Allscripts, a leading EHR vendor, and Inovalon, which supplies a wide range of data and analytics to health plans, have entered an agreement that enables users of Allscripts' ambulatory EHRs to send their clinical data to payers via Inovalon and receive patient-level analyses of the data in return.
This is the second major deal announced this year that facilitates data sharing between providers and health plans. Ambulatory EHR vendor Greenway, insurer Florida Blue, and Availity, a national health information network, announced last spring that they'd begun enabling Greenway clients to send clinical data to Florida Blue and to receive back patient care summaries based on claims and other data.
Although Inovalon didn't reveal which payers were interested in receiving Allscripts data, it serves hundreds of plans that together cover about half of the insured population, according to Keith Dunleavy, president and CEO of the company.
Inovalon aggregates claims, lab, pharmacy, durable medical equipment, functional status and patient demographic data for the payers, Dunleavy told InformationWeek Healthcare. For the past decade, Inovalon has also been collecting clinical data from providers for its health plan customers, he said. Most of that information has been manually abstracted from paper charts. But during the past five years, an increasing amount of the information has come from EHRs. With the permission of providers, he said, Inovalon has garnered "raw data" from their EHRs using a combination of export and "screen scraping" methods.
The Allscripts deal provides a higher level of sophistication, allowing Inovalon to take advantage of interfaces between Allscripts' EHRs and the back-end system of Inovalon, which is connected to the systems of its health plan customers.
"When a provider or provider group authorizes the integration, they don't have to do any more work onsite," Dunleavy said. "The back end [of Inovalon] handles the rest, coordinating the data exchanges for the providers."
Asked why physicians should be interested in providing clinical data to health plans -- their traditional antagonists -- Dunleavy listed several reasons, including:
-- Regulatory compliance. Providers have to submit clinical data regularly to meet payer requirements, including processes related to claims audits, claims integrity and quality assessment.
-- HEDIS chart reviews. Every plan collects HEDIS data, which is required by most state insurance departments, as well as by the Centers for Medicare and Medicaid Services (CMS) for government-funded managed care plans.