Epic Partnering With Insurer HCSC on ‘Payer Platform’

June 17, 2020
Exchange of information between HCSC health plans and providers who use Epic to streamline administrative processes, such as prior authorizations

The nation’s fifth-largest health insurer, Health Care Service Corp., is launching a health information platform through Epic — establishing a two-way exchange of information at the point of care between HCSC and providers in its networks who use Epic’s EHR.

HCSC has nearly 16 million members in its health plans in Illinois, Montana, New Mexico, Oklahoma and Texas. It is an independent licensee of the Blue Cross and Blue Shield Association. This agreement, one of the first of its kind between Epic and a large insurer, is designed to make secure information exchange between insurers, providers, and patients more efficient.

While other efforts such as the HL7 Da Vinci Project are taking a standards-based approach to payer-provider data sharing, this agreement takes advantage of Epic’s widespread use to avoid having to work through some of those interoperability hurdles. Epic’s software is used by more than two-thirds of providers and patients across the country, HCSC noted.

HCSC said its agreement with Epic would establish a secure “Payer Platform” for two-way exchange of information between HCSC health plans and providers who use Epic to:

• Review patient data (medical records, emergency room visits, diagnostic evaluations, lab results, claims, etc.).

• Streamline administrative processes, such as prior authorizations, paying claims, and other points of service.

• Facilitate a care management strategy and identify gaps in care, helping patients make smart care choices that will help reduce personal health care costs.

 “Sharing data between payers and providers at the point of care is a great way to make a real difference in patient care and lower health costs,” said Krishna Ramachandran, vice president of provider performance at HCSC, in a statement. “This agreement will help advance access to a truly integrated value-based care delivery system, while giving our providers and members actionable information to make more informed care decisions.”

“This relationship connects the provider, the payer, and the patient in a trusted network,” said Alan Hutchison, vice president of population health at Epic, in a statement. “It will enable a more robust, data- driven approach to improving patient health. It will also streamline administrative processes such as the authorization process for providers, so patients can receive more timely access to appropriate care.”

The Payer Platform will launch later this year for select providers and health systems across HCSC’s five states who already use Epic.