Anthem collaborates with Epic to give providers more data-driven insights 

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Anthem has announced a collaboration with Epic to facilitate secure, bi-directional exchange of health information between providers and Anthem’s affiliated health plans. 

This initiative leverages Epic’s Payer Platform for data-driven insights in care decisions. Clinical data, as well as admissions, discharge, and transfer data from hospital stays, will be integrated with Anthem’s operating system for an interoperable exchange of information between health plans and providers.

“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,” said Ashok Chennuru, chief Data and Insights Officer at Anthem. 

Anthem’s work with Epic stands to benefit more than 14.7 million consumers in Anthem’s affiliated health plans who see clinicians using Epic’s software, Chennuru said.

“By better bridging communications between providers and health plans, this connection is making it possible for patients to receive timely access to appropriate care,” said Alan Hutchison, vice president of Population Health at Epic. 

WHY THIS MATTERS

The interoperability capability is intended to help close clinical and medication gaps. 

It will also help to streamline administrative processes, such as prior authorization, which has been an issue for hospitals and physicians.

Providers will be able to send prior authorizations through Epic instead of using the phone or fax. Health plans can then quickly make decisions and electronically communicate back to the provider.

Anthem will be able 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 address care gaps such as medication adherence.

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 that use Epic, such as an initial group of health systems that includes the MetroHealth System, an essential system based in Cleveland 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.

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, labs companies and other partners. This approach enables providers to have a longitudinal view of a consumers’ health, helping clinicians make more informed decisions, Anthem said.

THE LARGER TREND

This work does not address CMS’ interoperability rule, finalized by the Centers for Medicare and Medicaid Services in January. 

The rule requires payers to implement application program interfaces for data sharing and to streamline prior authorization. Medicaid, CHIP and individual market Qualified Health Plans payers must build, implement and maintain the APIs to enable provider access to their patients’ data and streamline the prior authorization process.

ON THE RECORD

“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 Dr. David Kaelber, chief medical Informatics officer at MetroHealth. “Improving exchange and interoperability of data will help us give consumers the healthcare experience they have come to expect.”

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