Providence and Humana have announced a partnership to launch a new data exchange program aimed at enhancing value-based care. This initiative, revealed on October 30, 2023, seeks to facilitate secure and standardized clinical data sharing, streamline member attribution, reduce administrative burdens, and ultimately close existing gaps in patient care. The initiative addresses a significant issue in healthcare: the fragmented and inefficient data management systems that hinder effective coordination between providers and payers.
Transforming Data Exchange in Healthcare
The healthcare industry has long struggled with inadequate data infrastructure, making it difficult to track patient outcomes and coordinate care effectively. By utilizing national standards such as FHIR (Fast Healthcare Interoperability Resources), the program aims to create an interoperable ecosystem that allows for more timely and accurate data exchange. Michael Westover, Providence’s Vice President of Population Health Informatics, emphasized the importance of this initiative, stating, “If Providence and a small Northwest payer did something, people would say, ‘That’s great, but how’s that going to impact the world?’”
With Humana’s extensive reach as a large national payer, Westover believes this collaboration has the potential to significantly influence data exchange practices across the United States. He pointed out that effective value-based care relies on the free and bidirectional flow of data between payers and providers. Currently, Providence receives information in a multitude of inconsistent formats, which creates significant inefficiencies in their operations.
Aiming for Standardization and Efficiency
The new program will implement standardized application programming interfaces (APIs) to facilitate real-time exchanges of rosters, claims, gaps in care, and financial data. This development is expected to greatly reduce the clerical workload for clinicians and minimize delays for patients. Westover elaborated on the broader strategy of Providence, noting that this initiative is part of their commitment to scale value-based care across approximately 150 risk arrangements.
Westover also highlighted how standardized data exchange could significantly decrease implementation timelines, potentially reducing them from 18 months to mere days, while making the system easier to replicate with other payers. Improved data standardization is anticipated to enhance patient matching and care coordination, ensuring that individuals receive the appropriate care in a timely manner.
This initiative aligns with the goals set forth by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), which advocate for interoperability in healthcare. Westover noted that Providence is fulfilling its commitments under the Trusted Exchange Framework and Common Agreement (TEFCA) and other federal initiatives designed to promote open data exchange.
Ultimately, this collaboration between Providence and Humana aims to dismantle the “walled gardens” that currently exist within healthcare data management. By transitioning to a more standards-based exchange, provider organizations can redirect their focus from tedious data-cleaning processes to enhancing patient care and fostering innovation in healthcare delivery.
