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Anthem Collaborates With Epic to Speed Prior Authorizations, Alerts for Physicians

Analysis  |  By Scott Mace  
   May 26, 2021

Epic's Payer Platform, connected with Anthem Health OS, will drive data-driven insights.

Insurer Anthem is collaborating with EHR giant Epic to increase and improve bi-directional health information exchange, Anthem recently announced.

"As an organization committed to a digital-first approach, we know that enhancing the interoperability of health data is critical in redefining the future of healthcare," said Ashok Chennuru, chief data and insights officer at Anthem. "This effort helps bring the industry into the next step of its evolution where the right information gets to the right people at the right time—resulting in a more seamless healthcare experience and consumers receiving the care they need—where and when they need it. Our work with Epic stands to benefit more than 14.7 million consumers served by Anthem's affiliated health plans who see clinicians using Epic's software."

The bi-directional exchange moves clinical data, in addition to admissions, discharge, and transfer (ADT) data from hospital stays, via Epic's Payer Platform.

The collaboration integrates Epic's Payer Platform with Anthem's Health OS, Anthem's operating system enabling seamless health plan-provider collaboration.

"By better bridging communications between providers and health plans, this connection is making it possible for patients to receive timely access to appropriate care," said Alan Hutchison, vice president of population health and payer strategy at Epic. "This effort will also give clinicians more time to focus on delivering care and improve quality for consumers."

The initiative is intended to help close clinical and medication gaps in a patient's care. Anthem intends to use health information provided by clinicians in analyses that lead to data-driven insights, the company said.

Anthem insights will be able to be returned to the care team—in near real-time—to flag potential treatment decisions, resulting in higher-quality care, the company said.

Administrative processes, such as prior authorization, will be streamlined. Providers can send prior authorizations through Epic, instead of using phone or fax. This streamlined process will allow health plans to make quicker decisions and electronically communicate back to the provider, lessening administrative burden and allowing staff to spend more time on care.

In addition, Anthem will notify providers when patients are discharged from hospitals, encouraging providers to expedite follow-up care.

Health systems and providers such as The MetroHealth System, based in Cleveland, Ohio, which operates four hospitals, four emergency departments, more than 20 health centers and 40 additional sites, are among the initial group of health systems using the new interface. MetroHealth's initial focus on Payer Platform will be centered on care management and improving follow-up care, Anthem said in a statement.

"Being able to better communicate and reduce the amount of time we need to spend on administrative processes will allow our clinicians to spend more time delivering care," said David Kaelber, MD, PhD, MPH, chief medical informatics officer at MetroHealth. "Improving exchange and interoperability of data will help us give consumers the healthcare experience they have come to expect."

As one part of the Anthem Health OS strategy, the insurer also plans to integrate near real-time data with claims data and health information that Anthem receives from sources including health information exchanges, labs, and other partners. This integration lets providers have a longitudinal view of a consumers' health, to help clinicians make more informed decisions.

Scott Mace is a contributing writer for HealthLeaders.

Photo credit: Indianapolis - Circa April 2016: Anthem World Headquarters. Anthem is a Trusted Health Insurance Plan Provider V / Editorial credit: Jonathan Weiss /

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