Health Plans Keep Innovating Around Data-Sharing with Providers—Are Providers Noticing?

July 8, 2021
Anthem’s initiative to share real-time data of value to clinicians, with patient care organizations, is yet another signal that health plan leaders are getting serious about collaborating to improve patient outcomes

As I reported yesterday, “A few months ago, the Indianapolis-based Anthem, Inc., one of the largest U.S. health plans, which serves 107 million Americans, including 43 million in its health plans, announced a new initiative focused on health information exchange between Anthem and provider organizations.” The press release published by Anthem described it thus: “Anthem, Inc. (NYSE: ANTM) today announced an effort to facilitate secure, bi-directional exchange of health information between healthcare providers and Anthem’s affiliated health plans, as a result of its collaboration with Epic. Increasing and improving this communication aims to better leverage data-driven insights in care decisions, simplify healthcare, and ultimately improve health outcomes.”

Anthem’s press release quoted Ashok Chennuru, the company’s chief data and insights officer, as saying in a statement, “As an organization committed to a digital-first approach, we know that enhancing the interoperability of health data is critical in redefining the future of healthcare. This effort helps bring the industry into the next step of its evolution where the right information gets to the right people at the right time – resulting in a more seamless healthcare experience and consumers receiving the care they need – where and when they need it.”

Essentially, Anthem has collaborated with Epic Systems Corporation, leveraging Epic’s Payer Platform to create bi-directional exchange of data using on clinical data as well as admissions, discharge, and transfer data from hospital stays. Epic’s Payer Platform will be integrated with Anthem’s Health OS, which is Anthem’s operating system to enable seamless health plan-provider collaboration. Anthem has already gone live in providing this service to the leaders at MetroHealth system in Cleveland.

Streamlining administrative processes, such as prior authorization: Providers will be able to send prior authorizations through Epic instead of using phone or fax. Health plans can then quickly make decisions and electronically communicate back to the provider – lowering administrative burden and freeing up staff to spend more time on care.

The key areas of focus are: streamlining administrative processes, such as prior authorization, by allowing providers to send prior authorizations through Epic instead of using phone or fax; enhancing care management through providing clinicians with near-real-time access to consumer health data, to provide insight into preventive care recommendations and address care caps, such as around medication adherence; notifying providers of significant health events.

The press release quoted David Kaelber, M.D., Ph.D., M.P.H., MetroHealth’s chief medical informatics officer, as stating that “Being able to better communicate and reduce the amount of time we need to spend on administrative processes will allow our clinicians to spend more time delivering care. Improving exchange and interoperability of data will help us give consumers the healthcare experience they have come to expect,” Dr. Kaelber stated. And, of course, as the press release noted, the capability is bi-directional, so the leaders of patient care organizations including MetroHealth will be sharing information back, creating a data flow that will benefit everyone involved.

Meanwhile, in that article, I also interviewed Ashok Chennuru, and obtained his perspectives on this initiative. With regard to why the Anthem people are doing this, Chennuru told me, “I see this as a differentiator with other plans. So, we want to make this foundational, in the context of collaboration with providers. So the conversation shifts from, why are we denying claims, to pivot the conversation to be more focused on the consumer and the member.”

Not surprisingly, he reported to me, the MetroHealth leaders have reacted “very positively. They’re extremely pleased with the collaboration. And on the Anthem side, our care managers now have almost instantaneous access to information in the medical record, as the providers do. So our care managers—before, we had to make calls or wait for information or get faxes; now, the information is readily available to the care managers,” he said.

Importantly, he added, “In the past, care managers might have been gathering information on their own. Now, the information is right there, so the conversation is around how we can help and support providers, rather than on information-gathering. And more importantly, we’re not sending mixed messages, with Anthem care managers sending conflicting information to members and therefore confusing the providers. And in terms of digital adoption—if plumbers can now engage in digital adoption, why can’t we? And we plan to integrate everything into the mobile app that’s consumer-facing.”

I fully understand that some hospital, medical group and health system leaders, especially those whose organizations are still overwhelmingly operating in the fee-for-service world, might still be skeptical about these kinds of initiatives; after all, many of them are still involved in day-to-day struggles with health plans as payers. But you know what? This Anthem initiative is the real deal, and because of Anthem’s reach, there’s a real possibility that it will in fact end up distinguish itself from its competitors in various markets by implementing this service for a variety of hospitals, medical groups, and health systems to use. And right now, it’s limited to Epic’s product, but it was clear to me in speaking with Chennuru that he’d like to expand it to include other EHR vendors’ products as well.

And this is but one example of a broadening range of collaborative outreach moves being made by health plan leaders towards provider leaders, around a whole spectrum of different types of activities, including population health management and care management, data analytics, and other areas. Indeed, we’re awarding a health plan one of our Innovator Awards this year (and the name of that organization will be revealed later this month) for a highly collaborative analytics-for-population-health initiative.

So—things are happening. And the leaders of the most pioneering patient care organizations know it. It’s time to throw out any outdated perceptions of health plans, because the landscape around payer-provider collaboration is changing now by the month—and this Anthem initiative is just one of numerous examples of rubber-meets-the-road collaboration that everyone should be noticing.

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