Insurance company Humana Inc. (NYSE: HUM) and Providence, a Washington-based health system with 51 hospitals, are working on an initiative to streamline data exchange that they say is setting a new standard for interoperability between payers and providers in support of value-based care.
By leveraging national HL7 FHIR standards, Da Vinci Project Implementation Guides and modern application programming interfaces (APIs), the data exchange initiative is designed to empower clinicians with timely, actionable insights while reducing administrative complexity and protecting patient privacy.
The partners note that with upcoming federal regulations — such as the Centers for Medicare & Medicaid Services Interoperability and Patient Access Rule (CMS-0057) — organizations will soon be required to provide standardized, secure access to health data.
"The healthcare industry is overwhelmed by fragmented, inconsistent data formats that make care coordination costly and slow,” said Michael Westover, vice president of population health informatics at Providence, in a statement. “Because we want to be successful in value-based care contracts, Humana and Providence are building a shared foundation of administrative, financial and clinical data using national standards and modern technology.”
(Watch for an upcoming Healthcare Innovation interview with Providence’s Michael Westover and Chris Walker, Humana’s associate vice president for interoperability, for an in-depth look at this partnership.)
The first phase — automated member attribution for Humana Medicare Advantage members — will go live this month. This capability ensures providers can quickly and accurately identify which patients are under their care, eliminating manual processes and improving care coordination. This involves exchanging standardized data on attributed and assigned members within a value-based care population, ensuring that both the payer and provider have a common understanding of the patients they serve.
Future phases will expand data exchange capabilities to further reduce administrative burden and enhance clinical decision-making. By automating clinical data exchange, the initiative aims to close quality care gaps, reduce costs, and minimize manual efforts such as chart chasing. This enhances revenue capture and reduces administrative burdens for both providers and payers.
Providence and Humana anticipate their framework will be easily replicable, serving as a scalable model that can transform care across the healthcare industry.
"True interoperability should serve clinicians, patients and payers,” said George Renaudin, Humana’s president of insurance, in a statement. “Together with Providence, we’re enabling providers to deliver more effective care and helping our members spend less time on paperwork and more time on their health.”
