Providence and Humana have partnered to launch a new data sharing program to improve value-based care. Their project, announced Monday, seeks to enable secure, standardized sharing of clinical data, optimize member attribution, decrease administrative burdens, and close care gaps.
Poor healthcare data infrastructure is a well-documented problem. The industry’s current data management systems are fragmented and difficult to access, making it difficult for providers and payers to coordinate care and track patient outcomes. By leveraging national standards like FHIR, the new program implemented by Providence and Humana aims to create a more interoperable ecosystem that ensures more timely and accurate data.
The project also seeks to create a scalable framework that can be replicated among other payers and providers, said Michael Westover, vice president of population health informatics at Providence.
Humana is a suitable partner for this project because it is a large national payer, he said.
“If Providence and a small payer in the Northwest did something, people would say, ‘That’s great, but how will that affect the world?’ But when we start moving to Humana, which has a lot of reach and could impact vendors and suppliers across the country, I think we’re really talking about changing the way we exchange data as a nation,” Westover said.
He noted that value-based care only works if data flows freely and bidirectionally between payers and providers. However, Providence currently receives information in hundreds of inconsistent formats, which he says creates huge inefficiencies.
To help address this issue, Westover said the new program will use standardized APIs to enable real-time sharing of listings, claims, gaps in care and financial data, reducing manual work for physicians and delays for patients.
He noted that this effort is part of Providence’s broader strategy to scale value-based care across its approximately 150 risk agreements.
In Westover’s eyes, Providence is improving its performance and quality metrics without requiring behavioral changes on the part of doctors. He said standardized data sharing could reduce implementation timelines from 18 months to days, in addition to making this system replicable with other payers.
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, saying Providence is meeting commitments under TEFCA and other federal initiatives that promote open data sharing.
Ultimately, Westover said this work is about freeing health care from “walled gardens.”
The goal, he added, is to replace today’s costly manual data cleansing processes with a more standards-based exchange. In this way, provider organizations can devote more attention to patient care and innovation.
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