- Anthem and Epic on Wednesday announced a collaboration expanding bidirectional data exchange, in a bid to streamline administrative process like prior authorizations, a frequently cited pain point for providers, and give providers more real-time data on patient behaviors like medication adherence.
- The partnership will integrate Epic's payer platform into Anthem's operating system. The Indianapolis-based payer will also combine Epic's information with other sources such as claims logs, health information exchanges and lab companies.
- Providers will also be notified of significant health events, such as when a patient is discharged, in an effort to improve follow-up care.
As more patient health data are captured, providers have been testing how best to use the information to improve treatments. Knowing, for example, that a patient hasn't been taking prescribed medication regularly can help doctors better understand health conditions.
The new partnership will impact more than 14.7 million patients covered in Anthem-affiliated plans who see clinicians using Epic software, Ashok Cennuru, Anthem's chief data and insights officer, said.
Under the deal, Anthem's payer platform will be available to health systems and providers who use Epic. MetroHealth System, a four-hospital system in Cleveland, is one of the initial providers on the platform, Anthem said.
The payer will be able to capture consumer information from the clinician, analyze it and develop insights it can then send back to a care team to inform treatment decisions. The heightened data sharing involves clinical data as well as admissions, discharge and transfer data from hospital stays.
Under two sweeping interoperability regulations finalized by HHS early last year, hospitals are required to be able to send ADT data to other providers, or potentially be cut off from Medicare reimbursement. ADT notifications are correlated with a reduction in later re-admissions, according to research published in the Journal of the American Medical Informatics Association in 2017.
Interoperability has been a thorny issue for the healthcare industry. Epic in particular has been criticized for a perceived unwillingness to improve data sharing with other EHR vendors, and came out as a vocal opponent against HHS' effort to penalize information blocking.
However, Klas rated the company as among the best for making external data usable in a report late last year.
Prior authorization has also been a sticking point between payers and providers. The latter have heavily criticized Anthem for requiring prior authorization for more and more procedures in recent years.
The Trump administration in January finalized a rule requiring payers with Medicaid or exchange plans to issue faster prior authorization decisions and give providers and patients more electronic access to prior authorization data, including pending decisions. Payer lobby America's Health Insurance Plans slammed the rule as "half-baked," though hospital groups generally support it.
Epic, the largest EHR vendor in the U.S., has been pursuing other partnerships to add more medical benefits and capabilities to its extensive software network.. In October for example, the Verona, Wis.-based vendor announced a deal with Lyft to integrate its non-emergency medical transportation platform.
For its part, Anthem recently announced a join venture with Blackstone Growth and digital startup K Health that will focus on using AI tools to triage patient care and curb healthcare costs.