Providence and Humana have announced a collaborative initiative aimed at standardizing data sharing between payers and providers, a crucial step towards enhancing value-based care. This new data exchange program, unveiled on March 4, 2024, is designed to facilitate secure and uniform clinical data sharing, streamline member attribution, reduce administrative burdens, and close care gaps.
The healthcare sector has long struggled with subpar data infrastructure. Current systems are often fragmented and difficult to navigate, complicating the coordination of care and tracking of patient outcomes. By adopting national standards such as FHIR (Fast Healthcare Interoperability Resources), the initiative from Providence and Humana aims to foster a more interoperable environment that allows for timely and accurate data exchange.
Transforming Healthcare Data Management
According to Michael Westover, Vice President of Population Health Informatics at Providence, this project intends to create a scalable framework that could be adopted by other payers and providers nationally. He emphasized that partnering with Humana, a significant national payer, enhances the project’s potential impact. “If Providence and a small Northwest payer did something, people would say, ‘That’s great, but how’s that going to impact the world?’” Westover stated. “But when we start moving over to Humana, which has a lot of reach, I think we’re really talking about changing the way we do data exchange as a nation.”
Westover highlighted that effective value-based care depends on the free and bidirectional flow of data between payers and providers. Currently, Providence receives information in hundreds of disparate formats, which leads to considerable inefficiencies. To address this issue, the new program will utilize standardized APIs for the real-time exchange of rosters, claims, gaps in care, and financial data. This approach aims to minimize manual tasks for clinicians and reduce delays for patients.
Impact on Patient Care and System Efficiency
This initiative is part of Providence’s broader strategy to expand value-based care across its approximately 150 risk arrangements. Westover believes that by improving data exchange standards, Providence can enhance its performance metrics without necessitating behavioral changes from clinicians. He noted that standardized data exchange could potentially reduce implementation timelines from 18 months to just days, making it easier to replicate this system with other payers.
On the patient side, Westover pointed out that data standardization can significantly improve patient matching and care coordination, ensuring individuals receive the appropriate care at the right time. He linked this effort to the initiatives of the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), stating that Providence is committed to fulfilling obligations under the Trusted Exchange Framework and Common Agreement (TEFCA) and other federal initiatives that promote open data exchange.
Ultimately, Westover conveyed that this work aims to liberate healthcare from “walled gardens.” The goal is to replace current, costly manual data-cleaning processes with a standards-based exchange, allowing provider organizations to concentrate more on patient care and innovative practices. This initiative not only represents a technological advancement but also holds the potential to reshape the future of healthcare data management across the United States.
