By Mark Scrimshire, Chief Interoperability Officer, Onyx
In my previous article, I explained how verifiable connectedness works as a mechanism for portable trust in healthcare interoperability. Today I want to address the practical questions: Why is now the right time to act? What does adoption look like? And what’s the business case?
Why Now: The Convergence of Three Forces
Three forces are converging to create both urgency and opportunity for verifiable trust infrastructure.
First, regulatory deadlines are real. CMS-0057 requires payers to implement Provider Access, Payer-to-Payer, and Prior Authorization APIs. The compliance deadline is January 1, 2027, but organizations are building infrastructure now. Those who solve the trust problem early gain competitive advantage; those who don’t face mounting manual verification costs as connection volumes grow.
Second, the technology stack is mature. The vLEI credential system has been deployed globally in financial services. The open-source KERI protocol has production implementations. UDAP/FAST Security is mandated for TEFCA by January 2026. We’re not proposing new standards—we’re combining proven technologies in a novel way to solve a specific healthcare problem.
Third, network effects reward early movers. Organizations that establish credential portfolios now will have accumulated trust signals that late entrants cannot quickly replicate. The competitive moat deepens with each new connection. Waiting means playing catch-up against established networks.
The Business Case: ROI That Scales
The operational economics are compelling. Current manual onboarding costs $500-2,000 per payer-provider connection and takes two to six weeks. With verifiable credentials, established organizations can reduce this to minutes and cut costs by 70-90%.
| Metric | Current State | With Credentials |
| Onboarding time | 2-6 weeks | Minutes |
| Cost per connection | $500-2,000 | $50-150 |
| Manual verification | 80%+ manual | 80%+ automated |
| Audit trail | Fragmented | Built-in |
A growing number of healthcare organizations have acquired a LEI (Legal Entity Identifier). This seeds the digital version, the vLEI (verifiable Legal Entity Identifier).
For a mid-size payer managing 500 new provider connections annually, even conservative estimates suggest $200,000+ in annual savings from reduced verification overhead alone. This doesn’t account for strategic value: faster time-to-revenue for new provider relationships, reduced compliance risk through better audit trails, and competitive positioning as an early adopter.
The Bootstrap Playbook: Starting with What You Have
You don’t need industry-wide adoption to capture value. You need a bootstrap cohort: three to five organizations with existing trust relationships willing to formalize those relationships as verifiable credentials.
Here’s the practical playbook:
Step 1: Identify your anchor relationships. Which payers or providers do you already trust? Who would benefit from faster onboarding with your organization? Start there.
Step 2: Establish organizational identity. Each participating organization obtains a LEI (available for an issuer for around $60 per year, and a vLEI credential—a verifiable Legal Entity Identifier that serves as the root of trust for all subsequent credentials.
Step 3: Issue mutual credentials. Cohort members issue authorization credentials to each other, documenting existing trust relationships in cryptographically verifiable form.
Step 4: Publish and discover. Organizations publish their credential portfolios to the standard .well-known endpoint on their public web site. They will be publishing interoperability configuration information to this public folder as part of any CMS-0057 implementation. New partners discover and verify these credentials automatically.
Step 5: Grow the network. As new organizations approach your cohort, they present their existing credentials. If satisfactory, you issue credentials to them, expanding the network.
What’s Required to Participate
Technical requirements are modest. You need the ability to obtain and manage vLEI credentials (available through qualified vLEI issuers), infrastructure to issue and verify credentials (open-source implementations exist), and publication of credentials via standard web protocols. Most organizations’ existing IT infrastructure can accommodate these additions.
The harder requirement is organizational commitment. Someone needs to champion the initiative internally, secure modest budget for pilot participation, and dedicate technical staff time for integration. Based on our planning, a meaningful pilot requires three to five FTEs over nine months and $250,000-400,000 in total investment. As standard tooling emerges to address these requirements, we expect implementation costs to reduce.
The First-Mover Calculation
In network-effects businesses, timing matters enormously. The organizations that establish trust infrastructure early become the anchors around which the network forms. Their credential portfolios grow deeper. Their verification costs drop faster. Their competitive position strengthens.
Late entrants face a different calculation. They must build credential portfolios from scratch against established competitors. The network they’re trying to join has already formed patterns and preferences. The catch-up cost is real.
We’re at the inflection point. CMS-0057 compliance deadlines are driving urgent need for scalable trust infrastructure. The technology is ready. The first movers are assembling their cohorts now.
Join the Pilot
We’re recruiting organizations for a nine-month pilot program launching in Q1 2025. Participants will help define the technical specifications, demonstrate ROI, and establish the foundation for broader adoption.
If you’re a payer, provider organization, or health information exchange interested in solving the trust problem at scale, let’s talk. The window for first-mover advantage is open—but it won’t stay open forever. I’d welcome a conversation. Please reach to me at mark.scrimshire@onyxhealth.io