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Analysis

Why the Epic-Humana Collaboration is a Big Deal for the Revenue Cycle

By Alexandra Wilson Pecci  
   June 19, 2019

The partnership could reduce administrative burden, expedite payments, and lower cost to collect for insurance balances.

Last week's announcement that Humana Inc. and Epic Systems will collaborate to automate prior authorizations, send back claims information electronically, and integrate Humana's real-time benefits check tool, IntelligentRx, directly into Epic's e-prescribing workflow has the potential to be "transformative" for the industry, says Ryan Bohochik, Epic's director of value based care.

Through the partnership, Epic will deliver real-time pharmacy data and cost information, allow provider organizations to easily share clinical data, improve timeliness for prior authorization decisions, and provide clinicians with relevant quality and cost information as they make referral decisions at the point-of-care, among other things. 

We asked Bohochik to describe the partnership's implications for the revenue cycle.

HealthLeaders: What does this news mean for revenue cycle professionals?

Ryan Bohochik: Financial success in a value-based arrangement requires hospitals and physicians to more closely collaborate with their payer partners. Using technology to more easily share necessary information directly within workflow will enable better collaboration and reduce the administrative burden.

It should also help revenue cycle professionals reduce the time they spend on administrative tasks like requesting prior authorizations, so they can focus on areas that are more impactful for their patients.  

Longer term, we also expect that more automated sharing of information will allow for expedited payments and lower cost to collect for insurance balances.

HealthLeaders: What revenue cycle/insurance-related issues will this solve for hospitals and health systems?

Bohochik: One of the key areas we're tackling with the initial set of projects is the bi-directional exchange of clinical and claims data for shared patients.

We're also working on prior authorizations. This will allow providers to automatically submit prior authorization requests with key supporting documentation for any Humana patient they see.

The hope is that we'll see a significant reduction in manual steps for providers and their staff so patients can access care more quickly.

HealthLeaders: How novel is this solution for the industry as a whole?

Bohochik: It's transformative. The partnership and technology bring together disparate parts of the healthcare ecosystem and give healthcare providers, health plans, and patients the ability to share key pieces of information and interact using a common platform. It will provide a strong technical foundation for innovative payer/provider partnerships with a focus on the shift to value and the overall goal of keeping patients healthy.  

Because Epic and Humana have a direct relationship, we can also ensure that the approaches we develop will work for all organizations in a similar way so they can be easily implemented by participating provider organizations.

 

Alexandra Wilson Pecci is an editor for HealthLeaders.


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