Michigan Rollout Builds Momentum for Epic Payer Platform

Priority Health is accelerating the move to risk-based arrangements with most of the state’s healthcare providers.

Priority Health is rolling out its Epic Payer Platform this year, joining several major payers who have adopted the EHR data service.

The Michigan-based integrated health plan is the first insurer in Michigan to implement the platform, which will allow for real-time exchange of patient health information at the point of care between Priority Health and providers. It will first set up the platform with Spectrum Health and other contracted providers using Epic, then plans to expand in the coming years.

"We understand that data from a health plan needs to be actionable at the point of care to drive effective engagement from our provider partners," says Praveen Thadani, president of Priority Health. "Because Priority Health is part of an integrated delivery system, we are uniquely positioned to excel in this space, and have the needed tools and resources for successfully implementing an advanced information sharing tool."

The Epic Payer Platform reduces what had been a three-screen care coordination process (EHRs, population health disease registries, and practice management systems) for physicians to a single screen.

Michelle Ilitch, vice president of network solutions and value-based programs at Priority Health, says that will help reduce burnout. It will also help patients communicate with their care providers when they receive services outside the network.

One example particularly relevant in Michigan is snowbird patients who may receive vaccinations in Sun Belt states. If the Sun Belt provider uses Epic, the Epic Payer Platform will notify a patient’s primary care physician back in Michigan that the Sun Belt treatment resulted in a claim paid by Priority Health, thus closing a gap in care.

Michelle Ilitch, vice president of network solutions and value-based programs at Priority Health. Photo courtesy Priority Health.

The platform offers minimally disruptive alerts in the EHR to let the primary care provider know that a claim has been paid, Ilitch says.

"Many providers are not owned by health systems," she says. "If we refer an endoscopy scope to a GI practice, how do we know the patient actually showed up for the visit at the GI doctor and got the scope? [The] Epic Payer Platform will share to us that did in fact happen, because we'll be able to see that claim actually hit the system."

Physicians are also able to query gaps in care as reported by Priority Health, not just gaps reported in their own EHRs, Ilitch says, thus improving care coordination.

"We're moving, as a society, from a world that was based in static reports to views," she says. "What a health plan can do is liberate its datasets to improve quality, reduce costs, and respond to physician burnout."

Physicians "want to see views, to log into something and see it live," Ilitch says. "We don't necessarily want to log into something and pull down a bunch of static reports and then have to go fishing to tell a story."

This, in turn, will allow payers such as Priority Health to do less work to publish gaps in care reports. "Instead of us pushing data, physicians can pull data, live in the EMR," Ilitch says.

Priority Health's investment in the Epic Payer Platform will pay for itself "in spades when we see more providers be interested in taking financial downside risk," Ilitch says. "To us, the ROI proof point is accelerating that transfer of financial risk from a health plan to physicians and acute care hospitals. Over time, we will see that ROI play itself out as more doctors say, ‘You know what, I want to partner with Priority Health because they understand how important data is for me to be able to wring out waste.’ So that ROI will come over time."

The Epic Payer Platform also provides a unique way of documentation that's important for regulations tied to risk adjustment, Ilitch says.

"The tool is going to be able to help us better understand the actual disease burden of the populations we serve," she says.

Ilitch says provider uptake "will be taking place through the course of this year, through a series of cohorts that we're going to bring on over time, as we get health systems ready to tackle this with us. We're still in a world where change is hard, and COVID is distracting."

Priority Health wants primary care specialists to adopt the Epic Payer Platform at a pace to their liking.

"That's why our rollout is going to occur throughout this year and in future years," Ilitch says. "A lot of doctors view this as a big sigh of relief, because it takes away the guessing that happens a lot when a payer provides static PDF reports."

"If there was ever something that embodied the Quadruple Aim, it would be this tool," she says. "Better care, lower costs, patient satisfaction, and bringing the joy of practice back or dealing with physician burnout."

The Epic Payer Platform also complements the work Priority Health is doing with health information exchanges, Ilitch says.

"HIEs in Michigan solve a really important gap in how we connect together entities that are involved in social determinants of health, and help solve problems related to focus areas on what quality measures we want to go after,” she says. “Those HIEs solve an important role in helping us to communicate with electronic medical records that sit outside of the Epic platform."