A year-and-a-half into their partnership, EHR developer Epic and health insurer Humana are expanding the scope of their work together.
The companies announced Wednesday that their partnership has entered a new phase — one which will focus on streamlining the prior authorization process.
In this phase, 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, said Alan Hutchison, vice president of population health at Verona, Wisconsin-based Epic, in an email.
Once the software is integrated, health systems using the Epic EHR will be able to request and receive authorizations electronically from Humana, that is, confirm whether a procedure is covered by the patient’s insurance plan, Hutchison said.
Further, information from Louisville, Kentucky-based Humana about its members — like whether they have a history of medication adherence or are missing follow-up care after a hospitalization — will be made available to clinicians within the Epic EHR.
“Exchanging authorization and member insights electronically will be faster and more convenient for providers,” Hutchison said.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
New Orleans-based Ochsner Health will be one of the first providers in the country to implement the prior authorization and member insight features.
The health system plans to begin pilot programs for the new capabilities in the second quarter of 2021, said Dr. Philip Oravetz, the health system’s chief population health officer, in an email.
“[These functionalities] will enable us to more quickly identify and close quality care gaps while increasing our operational efficiencies in providing seamless, coordinated care to our patients,” Oravetz said.
Epic and Humana entered into a partnership in June 2019, when they announced that they will integrate technologies and share data.
In the past 18 months or so, the companies have shared HIPAA-compliant clinical information for more than a half-million of Humana’s health plan members. This information includes preventive screening results, diagnoses and clinical notes, Epic’s Hutchison said.
“The data is used to ensure members receive high-quality care based on HEDIS [Healthcare Effectiveness Data and Information Set] measures and to improve efficiency around administrative processes like claims payment,” he said.
Further, Humana integrated its real-time benefits check tool, IntelligentRx, directly into Epic’s e-prescribing workflow. More than 50,000 providers have utilized the tool, according to a news release.
Looking ahead, the companies plan to collaborate on enhancing decision support for specialist referrals, with the aim of reducing out-of-network costs by keeping referrals in-network.
Photo: alphaspirit, Getty Images
