.
- CMS-0057-F
In scope - Prior authorization APIs, patient and provider access, payer-to-payer exchange.
- FHIR enablement
In scope - The API layer, and the data work underneath it that decides whether the API returns anything useful.
- Cost structure
In scope - Labor, throughput and site-of-care economics — the part that is structural rather than cyclical.
- Program recovery
In scope - Clinical, claims or ERP programmes that have stopped moving.
- Clinical advice
Not us - We do not advise on care, protocols or anything requiring a licensed clinician.
- EHR implementation
Not us - We do not resell or implement EHR platforms. We govern the programmes around them.
What is changing
Three shifts we are working against.
01
Interoperability stopped being an IT question
CMS-0057-F puts prior authorization, patient access and payer-to-payer exchange on one clock. Organizations treating it as an API delivery will pay for the same capability again inside three years.
02
Margin pressure is structural, not cyclical
Labor cost, payer mix and site-of-care shift have all moved at once. Cost programs that reach only discretionary spend run out of room in the first year.
03
The workforce question became a capacity question
Staffing shortfalls stopped being a hiring problem. They are now a question of what the operating model asks of the people already there.
Where we work
Across the sector, not one corner of it.
Payers & health plans
Post-acute & behavioral health
Life sciences & med-tech
Digital health & HCIT
What we bring
Every service line, applied to Health Care.
Our thinking
What we pride ourselves on.
True of every Taidou engagement regardless of sector — and the three things we are most often told are unusual.
The person who scopes it runs it.
There is no handoff between the team that wins the work and the team that does it. If you met someone in the first conversation, you will still be dealing with them in the last one. This is the single thing clients tell us they notice first.
We write down what we are not doing.
Every engagement starts with a scope that names the things we have deliberately excluded and why. It makes the first conversation harder and every conversation after it easier.
We stay past the point it is comfortable.
Most firms hand over when the design is agreed and the change has been announced — the moment of maximum fragility. We hand over to named owners after it is running, and we come back to check.
Common questions
Before you call us.
Both, and the companies that supply them. A meaningful amount of the work sits precisely where the two meet, which is also where most of the interoperability difficulty lives.
Yes — and the first conversation is usually about whether meeting it as a filing or meeting it as an operating change is the right call for your organization. Those are different programmes with different costs.
No. Nothing we do requires a licensed clinician and we do not advise on care delivery, protocols or clinical judgement. We work on the operating and financial systems around care.
We govern programmes that touch it and we work with your implementation partner. We do not resell or implement EHR platforms and we take no vendor fees.
Where the sector meets
The sector calendar.
March
HIMSS Global Conference
Health information and technology
June
AHIP
Health insurance and plans
October
MGMA Leaders Conference
Medical group practice
December
CHIME Fall Forum
Health IT leadership
Related thinking
What we have published on this sector.
Research
Interoperability isn't a compliance deadline. It's a business model.
CMS-0057-F is being treated as a date to survive. The organizations treating it as an operating decision are the ones still compounding on it in three years.
ResearchWhy transformation programmes stall at month nine
WorkBack-office migration across three delivery centres
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