Interoperability clarifies care and reduces waste

P. Nelson Le, M.D., MBA

Associate VP, Product Strategy, Digital Health & Analytics

Bio

Dr. Le is a senior executive with a background in pediatric cardiology. He has more than 20 years of healthcare, business and digital experience. His career has been driven by a dedication to improving healthcare through process-driven, solution-oriented, innovative strategies.
In a fragmented healthcare system, interoperability is crucial in connecting systems that let clinicians see a variety of factors influencing their patients’ well-being.13 Interwoven systems of data foster integrated care delivery that enables value-based care practices to evaluate the right data at the right time within the right workflows to achieve the right outcomes.

In the United States, approximately 25% of all annual healthcare spending can be categorized as waste. This equates to an estimated range of $760 billion to $935 billion.13 And with healthcare spending approaching 18% of the national gross domestic product (GDP), there is an acute need to re-evaluate the system and eliminate inefficiencies that contribute to wasteful spending.13

Why it matters:

Interoperability is considered one of the levers that could address between $191 billion and $282 billion deemed as wasteful spending.13 The pandemic also increased the urgency for data-sharing in helping physicians determine the best course of treatment for their patients.

One of the largest domains of healthcare waste centers on administrative complexities between payers and providers, including inefficient billing and coding practices, authorization processes and administrative burden.

The prior authorization process, for instance, is considered among clinicians a daily frustrating and mundane task. Today, the process takes an average of 18 minutes and requires healthcare providers to disrupt their workflow and go outside of their electronic health records (EHR) system and into another system, such as a web portal or a phone call, to complete.1

 

The way forward:

As a solution, Humana partnered with Epic, the nation’s most widely-used EHR system, to develop new capabilities to allow physicians and clinical staff to complete prior authorizations within their own EHR workflows.

As part of the new authorization process, a series of automated events and application programming interfaces integrate the EHR with Humana systems to process the authorization, which allows healthcare providers and their staffs to stay within their workflow. If additional information or clinical documentation is needed, Humana questionnaires automatically appear in the EHR, allowing for convenient and easy collection of this information. Submission of authorization is automatically done directly from the EHR.

Humana plans to use standards-based interoperability, such as Fast Healthcare Interoperability Resources (FHIR), to continue to deliver solutions to improve experiences and remove burden for members and healthcare providers alike, including patient access to data, payer-to-provider data exchange, attributed patient rosters and quality measure reporting—all essential to value-based care.

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