Anthem has partnered with Epic Systems Corp. to create an information exchange platform between its health plans and provider organizations, with the aim of automating prior authorization requests, providing data-driven insights into patient care and promoting value-based payments, the insurer said Wednesday.
Anthem, which operates Blue Cross and Blue Shield plans in 14 states, launched a pilot program with Epic and MetroHealth System in Cleveland. That pilot could include approximately 21,000 patients across the four-hospital and 40 health center system. Over the next few years, the Indianapolis-based insurer aims to expand the partnership across every hospital in its network that uses Epic's payer platform. The insurer estimates it will be used to exchange the clinical information of about 14.7 million Anthem members.
Epic's payer platform could help cut costs for these individuals—by highlighting which medications are covered under a patient's insurance policy and reducing duplicative testing—and bridge gaps in care by allowing providers to review previous medical records, labs results and claims data for shared patients, said Ashok Chennuru, chief data and insights officer at Anthem.
"We also see this as a push toward value-based care because one of the keys for providers to adopt value-based care, including risk, is making sure we have the seamless data exchange between the payers and the providers," Chennuru said, adding that the company is in value-based relationships with 100,000 providers nationwide.
Anthem will integrate Epic's payer platform into its Health OS operating system, or its data integration and insight engine that it shares with providers, said Rajeev Ronanki, chief digital officer at Anthem.
Over the next three years, the company aims to integrate additional EHR providers into this platform, he said, like Cerner Corp., athenahealth and eClinicalWorks. The company started the program with Epic because of its large footprint. Two-thirds of hospitals across the nation use the EHR provider, Ronanki said. Ultimately, Anthem aims to connect the some 2 million providers at the large and small health systems it partners with.
"Our goal is that, over the next three years, all of our providers will be connected into Health OS, creating essentially what would be a digitally integrated network across the country for us," Ronanki said.
He declined to share financial details of Anthem's partnership with Epic. It's not the first insurer to use the EHR platform for sharing data.
Health Care Service Corp., Humana and Blue Shield of Minnesota have all gone live on Epic's payer platform. In March, Humana announced it was ramping up its partnership with the EHR giant to streamline electronic prior authorization requests.
The investment comes as Congress debates cracking down on how payers approve—or deny—provider care requests for patients.
