In our earlier blog, we detailed the recent Centers for Medicare and Medicaid Services (CMS) Health Ecosystem Pledge Program, which aims to create a patient-centric health data ecosystem centered on interoperability and patient empowerment. We highlighted the key areas we’ll be watching and outlined the work pledge signers must do to turn good intentions into real change. Now, let’s examine who will help bring those intentions to life: multi-stakeholder initiatives (MSIs).

Why MSIs Matter

The CMS pledge is big on vision but light on details about execution. That’s not unusual. Pledges are intended to inspire and drive change and innovation, but they do not provide a step-by-step playbook for achieving a goal. But to avoid creating more silos or duplicative “solutions,” organizations must anchor their work in a strategy of using standards and frameworks that can scale volumes of interoperable health data in a meaningful way. That’s where MSIs come in. MSIs embody the 21st-century model of industry driving standards development to meet their data acquisition and exchange needs while also informing policies that advance our nation’s overall health data ecosystem frameworks.

From the work of HL7s Da Vinci Project, FHIR at Scale Taskforce (FAST), and The Gravity Project to state-level initiatives, MSIs have already laid critical groundwork for the interoperability goals CMS is pushing forward. Their convening power, governance, and technical outputs make them logical vehicles for aligning pledge commitments with actual implementation.

Which MSIs Have a Stake?

Da Vinci Project
The HL7 FHIR Da Vinci Project is closely aligned with CMS interoperability policies, especially around value-based care and burden reduction goals, including transforming electronic prior authorization and data transparency for patients. Its Implementation Guides for Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS) are explicitly referenced in CMS rules. Additional work on payer data exchange (PDex), Formulary and Plan Net supports the pledge’s call for integrated digital ecosystems and improved patient access. Those who signed the pledge can participate in Connectathons and pilot projects through Da Vinci’s Trebuchet Pilot Program to advance implementation of the standards.

• Pledge signers active in Da Vinci include: Epic, Oracle Health, Optum, Blue Cross Blue Shield Association, and Health Care Service Corporation.

FHIR at Scale Taskforce (FAST)
The HL7 FHIR at Scale Taskforce (FAST) has focused on developing the technical infrastructure needed to support nationwide FHIR-based exchange. Its work on identity, trust frameworks, consent, directories, and interoperability testing aligns directly with CMS’s Health Tech Ecosystem pledge.

• Identity and Security: Standards for scalable, cross-network authentication and authorization.
• Consent Management: FHIR-native tools for capturing and exchanging patient consent.
• National Directory: FHIR-based approach to provider and endpoint directories, connected to CMS pilot efforts.
• Testing at Scale: A structured framework for real-world validation through pilots and Connectathons.
  • FAST pledge members initially include: Humana, Optum, Blue Cross Blue Shield Association, Health Care Service Corporation, CMS itself.

Gravity Project
Gravity Project focuses on developing standards for capturing and exchanging social determinants of health (SDOH) data, which CMS has flagged as essential for advancing equity and whole-person care. Without common definitions and codes for SDOH data, digital ecosystems will always be incomplete.

• Gravity Project pledge members include: Humana, AMA, Highmark, Blue Cross Blue Shield Association, Epic, United Health Group, CVS Health, and Elevance Health.

State Initiatives
States like Washington (through legislation such as HB 1357) and Massachusetts (via MHDC collaborations) are showing how state-level policy and public-private partnerships can complement and/or reinforce national frameworks. These aren’t accelerators in the HL7 sense, but they’re proving grounds that strategically align, test and refine what’s possible in real-world systems.

Other Key Communities Driving Alignment

While HL7 accelerators like Da Vinci, FAST, and Gravity are tightly aligned to and enabling CMS policy and technical frameworks, other multi-stakeholder communities are also critical for sustaining pledge momentum. These organizations are already convening stakeholders and building the trust frameworks needed for broad adoption.

• CARIN Alliance
  CARIN has been at the forefront of enabling consumers to access and share their health data using open APIs and FHIR-based standards. Its work on Blue Button 2.0 and common implementation guides for payer-to-app data exchange ensures the patient-facing side of interoperability keeps pace with payer and provider systems. The CMS pledge’s emphasis on patient-centricity makes CARIN’s leadership especially relevant.
• The Sequoia Project
  Sequoia has played a leading role in operationalizing national-scale exchange networks. Its work on data usability, information blocking, and emergency preparedness positions it as a critical bridge between federal initiatives and real-world exchange across networks. Sequoia’s governance and trust-building functions will be key to making the pledge more than a paper promise, including managing TEFCA’s Recognized Coordinating Entity (RCE).
• CommonWell Health Alliance
  CommonWell has established one of the largest national frameworks for record location and exchange, connecting providers, EHR vendors, and now payers. Its ability to scale connectivity across otherwise fragmented networks makes it a foundational community for realizing the pledge’s vision of integrated digital ecosystems.

Together, CARIN, Sequoia, and CommonWell extend the impact of the accelerators and other MSIs by ensuring patient access, governance, and national-scale exchange are all part of the solution. Without their contributions, pledge commitments risk stalling at the pilot stage instead of reaching true ecosystem adoption.

Should Every Pledge Signer Engage with MSIs?

The short answer: yes. Participation can take different forms—formal membership, early adopter participation, or simply attending public calls and testing events (virtual or in-person), such as Connectathons. But sitting on the sidelines while others do the hard work of defining and testing standards and implementation guides isn’t a winning strategy. Your lack of participation may result in getting left behind as others define the way forward, which can have a negative impact on your business because your needs and experiences are not factored into the standards design process.

If companies that signed the pledge want to deliver on their commitments, aligning with MSIs is the most efficient path forward. These initiatives are where standards are developed, tested, and proven to facilitate the exchange of interoperable health data at scale. They’re also the best way to ensure that competitive interests don’t derail progress and that the industry moves forward together.

The Bottom Line

The CMS pledge has put a spotlight on what’s possible. But pledges don’t reduce prior authorization burdens, connect systems, or empower patients with data to achieve wellness; implementing real-world capabilities does. And the groundwork to support implementation is happening in the MSIs that many pledge signers are already a part of.

The question isn’t whether MSIs will play a role in making the pledge a reality. The question is whether every pledged organization and others will recognize that its most strategic move is to jump into the MSI pool and help the industry swim forward together while meeting your business needs

If you’re not sure where your organization should plug in or if you see a gap that might call for a new multi-stakeholder initiative, let’s connect. Contact us to schedule an initial conversation about your goals and explore how POCP can help you take the next step.