Today, the flow of data between care providers and health insurance plans is often in one direction, incomplete, and not fast enough—leading to ineffective collaboration between the two groups. This lack of communication and coordination can frustrate providers and consumers, and—more importantly—potentially delay care or lead to poorer health outcomes.
We will not be able to take the next step in healthcare’s digital evolution until we have real-time, bi-directional exchange of data between groups, such as health insurance plans and care providers, who play significant roles in helping consumers lead healthier lives.
At Anthem, our decades of experience serving more than 110 million people convince us that truly reducing the pain points along the health care journey requires effective bi-directional data exchange built on a hybrid model.
This model must incorporate data sources such as electronic health record companies, health information exchanges (HIEs), healthcare providers, and third-party vendors that also collect and/or produce health information. And that data needs to include clinical data; lab results; and information about hospital admission, discharge, and transfer.
Streamline administrative processes
The current prior authorization process is one example. It relies on outdated technology (phone calls and faxes) and can occupy a significant amount of staff time, creating a bad experience for providers and consumers.
With bi-directional data exchange, the prior authorization process would be simplified. Provider offices would be able to utilize their EHR system to send prior authorization requests to insurance companies with the necessary health data accompanying the request. Insurers can then quickly make decisions and electronically communicate back to the provider.
This automated process would lower administrative burden, free up staff to spend more time with patients, and enhance both the provider and consumer experience by reducing frustrations.
Improve care management
Leveraging next-generation data exchange also can help improve gaps in communication and information sharing around the discharge process.
Exchange of admissions, discharge and transfer (ADT) data will speed up notifications to care management teams and allow for embedding ADT data in care management workflows. These changes will — among other benefits — optimize discharge planning and care coordination across in-network and out-of-network providers.
Care providers and insurers will also be able to use this data exchange to better communicate with each other — and consumers — to enable more timely follow-up that may help reduce the risk of readmissions and the lower cost of care.
Enhance the healthcare experience
Care teams at health insurance plans, provider offices, and health systems are committed to helping consumers improve their health and wellbeing. Unfortunately, the siloed natured of health data often creates a negative consumer healthcare journey, including delayed follow-up because a provider hasn’t received information from another, duplicate requests for health information, and slow responses.
In an environment where data flows more freely, in a secure manner, care teams will be better equipped to be consumers’ healthcare partners.
Health insurers—with their data analytics capabilities—can use the data they’ve received to identify care gaps, predict potential health issues, and then proactively send these findings to the person’s care providers—allowing for more timely, proactive and personalized care. Health insurers and providers can also communicate these insights directly with consumers—resulting in a more engaged consumer.
Lowering administrative burden, improving care management, and enhancing the healthcare experience are just the tip of the iceberg when it comes to the benefits of secure, bidirectional data exchange. This is why Anthem has been working with EHR companies, care providers, and other stakeholders to move the industry to the next step in healthcare’s evolution.
In this next stage, the right information will get to the right people at the right time, resulting in simplified healthcare and consumers receiving the care they need—where and when they need it.
Ashok Chennuru currently serves as the chief data and analytics officer at Anthem.