Providence and Humana launch initiative to standardize payer-provider data sharing
Providence and Humana have joined forces to launch a new data exchange initiative to improve value-based care. The project they announced Monday aims to enable secure and standardized clinical data sharing, simplify membership attribution, reduce administrative burden and close gaps in care.
Weak healthcare data infrastructure is a well-documented problem. The industry's current data management systems are fragmented and difficult to access, making it challenging for providers and payers to coordinate care and track patient outcomes. By leveraging national standards such as FHIR, the new initiative from Providence and Humana aims to create a more interoperable ecosystem and ensure data is more timely and accurate.
The project also seeks to create a scalable framework that can be replicated across other payers and providers, said Michael Westover, vice president of population health informatics at Providence.
He said Humana was the right partner for the project because it is a large national payer.
“If a small payer in Providence and the Northwest did something, people would say, ‘That’s great, but what impact will that have on the world?’ But when we start moving to Humana, which has a lot of impact and could impact vendors and providers across the country, I think what we’re really talking about is changing the way we do data exchange as a country,” Westover said.
He noted that value-based care only works when data flows freely in both directions between payers and providers. However, Providence currently receives information in hundreds of inconsistent formats, which he said creates huge inefficiencies.
To help address this issue, Westover notes that the new program will use standardized APIs to exchange gaps in roster, claims, care and financial data in real time, thereby reducing physical work for clinicians and delays for patients.
He noted that the work is part of Providence's broader strategy to expand value-based care into approximately 150 risk arrangements.
In Westover's view, Providence is improving its performance and quality metrics without requiring clinicians to change their behavior. Standardizing data exchange could reduce implementation time from 18 months to days and make the system replicable with other payers, he said.
On the patient side, Westover noted that data standardization can improve patient matching and care coordination, ensuring the right person receives the right care at the right time.
He tied the effort to CMS and ONC's push for interoperability and said Providence is fulfilling its commitments under TEFCA and other federal initiatives promoting open data exchange.
Ultimately, Westover said, the work is about freeing health care from the “walled garden.”
The goal is to replace today's expensive manual data cleansing processes with more standards-based exchanges, he added. This allows provider organizations to focus more on patient care and innovation.
Photo: da-kuk, Getty Images
