Epic, Elevance Health CEOs make a pitch for harnessing data, AI to support providers

Healthcare technology giant Epic is leveraging its massive clinical research database, with data on 226 million patients, to develop a next-generation decision support tool for clinicians.

Elevance Health, formerly Anthem and the nation’s second-largest insurer, leverages its clinical data platform, called Health OS, and artificial intelligence to help providers close gaps in care and reduce burdensome paperwork, according to CEO Gail Boudreaux.

The insurer's goal is to break down data silos and integrate data on patients' physical, mental and social health into a longitudinal patient record within electronic health record (EHR) systems, Boudreaux said during the Forbes Healthcare Summit this week in New York City.

"As an industry, we're still at the very beginning because we're working in silos still as an industry and we have a big opportunity to bring that together. Data will be that connective tissue that helps us do that," Boudreaux said.

While sharing the stage at the Forbes event, Boudreaux and Epic CEO Judy Faulkner shared how the two organizations are using data and technology, including AI, to create "hyperconnectivity" in healthcare and bring data to providers' fingertips. 

Two years ago, Elevance Health unveiled a partnership with Epic to more effectively facilitate direct and bilateral data exchange with its providers. That collaboration harnesses Epic's Payer Platform, embedded directly into the payer's Health OS and into providers' workflows. The platform enables the payer and providers to share clinical data and information at discharge from the hospital, for example.

This data integration is critical for providers in value-based payment arrangements to target the most pressing needs across their patient panel with near-real-time information and make the right referrals or the right intervention.

"It's the integration of bringing together physical, behavioral and social issues to drive better outcomes. We identify where there are gaps in care both across behavioral and medical and then work with our care providers. In some of the work that we're doing with Judy's [Faulkner] team is identify those, maybe in MyChart, and then have a physician through our value-based care, where we're paying them to do that, to have an impact on them," Boudreaux said while staging the stage with Faulkner at the Forbes event. "It's about the connectedness and making it simple for the user. We have better insights, we can build it into our value-based care, how we pay our care providers, and then we can put it in the [patient] record."

Elevance uses AI to support predictive insights and to help providers address gaps in care, such as to identify fall risks and medicine interactions, to improve patient outcomes, she noted. The payer also is using AI-based chatbots to improve communication with members.

"We get a higher NPS score. The answers are clearer and the model learns and keeps learning," Boudreaux said.

And, AI helps to address provider pain points and cut down on administrative burden. "We have thousands of pages of protocols and notes and policies and regulations. We can put that through our models and simplify it for our clinical nurse case managers so that they can focus their time on what they should do, which is working with the physicians," she said.

Another pain point is updating information in provider directories which are often only 60% to 70% accurate, she noted. By leveraging AI, which enables personalized data match, Elevance has improved the accuracy of provider directories to 90%, she said.

"Using automation to improve how we work in the healthcare system and connect it, that's where we're going to see the real early value. We have a lot of use cases right now to use that data and make the system better, just more connected and simple for people," Boudreaux said.

Faulkner offered more details about the new point-of-care tools Epic is developing by leveraging its Cosmos research database, which encompasses 226 million patient records from over 9.8 billion encounters, representing patients in all 50 states.

Epic's upcoming "Best Care Choices for My Patient" tool will offer the capability to get recommendations on treatments that worked for other similar patient profiles.

"As a physician, I may have a patient in front of me. Right now, about 10% of the decisions doctors make come to evidence-based medicine, the other 90% is anecdotal or what you tried last time. Now we can look and say 'OK, there are 28,572 patients just like this one and here's what has worked for them, in different ways. That for some treatments, you may get better results quicker. For other medications, it may be it take longer, but it's a better result. Maybe a patient has a risk of stroke. Maybe some medications are more expensive. That information is going to be shown to the clinician who can then make the best choices for the patient," Faulker said during the Forbes event.

That tool will be available to Epic users next fall, in 2024, Faulkner said.

The EHR company also is going all-in on generative AI in healthcare.

Epic is tapping Microsoft's AI expertise to integrate the technology into its EHR platform. In August, the company announced it was working with Microsoft to accelerate generative AI-powered 'copilot' tools to help clinicians save time. These "copilot" solutions aim to help with medical note summarization, offer coding suggestions and provide access to real-world evidence for patient care, Epic executives said.

"We're really trying to decrease the burden on the clinicians," Faulkner said.

Faulkner noted that another Cosmos tool, called "Look-alikes," is now live and enables physicians identify mystery and rare diseases by finding patients with similar symptoms and then connect with those patients' physicians to share resources.

Epic is harnessing AI in other ways to support more personalized care for patients. The company is partnering with Qualtrics to integrate patients' experience data directly with their health information in Epic, making it easier for providers to offer a more personal healthcare experience for millions of patients.

Patients bring expectations from other industries into all interactions with healthcare. Qualtrics, a customer experience software company, works with healthcare and life sciences companies such as Kaiser Permanente, Intermountain, Mayo Clinic and Humana to improve the patient experience, according to the company.

"Healthcare has done a remarkable job advancing the science of clinical care, and now this collaboration will fuse the emotional experience of care – and responsiveness to it – into healthcare delivery," Dr. Adrienne Boissy, Qualtrics' chief medical officer, said. "Being able to bring Qualtrics AI and natural language processing capabilities to the millions of patients Epic touches is game changing as we amplify the value of experiences to patients and providers alike."

As an example, if a patient indicates that they are increasingly frustrated with scheduling an appointment, Qualtrics will detect and analyze that sentiment and flag it for the proper teams through Epic, who can then engage the patient, and resolve the issue. By connecting feedback to health data, the partnership enables a more responsive and personal experience, which is core to both relationships and outcomes in healthcare, Boissy said.