Epic, Humana ramp up partnership to focus on streamlining prior authorizations

Doctor computer keyboard
EHR vendor Epic and Humana will connect their software to manage prior authorizations electronically and make Humana member information available to providers at the point of care, the companies said. (Getty/jacoblund)

Two years after teaming up to boost data sharing and ease administrative headaches, Epic and Humana are ramping up their partnership to streamline prior authorizations for providers.

In this next phase of the collaboration, EHR vendor Epic and Humana will connect their software to manage prior authorizations electronically and make Humana member information available to providers at the point of care, the companies said.

These insights, such as the history of medication adherence, notifications of past-due medical services and coordination of care for chronic conditions, will help providers make medical decisions in real-time, according to the companies.

“Humana is taking a proactive approach to improving the experiences of patients and physicians with partners like Epic,” Alan Wheatley, president of Humana’s retail segment, said in a statement. “By increasing the efficiency of health plan interactions and delivering valuable health insights at the point of care, we increase physicians’ ability to provide efficient, quality care.”

RELATED: Humana to integrate real-time benefits check into Epic's EHR

Ochsner Health, a nonprofit academic healthcare system in Louisiana, will be the first health system to implement Humana’s prior authorization and member insights using the Epic EHR platform.

“Having a comprehensive view of our patients’ medical history and health insights allows our clinicians to dedicate more time to addressing health concerns and setting a course for treatment,” Philip Oravetz, M.D., chief population health officer at Ochsner Health, said in a statement.

The COVID-19 pandemic has brought a critical need for data sharing and reducing obstacles to seeking care, noted Alan Hutchison, vice president of population health at Epic. 

“The past year has shown us how important it is to share data so that we can understand the health of patients and members, communicate with their providers to address chronic conditions, understand gaps in care, and reduce barriers to getting that care,” Hutchison said.

As part of the first stage of the partnership between Epic and Humana, the two companies announced in 2019 they would integrate technologies. The insurer integrated its IntelligentRx tool, which is used for real-time benefits checks, with Epic’s electronic prescribing platform. Since then, more than 50,000 providers have deployed the IntelligentRx tool, according to the companies.

In addition, Epic and Humana have now enabled clinical data sharing for more than a half-million Humana members, the companies said.

Later in 2021, the companies will provide decision support for specialist referrals to allow patients to choose in-network providers.

RELATED: Health Care Service Corp. taps Epic for data exchange platform

A recent study by America’s Health Insurance Plans found that electronic prior authorizations can reduce the amount of time needed to fax administrative materials in health care.

In December, the Trump administration called for a new regulation that would streamline prior authorization. The rule from the Centers for Medicare & Medicaid Services (CMS) requires payers for some government programs to create application program interfaces (APIs) to enable data exchange and prior authorization.

However, the Biden administration appears to have withdrawn that rule as the rule does not appear in the Federal Register. A CMS spokesperson told Fierce Healthcare that the matter is currently under CMS review.

The White House did issue a memo shortly after Biden was inaugurated Jan. 20 calling for a freeze on any last-minute regulations finalized by his predecessor, Robert King reported.

The healthcare industry can save $13.3 billion on administrative waste by automating prior authorizations according to the CAQH 2019 Index. CAQH is an organization that aims to streamline healthcare administration.

In a 2019 survey by the Medical Group Management Association (MGMA), 83% of healthcare practice leaders called prior authorization “very” or “extremely” burdensome.