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Humana Inc., a leading health and well-being company, and Epic, developer of the nation’s most widely used comprehensive health record, are entering a new stage of their joint effort to improve patient, provider, and health plan collaboration.
Data interoperability is sought after by various players in the specific market. Holon Solutions, for instance, has built a patented technology software, CollaborNet®, which provides healthcare practices with patient insights so that they can focus on delivering optimal patient care.
But, since data, including health-related data, means assets for these companies, not all of them have been so keen on sharing it, even when this could mean better healthcare.
Epic, America’s largest electronic health record company, has launched an effort to block the flow of its data into apps that could benefit the healthcare system.
The company, a major beneficiary of a $48B Obama-era program to adopt EHRs, has made clear it will try to stop a proposed rule to support the seamless and secure exchange of health data.
The two companies aim is to reduce the administrative burden in healthcare by securely exchanging information between providers and the health plan.
In their first 18 months of partnership, clinical data for more than a half-million of Humana’s health members has been shared. Humana’s Real-Time Benefits Check (RTBC) tool, IntelligentRx, which delivers real-time prescription benefit information in Epic’s platform, has been utilized by over 50,000 providers.
During the next phase, Humana and Epic will add support for automated prior authorizations and member insights at the point of care. What electronic prior authorizations do is reduce the time providers need to verify whether a certain procedure is covered by insurance. The bottom line of the process is better and more rapid access to care for patients. Member insights allow information from Humana (for example, preventative services that are past due, history of medication adherence, and care coordination for known chronic conditions) to drive real-time decision support in providers’ systems.
“The past year has shown us how important it is to share data so that we can understand the health of patients and members, communicate with their providers to address chronic conditions, understand gaps in care, and reduce barriers to getting that care,” said Alan Hutchison, vice president of population health at Epic. “Throughout our partnership, we’ve witnessed Humana’s dedication to innovation and the health of their members. The success of this first phase shows there is a tremendous opportunity for the future.”
The other solution Epic and Humana will deliver in 2021 includes decision support for specialist referrals. Basically, physicians will receive help to choose in-network providers when referring a patient to a specialist, which is going to reduce the costs otherwise supported for consulting a specialist outside the network.
Ochsner Health, Louisiana’s largest non-profit academic healthcare system, will be one of the first to implement prior authorizations and member insights, supported by Humana. These features will allow the clinician to remain in current workflows—not switch systems or screens—when ordering procedures. Humana and Epic designed these features together, the aim being to lessen the burden on providers and improve the timeliness of prior authorization decisions.
“Having a comprehensive view of our patient’s medical history and health insights allows our clinicians to dedicate more time to addressing health concerns and setting a course for treatment,” said Philip Oravetz, MD, chief population health officer at Ochsner Health.
Humana has continuously formed partnerships and is not at its first collaboration for better healthcare support. Back in 2018, it was working with Walgreens, in order to form a partnership between the two companies, following the setting up of a pilot program that saw the opening of two senior-focused care centers in existing Walgreens stores in Kansas City, Missouri, to serve Medicare patients.
As part of another, more recent agreement, Humana was going to deploy IBM Watson Assistant for Health Benefits, an AI-enabled virtual assistant built-in the IBM Watson Health Cloud. At first, the service will be available to all of Humana’s 1.3 million Employer Group medical members, and 1.8 million of Humana’s Employer Group dental members.
“Humana is taking a proactive approach to improving the experiences of patients and physicians with partners like Epic,” said Alan Wheatley, president of Humana’s retail segment. “By increasing the efficiency of health plan interactions and delivering valuable health insights at the point of care, we increase physicians’ ability to provide efficient, quality care.”
Humana Inc. (NYSE: HUM) is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.
Founded in a basement in 1979 with 1½ employees, Epic develops software to help people get well, help people stay well, and help future generations be healthier. More than 250 million patients have a current electronic record in Epic.
Their software is used in academic medical centers, children’s organizations, community hospitals, dental clinics, hospice, independent practices, integrated delivery networks, mental health, multi-specialty groups, payers, rehab centers, retail clinics, safety net providers, skilled nursing, patient’s homes and their portable devices.