Partnership moves into next phase, including first health system to automate prior authorizations
Humana Inc., a leading health and well-being company, and Epic, developer of the nation’s most widely used comprehensive health record, have completed the first stage of a joint effort to improve patient, provider, and health plan collaboration and reduce administrative burden in healthcare by securely exchanging information between providers and the health plan. In their first 18 months of working together, clinical data for more than a half million of Humana’s health members has been shared, and over 50,000 providers have utilized Humana’s Real-Time Benefits Check (RTBC) tool, IntelligentRx, which delivers real-time prescription benefit information in Epic’s platform.
“Throughout our partnership, we’ve witnessed Humana’s dedication to innovation and the health of their members. The success of this first phase shows there is tremendous opportunity for the future.”
During the next phase, Humana and Epic will add support for automated prior authorizations and member insights at the point of care. Electronic prior authorizations reduce the time it takes providers to find out whether a procedure is covered by insurance—speeding up access to care for patients. Member insights allow information from Humana (for example, preventative services that are past due, history of medication adherence, and care coordination for known chronic conditions) to drive real-time decision support in providers’ systems.
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Ochsner Health, Louisiana’s largest non-profit academic healthcare system, will be one of the first to implement prior authorizations and member insights, supported by Humana. These features will allow the clinician to remain in current workflows—not switch systems or screens—when ordering procedures. Humana and Epic jointly designed these features to reduce the burden on providers and improve the timeliness of prior authorization decisions.
“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,” said Philip Oravetz, MD, chief population health officer at Ochsner Health.
“Humana is taking a proactive approach to improving the experiences of patients and physicians with partners like Epic,” said Alan Wheatley, president of Humana’s retail segment. “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.”
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“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,” said Alan Hutchison, vice president of population health at Epic. “Throughout our partnership, we’ve witnessed Humana’s dedication to innovation and the health of their members. The success of this first phase shows there is tremendous opportunity for the future.”
The other capabilities Epic and Humana will deliver in 2021 include decision support for specialist referrals. This will reduce out-of-network costs by helping physicians choose in-network providers when referring a patient to a specialist.
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