Providence and Humana have teamed as much as launch a new data exchange program to enhance value-based care. Their undertaking, introduced on Monday, seeks to allow safe and standardized scientific information sharing, streamline member attribution, lower administrative burdens and shut care gaps.
Healthcare’s poor information infrastructure is a well-documented issue. The business’s present information administration methods are fragmented and tough to entry, which makes it difficult for suppliers and payers to coordinate care and monitor sufferers’ outcomes. By leveraging nationwide requirements like FHIR, the brand new program rolled out by Windfall and Humana goals to create a extra interoperable ecosystem that ensures extra well timed and correct information.
The undertaking additionally seeks to create a scalable framework that may be replicated throughout different payers and suppliers, stated Michael Westover, Windfall’s vice chairman of inhabitants well being informatics.
Humana is an appropriate companion for this undertaking as a result of it’s a massive nationwide payer, he stated.
“If Windfall and a small Northwest payer did one thing, folks would say, ‘That’s nice, however how’s that going to influence the world?’ However once we begin transferring over to Humana, which has lots of attain and will influence distributors and suppliers throughout the nation, I believe we’re actually speaking about altering the way in which we do information trade as a nation,” Westover said.
He famous that value-based care solely works if information flows freely and bidirectionally between payers and suppliers. But, Windfall at the moment receives info in tons of of inconsistent codecs, which he stated creates huge inefficiencies.
To assist repair this, Westover famous that the brand new program will use standardized APIs to permit for the real-time trade of rosters, claims, gaps in care and monetary information — lowering clinicians’ handbook work and sufferers’ delays.
He identified that this effort is a part of Windfall’s broader technique to scale value-based care throughout its roughly 150 threat preparations.
In Westover’s eyes, Windfall is enhancing its efficiency and high quality metrics with out requiring habits modifications from clinicians. He stated standardized information trade might reduce implementation timelines from 18 months to days — in addition to make this method replicable with different payers.
On the affected person facet, Westover famous that information standardization can enhance affected person matching and care coordination, making certain the appropriate individual receives the appropriate care on the proper time.
He linked the trouble to CMS and ONC’s push for interoperability, saying Windfall is fulfilling commitments below TEFCA and different federal initiatives selling open information trade.
In the end, Westover stated this work is about releasing healthcare from “walled gardens.”
The aim, he added, is to switch at the moment’s costly, handbook data-cleaning processes with a extra standards-based trade. This fashion, supplier organizations can dedicate extra of their deal with affected person care and innovation.
Photograph: da-kuk, Getty Pictures
