By Kelly Gwynn, Chief Operating Officer

Last week was one of those weeks that reminds you why governance and collaboration matter.

We began in Arlington, Virginia at the Surescripts offices, where the DirectTrust Board and Commission gathered for a full day of meetings. In one day, we held a Commission Meeting, a Board Meeting, heard a presentation from our legal and policy advisor Jodi Daniel, partner at Wilson Sonsini Goodrich & Rosati, on HTI-5 and its impacts, and concluded with a joint Board/Commission strategy session focused on the impacts of HTI-5, accreditation, and membership.

Bringing the Board and Commission together in the same room created space for something we don’t always get enough of: intentional collaboration. The conversations were not simply operational updates, rather they were forward-looking and focused on strategic planning.

Trust and Transparency Take Center Stage

Immediately following our governance meetings, we traveled into Washington, D.C. for the Assistant Secretary for Technology Policy (ASTP) Annual Meeting, where “Trust and Transparency” set the tone from the opening panel: Health Technology for Transparency and Affordability.

Moderated by Steve Posnack, Principal Deputy Assistant Secretary for Technology Policy, the discussion focused squarely on what transparency truly means for patients — not just access to data, but clarity in cost, accountability in systems, and the ability to make informed decisions.

Cynthia Fisher, Founder and Chairman of PatientRightsAdvocate.org, shared compelling examples of how pricing transparency directly impacts patients’ ability to navigate care. Her message was clear: Transparency is not theoretical; it affects real financial and health outcomes. As she said, “Transparency is transformative.”

Jocelyn Keegan, Vice President of interoperability at Aetna and DirectTrust Commissioner, highlighted Aetna’s efforts to ensure cost transparency through tools such as cost estimators and fee schedule visibility. The panel reinforced something we discuss frequently within our community: Transparency requires both policy direction and operational execution.

The takeaway? Rules alone do not create trust. Implementation does.

On the Hill: The Next Generation of Community Care

Later that day, members of our team headed to Capitol Hill to attend the Senate hearing, “Building a 21st Century VA Health Care System: Assessing the Next Generation of VA’s Community Care Network.”

We heard testimony from Richard F. Topping, Assistant Secretary for Management and Chief Financial Officer for the U.S. Department of Veterans Affairs (VA), regarding the Veterans Community Care Program (VCCP) and the Community Care Network (CCN) Next Generation procurement.

His testimony outlined a significant modernization effort. The VA is not simply “purchasing” community care, it is reshaping how that care is measured, incentivized, and managed. Under CCN Next Gen, the VA is introducing a 10-year multiple-award IDIQ contract vehicle designed to increase competition, modernize provider networks, and drive continuous performance improvement.

At its core, the redesign is anchored by several defining elements:

  • There are five pillars: Quality, Value, Alternative Payments, Utilization Management, and Program Integrity
  • The goal is not volume. The goal is outcomes.
  • The VA estimates that the cost-containment framework could reduce community care spending by 8–14% over the life of the contracts — potentially between $54 billion and $100 billion over the next decade.
  • Those savings are expected to come from fewer unnecessary hospitalizations, better management of high-cost services and drugs, improved quality, and stronger fraud and payment controls

What stood out most, however, was the emphasis on choice and accountability. In fiscal year 2025, 41.8% of all VA health appointments were delivered in the community. Veterans want flexibility. They want care that meets them where they are. And they want systems that protect both quality and taxpayer resources.

Sound familiar?

Across the week — from our own Board and Commission discussions to ASTP’s focus on transparency to the Senate’s review of VA modernization — consistent themes emerged:

  • Trust must be measurable;
  • Transparency must be operationalized;
  • And governance must be intentional.

What This Means for DirectTrust

HTI-5, evolving transparency requirements, value-based payment reform, accreditation rigor, membership structure — these are not separate tracks. They are converging forces shaping the future of digital health.

As a community convener, ANSI-accredited standards body, and accreditor, DirectTrust sits at the intersection of policy intent and operational reality. Our work in accreditation, technical trust frameworks, and ecosystem collaboration directly supports the type of modernization and accountability being discussed at the national level.

Last week reinforced something important for our team: The national conversation around trust is accelerating. The question is not whether transparency and accountability will expand. The question is how well the infrastructure — technical, organizational, and governance — is prepared to support it.

That is the work ahead. And it is work worth doing.