UPDATE: June 12, 2019: Humana is also talking with other electronic medical record companies on ways to share data and create stronger working relationships, Alan Wheatley, president of Humana's retail segment, told Healthcare Dive on Wednesday.
Though "not all EMR companies are created equal," Wheatley said, "we have some plans to cross collaborate" with other health IT vendors on similar projects.
- Humana is integrating its real-time benefit check into Epic's EHR system in an attempt to lower costs and increase medication adherence, the insurer announced Tuesday.
- The tool, called IntelligentRx, will be baked into Epic's e-prescribing workflow to give clinicians immediate access to a patient's medical history and treatment options, including individual medication cost and insurance coverage.
- Louisville-based Humana is the first payer to collaborate with EHR giant Epic on a project of this kind and looks forward to an expansion of their partnership, Humana’s president of retail Alan Wheatley told Healthcare Dive. The two companies have been in talks for two years on the project.
Real-time benefit check technology makes prescription benefit details such as patient out-of-pocket costs, drug alternatives and prior authorization information available to the provider as they decide treatment options.
The Epic-Humana partnership is between two of the largest healthcare companies, but it's by no means the first industry effort to increase adoption. In 2017, Surescripts partnered with six EHR companies, including Epic, along with CVS Health and Express Scripts on its real-time prescription benefit service.
The government is getting involved as well. CMS released a proposed rule in November suggesting Medicare Part D plans adopt real-time benefits checks so doctors can check whether a cheaper drug is available to patients in an effort to tackle drug costs.
Specialty drug costs alone skyrocketed to from $8.7 billion to $32.8 billion in Medicare Part D between 2010 and 2015, according to the Congressional Budget Office.
The high price tags can hit people by surprise. Half of patients don't fill a prescription because it costs too much when they arrive at the pharmacy, according to a CoverMyMeds 2018 survey, and 75% reported they received a prescription that cost more than expected.
Medication non-adherence has palpable repercussions on health, leading to an estimated 10% of hospitalizations. It also costs the healthcare system up to $289 billion a year, according to a review in the Annals of Internal Medicine.
When prescribers use IntelligentRx and see the range of treatment options, they choose the most cost-effective treatment nearly 40% of the time, according to Humana.
More than 250 million patients have a current record in Epic, which was rated the No. 1 overall software suite by KLAS for the ninth year in a row in 2019. But it's unclear how many patients will benefit from the partnership.
Roughly half of Humana's Medicare Advantage members already see a doctor who uses Epic's platform, Wheatley said. Humana does not have a ballpark figure for how many of its overall beneficiaries will be affected, though Wheatley expects the population to be "significant."