The regulatory landscape for healthcare payers is evolving at an unprecedented pace. With increasing oversight, longer audits, and complex filing requirements, organizations must prepare for heightened scrutiny. Disjointed data and fragmented response strategies are no longer sustainable—compliance efforts must evolve into proactive, strategic initiatives that ensure accuracy, transparency, and trust.
This article explores how healthcare payers can turn regulatory challenges into opportunities by implementing smarter data foundations and aligning compliance efforts with enterprise strategies. Experts from Sequoia Insight and Teradata will discuss emerging trends, payer vulnerabilities, and actionable solutions for transforming regulatory response into a competitive advantage. Join us at the Industry AI Symposium to gain insights that can shape your organization's approach to compliance and risk management.
As uncertainty builds at the federal level, state regulators remain focused on evolving their oversight of healthcare payers. From market conduct filings and all-payer claims databases to alternative payment models and prescription drug reporting, today’s regulatory landscape isn’t just expanding, it’s accelerating.
For healthcare payers, the implications are enormous. As Medicaid federal funds appear targeted for cuts and cost-sharing burdens on states look to increase, oversight is intensifying, audits are lasting longer, and filing requirements are more demanding. In this environment, the stakes for getting your data right (and your response model clear) have never been higher.
At the upcoming Industry AI Symposium, Kevin Ericson, Regulatory Lead from Sequoia Insight, will lead a session on what this shift means for payers and how organizations can prepare. Ericson and I will discuss regulatory trends, payer vulnerabilities, and how smarter data strategies can turn compliance into competitive advantage.
Regulatory pressure is no longer a back-office concern
Healthcare regulation is no longer the domain of siloed compliance teams or periodic checklists. Today’s regulators have not only improved their technology, data literacy, and coordination, they are also employing greater creativity to test accuracy and transparency in filings.
Whether it’s the Market Conduct Annual Statement (MCAS), All-Payer Claims Databases, or RXDC submissions to federal agencies, the volume and complexity of required filings is rising. States are increasingly holding payers accountable for metrics like claim denials, appeals handling, and total medical expense trends. That accountability includes the expectation of consistency across filings, regardless of which department submits them or which program and regulatory authority is being addressed.
When those expectations aren’t met, the consequences go beyond fines. Regulatory skepticism can not only lead to delayed rate approvals and frozen assets, it can undermine a payer’s financial standing with investors.
The real risk: Disconnected data and disjointed response
For many organizations, regulatory response is still reactive, fragmented, and labor-intensive. Different teams are responsible for different filings. Data definitions vary by department and regulatory authority, and known data issues are poorly tracked and communicated, let alone addressed consistently, across the enterprise.
The data is never perfect. But if one team can explain a data issue clearly, and another team can’t, it’s not just inconsistent. It’s risky. It weakens trust with regulators and limits your ability to see and articulate what’s really going on inside your business.
When multiple regulatory responses are built on different truths, credibility erodes. The ability to demonstrate transparency, consistency, and control is not only a regulatory requirement; more than ever before, it’s a competitive advantage.
The case for a smarter, more adaptable data foundation
Teradata helps payers build a centralized, scalable data foundation that enables regulatory agility. By layering a regulatory lens on top of enterprise data, payers can produce consistent, explainable outputs for all filings, without duplicating effort.
This model supports:
- Shared views across regulatory teams to align messaging and minimize contradictions
- Rule-based data validation and harmonization through tools like Teradata’s Reference Data Manager
- Pre-submission forensic analysis for accuracy, transparency, and defensibility
- Support for structured and unstructured data, enabling payers to classify documents, reconcile variances, and surface key audit details automatically
- Concurrent, multi-use data strategies, so one trusted dataset can serve operations, compliance, and analytics alike
When payers take a deliberate, programmatic approach to regulatory response, they gain accuracy and control. Instead of scrambling for submissions or reacting to audits, they build trust with regulators, safeguard their financial reputation, and reduce the cost of compliance.
Attend the summit: See what’s possible
The Industry AI Symposium will explore how leading healthcare payers are transforming regulatory operations with data, automation, and intelligence. Sequoia Insight’s Kevin Ericson will provide expert insight into emerging regulatory trends, while I will highlight how regulatory functions can benefit from a consistent, deliberate, enterprise approach.
You’ll leave with insight into:
- The evolving regulatory climate and what it means for your organization
- The risks of fragmented data and disconnected teams
- The technology and strategy that can transform your data from a liability into a regulatory asset
It’s no longer enough to be responsive. Payers need to prepare, align, and lead.
Join us at our upcoming virtual summit to explore how leading payers are putting these capabilities into action—and what it could mean for the future of healthcare operations.