Highmark to Use Epic Payer Platform, Google Cloud to Ease Collaboration

Pittsburgh-based Highmark Health says it is collaborating with Epic and Google Cloud to better support coordination between payers and providers.

Epic’s Payer platform is designed to facilitate collaboration between insurers and healthcare providers. Highmark said that by connecting to Google Cloud, insights shared with payers and providers can be used to inform consumers about the best actions to take in their care journey.

More than half of Highmark’s 7 million insurance plan members are currently attributed to an Epic provider. For every attributed member, Highmark said it anticipates closing approximately 2.5 care gaps automatically, with a potential more than 300 percent increase in closed care gaps.

Highmark Health’s 14-hospital provider system, Allegheny Health Network, estimates that this shared claims data will amount to $2.7 million in annual savings, which can be reinvested in quality clinical care and patient experience.

Highmark said that from a physician’s perspective, payer-derived insights delivered to existing provider workflows in Epic provide a more complete view of patient health. This knowledge may include patient conditions, in- and out-of-network visit history, available health plan benefits and programs, insurance claims, acute event alerts, decision support, and case management. the attention.

“Epic’s Payer platform is a powerful resource that enables payers and providers to work together more effectively. Combining that resource with Google Cloud technology gives Highmark Health the ability to change the paradigm,” said Tony Farah, MD , executive vice president, chief medical officer and Clinical Transformation Officer at Highmark Health, in a statement. “It’s another step forward in achieving better experiences for both consumers and physicians, while improving health outcomes and reducing the cost of care.”

Google Cloud data analytics technologies, such as BigQuery and Healthcare Data Engine, will facilitate the sharing of information with provider partner organizations using Epic, Highmark health plan staff, and Highmark members through other integrated digital channels , such as the patient portal.

“Highmark Health’s use of Google Cloud will enable the organization to create an AI-powered intelligence system to deliver valuable analytics and insights to healthcare workers, patients and members,” said Amy Waldron, chief strategy officer. and Google Healthcare and Life Sciences Solutions. Cloud, in a statement: “Highmark Health’s investment in cloud technology is delivering real-time value and simplifying communications; it is redefining the provider and consumer experience.”

Highmark added that automated information sharing can trigger actions to improve health outcomes, such as creating an authorization case, requesting a concurrent critical care review, or initiating transitional care. Additionally, health systems working with Highmark can leverage care gap statuses calculated by the health plan to initiate actions to close the gap, avoid unnecessary outreach activities, and understand quality performance outcomes from the perspective of the health plan. health plan.

Using Epic’s Payer platform, notification can occur when a patient has an event, such as an emergency department arrival, admission, patient class change, or discharge. Health plans often ask to be notified when a member has been admitted to or discharged from a hospital. Without technology like Epic’s Payer platform, health system administrators often engage in time-consuming endpoints like making phone calls or sending faxes.

“Leveraging automation to share data responsibly is a game-changer, especially when it comes to reducing the administrative burden of transmitting clinical information in multiple directions: payers, providers and customers,” said Richard Clarke, Ph.D., senior vice president and chief analytics officer at Highmark Health, in a statement. “It facilitates informed decisions without the need for manual back-and-forth, all within the confines of Highmark’s secure Google Cloud infrastructure.”

In addition to Epic’s Payer platform, Highmark Health said it is implementing a suite of tools to improve digital enablement for provider partners, including a new provider resource center and provider portal powered by Availity.