LOS ANGELES—Highmark is teaming up with Epic and Google Cloud to improve the flow of data between payers and providers to enhance care coordination and drive better outcomes.
The goal, the insurer said, is to arm providers with the most valuable data at the point of care, enabling them to improve patient outcomes and close critical care gaps.
"We really need better ways to get the right information in front of the clinicians at the right time," Richard Clarke, Ph.D., senior vice president and chief analytics officer for Highmark Health, told Fierce Healthcare.
Epic's Payer Platform allows for "bidirectional" data sharing between the payer and the provider, he said, and Google Cloud's technology makes it flexible enough to connect with Highmark's existing systems readily.
Highmark said that more than half of its approximately 7 million members are attributed to a provider that uses Epic, so starting there made sense as a way to drive improvements for a significant member pool. For each of those members, the insurer expects the platform to automatically close 2.5 care gaps, with the potential to increase care gap closures by 300% or more.
Allegheny Health Network, Highmark's health system, projects that the shared claims data could drive $2.7 million in savings each year, which can be invested in improving care.
Tony Farah, M.D., executive vice president and chief medical and clinical transformation officer at Highmark, told Fierce that while closing these gaps is important work, it's "just table stakes," and there is far more that access to data can enable providers to do.
The Holy Grail, he said, is a model that "activates" at the patient's visit but also enables the provider to see beyond that appointment to what's happening in between. In addition, providers need to be armed with the tools to know how to use data effectively when they do have them, he said.
"What's happening is, with our algorithms, we know clinically what to do," Farah said. "We are now able to track and figure out what's changing a patient's condition."
In addition to the direct improvements in patient care, the Highmark team sees the potential for the partnership to address administrative burdens on providers. Given that they're already connected to Epic's electronic health record, the information provided by the Payer Platform is embedded in their existing workflows.
Farah said that Highmark piloted a program with Allegheny Health Network that it's now taking to other providers, where they are "gold carding" clinicians to enable prior authorizations to be processed more quickly, and digging in with these organizations to determine which clinicians may see more denials and why.
"The idea is to take them from the current state to where, 'OK, I'm the doctor now, I'm submitting this authorization and I know it's going to be approved,'" he said.
And rethinking this process, which is a major pain point for docs, is less about an overhaul and boils down to enabling that flow of data back and forth, he said.
Clarke said the latest initiative builds on Highmark's existing work with its Living Health strategy, which also taps into Google Cloud. Many of its recent tech investments, however, are focused internally on its own systems, and this effort allows the team to turn that work more outward.
"We have this, now let's make sure that information is getting to as many places as possible where it can add value," he said. "We've been investing kind of to do that back into a lot of our internal systems, and this gives us another app to deliver that to more external partners."