Humana, Epic Tackle Electronic Prior Authorizations, Member Data

March 29, 2021 - After collaborating for 18 months on streamlining data exchange between health plans, patients, and providers, Humana and Epic are moving into the next phase of their partnership which involves electronic prior authorization and member insights.

“Humana is taking a proactive approach to improving the experiences of patients and physicians with partners like Epic,” said Alan Wheatley, president of Humana’s retail segment. “By increasing the efficiency of health plan interactions and delivering valuable health insights at the point of care, we increase physicians’ ability to provide efficient, quality care.”

In this new phase, Humana and Epic plan to leverage automatic prior authorizations. The goal of implementing this approach is to diminish the lag between when a provider prescribes a treatment and receives confirmation from the patient’s payer regarding whether the procedure will be covered.

The partners will also focus on member insights at the point of care. Member insights will encompass information such as overdue preventive services, medication adherence records, and care coordination for chronic disease management. Having this data at their fingertips when the member is in front of them will help providers’ treatment decision-making.

“The past year has shown us how important it is to share data so that we can understand the health of patients and members, communicate with their providers to address chronic conditions, understand gaps in care, and reduce barriers to getting that care,” said Alan Hutchison, vice president of population health at Epic.

Both the electronic prior authorization and the member insights will be integrated into physicians’ workflows, the partners explained in the press release.

Ochsner Health in Louisiana will be among the first health systems to engage in the second phase of this partnership by adopting the prior authorization capabilities and leveraging Humana’s member insights.

Additionally, Humana and Epic will build out their specialist referral support solution in 2021.

The partnership’s first phase produced positive outcomes by enabling real-time data exchange for prescription benefit information, the partners disclosed.

More than 50,000 providers used the Real-Time Benefits Check tool, the press release reported, resulting in successful clinical data transfers for more than 500,000 Humana members.

“Throughout our partnership, we’ve witnessed Humana’s dedication to innovation and the health of their members. The success of this first phase shows there is tremendous opportunity for the future,” Hutchison added.

Electronic prior authorizations have the potential to speed up care delivery and decrease the burden on provider, according to a recent study conducted on behalf of America’s Health Insurance Plans (AHIP).

The total number of prior authorizations jumped by 34 percent after implementing electronic prior authorization. A third of these transactions took two hours or less, compared to previously when when 24 percent of prior authorizations took two days or longer to fulfill.

“The review of over 40,000 transactions showed the impact electronic prior authorization makes in health care,” said Denise H. Clayton, research economist of Health Economics and Evaluation at RTI International. RTI International was an advisor for this study.

“Because clinicians and their staff report more benefits from ePA when they use it more often, greater provider adoption of ePA could help further realize its promise.”

Leaders across the healthcare industry have been calling for more widespread use of electronic prior authorization.

However, the progress has been slow, leaving providers and payers pointing fingers at each other. The American Medical Association (AMA) has charged payers with not living up to their commitment to prior authorization reform, citing surveys that demonstrated payers’ slow response times.

Payers have retorted that providers have been resistant to electronic prior authorization, thereby delaying the entire reform process.

However, payers did acknowledge flaws in the prior authorization system and launched the Fast PATH Initiative to address these issues.