Health insurer Anthem and electronic health record (EHR) behemoth Epic are partnering on an effort to facilitate bi-directional exchange of health data between healthcare providers and Anthem’s affiliated health plans.
The initiative between the Indianapolis-based Anthem and Epic leverages Epic’s Payer Platform. The bi-directional exchange of data using Payer Platform involves 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, according to officials.
“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,” Ashok Chennuru, chief data and insights officer at Anthem, said in a statement. “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. Our work with Epic stands to benefit more than 14.7 million consumers served by Anthem’s affiliated health plans who see clinicians using Epic’s software.”
Officials say they believe this capability will help close clinical and medication gaps that may exist in an individual’s care. To do this, Anthem will look to capture consumer health information provided by clinicians, analyze that data, and develop data-driven insights. These insights can then be delivered back to the care team – in near real-time – to flag potential care needs and inform treatment decisions, resulting in higher quality care, they contend.
Last year, Epic announced a collaboration with Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), in which the two companies would establish a two-way exchange of information at the point of care between HCSC and providers in our networks who use Epic. Officials at the time asserted that “this agreement is one of the first of its kind between Epic and a large insurer, designed to create a secure, interconnected and efficient health system and information exchange between insurers, providers, and patients.”
To advance digital health and as a part of its broader Health OS strategy, Anthem will also integrate this near real-time data with claims data and health information that Anthem receives from sources such as health information exchanges (HIEs), labs companies, and other partners. This approach allows providers to have a longitudinal view of a consumers’ health, helping clinicians make more informed decisions, officials noted.
The increased exchange of health data should also help enhance many other aspects of the healthcare journey for providers and consumers, according to officials, such as:
- 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 – potentially lowering administrative burden and freeing up staff to spend more time on care.
- Enhancing care management: With near real-time access to consumer health data, clinicians will have additional insight into preventive care recommendations and addressing care gaps, such as medication adherence, to help them develop enhanced care plans that are proactive and personalized.
- Notifying providers of significant health events: Providers will be notified when their patients are discharged from the hospital and encouraged to conduct more timely follow-up care
Payer Platform is available to health systems and providers who use Epic, such as an initial group of health systems that includes MetroHealth System, based in Cleveland, Ohio, that operates four hospitals, four emergency departments, more than 20 health centers and 40 additional sites. MetroHealth’s initial focus on Payer Platform will be on care management and improving follow-up care.
“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,” said David Kaelber, M.D., Ph.D., CMIO at MetroHealth. “Improving exchange and interoperability of data will help us give consumers the healthcare experience they have come to expect.”
